Accuracy of contrast-enhanced MDCT and MRI for identifying the severity and cause of neural foraminal stenosis in cervical radiculopathy: a prospective study.
OBJECTIVE
The purpose of this study was to determine the accuracy of IV contrast-enhanced MDCT and MRI for evaluation of the severity and cause of neural foraminal stenosis in patients with cervical radiculopathy.


METHODS
Eighteen patients with cervical radiculopathy prospectively underwent contrast-enhanced MDCT and MRI. Contrast-enhanced MDCT scans were acquired at 1-mm thickness and reconstructed in oblique axial (parallel to disk) and sagittal (perpendicular to neural foramen) 2-mm sections without a gap. The MRI sequences used were sagittal T1-weighted, fast spin-echo T2-weighted, 3D fast spin-echo T2-weighted, axial T2-weighted, and 3D gradient-recalled echo. Three neuroradiologists independently and blindly rated the severity and cause of neural foraminal stenosis on a 4-point scale. Using the same scale at surgery, one of three surgeons rated the severity and cause of neural foraminal stenosis, and the results were used as the reference standard. Interobserver and intraobserver agreement (kappa) was calculated.


RESULTS
For severity of neural foraminal stenosis, the sensitivities of contrast-enhanced MDCT (50/55, 91%) and MRI (55/57, 96%) were similar, as were their specificities (contrast-enhanced MDCT, 13/24, 54%; MRI, 11/24, 46%). For cause of neural foraminal stenosis, the accuracies of contrast-enhanced MDCT (46/54, 85%) and MRI (45/57, 79%) were similar. Interobserver agreement on severity of neural foraminal stenosis was moderate to almost perfect for contrast-enhanced MDCT (kappa=0.50-1.00) and MRI (kappa=0.43-1.00). For cause of neural foraminal stenosis, interobserver agreement was moderate to substantial for contrast-enhanced MDCT (kappa=0.52-0.76) but only fair for MRI (kappa=0.23-0.39). Intra observer agreement was very high for severity of neural foraminal stenosis (contrast-enhanced MDCT, kappa=0.85; MRI, kappa=0.80) and cause of neural foraminal stenosis (contrast-enhanced MDCT, kappa=0.86; MRI, kappa=1.00).


CONCLUSIONS
Contrast-enhanced MDCT is as accurate as MRI in evaluation of the severity and cause of neural foraminal stenosis and may have better interobserver agreement.
Douglas-Akinwande
Annette C
AC
Department of Radiology, Indiana University Medical Center, University Hospital 0279, and Department of Neurosurgery, Indiana University School of Medicine, 550 N University Blvd., Indianapolis, IN 46202, USA.
Rydberg
Jonas
J
Shah
Mitesh V
MV
Phillips
Michael D
MD
Caldemeyer
Karen S
KS
Lurito
Joseph T
JT
Ying
Jun
J
Mathews
Vincent P
VP
D000328:Adult; D016009:Chi-Square Distribution; D003287:Contrast Media; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011843:Radiculopathy / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013130:Spinal Stenosis / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
D003287:Contrast Media