title: Diagnostic value of oblique magnetic resonance images for evaluating cervical foraminal stenosis.
abstract: BACKGROUND
  The benefits of oblique magnetic resonance imaging (MRI) reformations to assess cervical neural foramina have been reported previously in clinical and cadaveric studies. But there is a paucity of literature investigating intra- and interobserver variabilities for assessing cervical foraminal stenosis using oblique MRI views.
  
  
  OBJECTIVE
  To determine the value of oblique MRI views compared with axial and sagittal views for assessing foraminal stenosis of the cervical spine using intra- and interobserver variabilities.
  
  
  METHODS
  A retrospective study.
  
  
  METHODS
  Twenty-six patients were included.
  
  
  METHODS
  Two independent reviewers blindly identified the presence of foraminal stenosis as definite or indeterminate on the sagittal, axial, and oblique views. The assessments using the different views were compared using an independent t test. Intra- and interobserver variabilities were assessed using Kappa analysis.
  
  
  METHODS
  We evaluated the cervical spine MRIs of patients with varying degrees of foraminal stenosis. The mean age of the patients was 60.8 years (range 50-86 years). Male to female ratio was 16:10. The oblique images were obtained by reformatting the scans perpendicular to the long axis of the right and left neural foramina, respectively.
  
  
  RESULTS
  The oblique or axial views had significantly greater confidence rates for determining the presence of foraminal stenosis than the sagittal views (92.3%, 88.1% vs. 58.0%, respectively, p=.000). The oblique view had significantly better intraobserver agreement than the sagittal and axial images. Both the axial and oblique views had significantly better interobserver agreement than the sagittal images.
  
  
  CONCLUSIONS
  Oblique MRI views of the cervical spine significantly reduce the degree of intra- and interobserver variabilities and increase observer confidence in the assessment of foraminal stenosis. Our results suggest that routine use of oblique cervical MRI views might be useful for evaluating cervical foraminal stenosis.
authors.affiliation: Department of Orthopaedic Surgery, Medical College of Hallym University, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, Republic of Korea. Electronic address: amhangpark@gmail.com.
authors.forename: Moon Soo
authors.initials: MS
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 102-752, Republic of Korea.
authors.forename: Seong-Hwan
authors.initials: SH
authors.lastname: Moon
authors.affiliation: Department of Orthopaedic Surgery, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 102-752, Republic of Korea.
authors.forename: Hwan-Mo
authors.initials: HM
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Medical College of Hallym University, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, Republic of Korea.
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Medical College of Hallym University, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, Republic of Korea.
authors.forename: Jae Keun
authors.initials: JK
authors.lastname: Oh
authors.affiliation: Department of Orthopaedic Surgery, Medical College of Hallym University, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, Republic of Korea.
authors.forename: Seung Yeop
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Medical College of Hallym University, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, Republic of Korea.
authors.forename: Jong Byung
authors.initials: JB
authors.lastname: Oh
authors.affiliation: Department of Orthopedic Surgery, BJC Institute of Health at Washington University School of Medicine, 425 S. Euclid Ave., Suite 5505, St. Louis, MO 63110, USA.
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D013130:Spinal Stenosis / Q000175:diagnosis*
keywords: Cervical spine; Foraminal stenosis; Magnetic resonance image; Oblique MRI; Observer confidence; Observer variability