title: Comparison of two MR grading systems for correlation between grade of cervical neural foraminal stenosis and clinical manifestations.
abstract: OBJECTIVE
  To compare the reliability of two recently reported MR grading systems of cervical neural foraminal stenosis (CNFS) and their correlation with clinical manifestations.
  
  
  METHODS
  We evaluated 188 patients (male : female = 80 : 108; mean age of 41 years) who visited our institution and underwent oblique sagittal MRI of the cervical spine. Two radiologists evaluated the MRI findings for the presence and grade of CNFS at the narrowest point, with the grading systems (Park, Kim and mKim systems) suggested by Park et al and Kim et al. More than one positive neurologic sign and more than one neurologic clinical symptom was considered a positive neurologic manifestation of each foraminal stenosis. Interobserver agreement between the two readers was analyzed using kappa statistics. Non-parametric correlation analysis (Spearman's correlation) was used to evaluate the correlation coefficients (R) to assess the relationship between CNFS grade and clinical manifestations.
  
  
  RESULTS
  Both the Park and mKim systems demonstrated a relatively high correlation (R = 0.714-0.764) between the CNFS grade and clinical manifestation, while the Kim system yielded a moderate correlation (by Reader 2). The Park and mKim systems demonstrated higher correlation values at the level of C6-7 than C4-5, while the Kim system showed no difference in correlation at the cervical spine level.
  
  
  CONCLUSIONS
  Both the Park and mKim systems provide a reliable, reproducible CNFS diagnosis, while the Kim system has a slightly inferior reliability. The Park and mKim systems had a similar, relatively high clinical correlation.
  
  
  CONCLUSIONS
  Grades 2 and 3 of the Park system and Grade 2 in the Kim and mKim systems exhibited a similar clinical significance. Patients with a grade of 0 (using each system) consistently exhibit negative neurologic manifestation.
authors.affiliation: 1 Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
authors.forename: Kyu H
authors.initials: KH
authors.lastname: Lee
authors.affiliation: 1 Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
authors.forename: Hee J
authors.initials: HJ
authors.lastname: Park
authors.affiliation: 1 Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
authors.forename: So Y
authors.initials: SY
authors.lastname: Lee
authors.affiliation: 1 Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
authors.forename: Eun C
authors.initials: EC
authors.lastname: Chung
authors.affiliation: 1 Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
authors.forename: Myung H
authors.initials: MH
authors.lastname: Rho
authors.affiliation: 2 Department of Neurosurgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
authors.forename: Hyunchul
authors.initials: H
authors.lastname: Shin
authors.affiliation: 2 Department of Neurosurgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
authors.forename: Young J
authors.initials: YJ
authors.lastname: Kwon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011843:Radiculopathy / Q000000981:diagnostic imaging* / Q000209:etiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013130:Spinal Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D055815:Young Adult