OBJECTIVE: Our objective was to assess observer variation in MRI evaluation in patients suspected of lumbar disk herniation. SUBJECTS AND METHODS: Two experienced neuroradiologists independently evaluated 59 consecutive patients with lumbosacral radicular pain. Per patient, three levels (L3-L4 through L5-S1) and the accompanying roots were evaluated on both sides. For each segment, the presence of a bulging disk or a herniation and compression of the root was reported. Images were interpreted twice: once before and once after disclosure of clinical information. Interobserver agreement was expressed as unweighted kappa values. RESULTS: Without clinical information, interobserver agreement for the presence of herniation or bulging disk was moderate (full agreement, 84%; kappa = 0.63; 95% confidence interval [CI], 0.53-0.72). Of a total of 352 segments evaluated, there was disagreement on 58 segments (17%): bulging disk versus no defect in 26 (7.4%), bulging disk versus herniation in five (1.4%), and hernia versus no defect in 27 (7.7%). With clinical information, twice as many bulging disks were reported but no new herniations were detected. Agreement slightly decreased, but not significantly (full agreement, 77%; kappa = 0.59; 95% CI, 0.49-0.69; p = 0.12). CONCLUSION: On average, more than 50% of interobserver variation in MRI evaluation of patients with lumbosacral radicular pain is caused by disagreement on bulging disks. Knowledge of clinical information does not influence the detection of herniations but lowers the threshold for reporting bulging disks.
OBJECTIVE: Our objective was to assess observer variation in MRI evaluation in patients suspected of lumbar disk herniation. SUBJECTS AND METHODS: Two experienced neuroradiologists independently evaluated 59 consecutive patients with lumbosacral radicular pain. Per patient, three levels (L3-L4 through L5-S1) and the accompanying roots were evaluated on both sides. For each segment, the presence of a bulging disk or a herniation and compression of the root was reported. Images were interpreted twice: once before and once after disclosure of clinical information. Interobserver agreement was expressed as unweighted kappa values. RESULTS: Without clinical information, interobserver agreement for the presence of herniation or bulging disk was moderate (full agreement, 84%; kappa = 0.63; 95% confidence interval [CI], 0.53-0.72). Of a total of 352 segments evaluated, there was disagreement on 58 segments (17%): bulging disk versus no defect in 26 (7.4%), bulging disk versus herniation in five (1.4%), and hernia versus no defect in 27 (7.7%). With clinical information, twice as many bulging disks were reported but no new herniations were detected. Agreement slightly decreased, but not significantly (full agreement, 77%; kappa = 0.59; 95% CI, 0.49-0.69; p = 0.12). CONCLUSION: On average, more than 50% of interobserver variation in MRI evaluation of patients with lumbosacral radicular pain is caused by disagreement on bulging disks. Knowledge of clinical information does not influence the detection of herniations but lowers the threshold for reporting bulging disks.
Authors: E Arana; F M Kovacs; A Royuela; A Estremera; H Sarasíbar; G Amengual; I Galarraga; C Martínez; A Muriel; V Abraira; J Zamora; C Campillo Journal: AJNR Am J Neuroradiol Date: 2011-04-14 Impact factor: 3.825
Authors: Gustav Andreisek; Richard A Deyo; Jeffrey G Jarvik; Francois Porchet; Sebastian F X Winklhofer; Johann Steurer Journal: Eur Radiol Date: 2014-07-31 Impact factor: 5.315
Authors: Jon D Lurie; David M Doman; Kevin F Spratt; Anna N A Tosteson; James N Weinstein Journal: Spine (Phila Pa 1976) Date: 2009-04-01 Impact factor: 3.468
Authors: Abdelilah El Barzouhi; Carmen L A M Vleggeert-Lankamp; Geert J Lycklama À Nijeholt; Bas F Van der Kallen; Wilbert B van den Hout; Annemieke J H Verwoerd; Bart W Koes; Wilco C Peul Journal: PLoS One Date: 2013-07-10 Impact factor: 3.240