C H Cho1, L Hsu2, M L Ferrone3, D A Leonard3, M B Harris3, A A Zamani2, C M Bono3. 1. From the Departments of Radiology (C.H.C., L.H., A.A.Z.) ccho81@partners.org. 2. From the Departments of Radiology (C.H.C., L.H., A.A.Z.). 3. Orthopedic Surgery (M.L.F., D.A.L., M.B.H., C.M.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND AND PURPOSE: The multisociety task force descriptively defined abnormal lumbar disk morphology. We aimed to use their definitions to provide a higher level of evidence for the validation of MR imaging in the evaluation of this pathology in patients who have undergone diskectomy by retrospectively classifying their preoperative MRI. MATERIALS AND METHODS: This retrospective, institutional review board-approved study included 54 of 86 consecutive patients (47 men; average age, 44 years) enrolled in an ongoing prospective trial of surgically treated lumbar disk herniation who had preoperative MRI and documented intraoperative classification of the abnormal disk as protrusion, extrusion, or sequestration by the treating surgeon. Preoperative MRI was classified by 2 blinded radiologists; discrepancies were resolved by a third reader. Statistical analysis of interobserver agreement and imaging compared with surgical findings was performed. RESULTS: The readers disagreed on only 1 of the 54 cases. The third reader resolved the disagreement. Eight protrusions and 46 extrusions were found on imaging, with no sequestrations. At surgery, there were 13 protrusions and 40 extrusions, with 2 of the extrusions also containing sequestrations; the remaining case had only sequestration. There were 16 discrepancies between imaging and surgery, resulting in 70% agreement. CONCLUSIONS: This study, which was intended to validate the multisociety combined task force definitions of abnormal disk morphology by using MR imaging with a surgical criterion standard, found 70% agreement between imaging diagnosis and surgical findings. Although reasonable, this finding highlights differences that often exist between intraoperative and preoperative imaging findings of lumbar disk herniation.
BACKGROUND AND PURPOSE: The multisociety task force descriptively defined abnormal lumbar disk morphology. We aimed to use their definitions to provide a higher level of evidence for the validation of MR imaging in the evaluation of this pathology in patients who have undergone diskectomy by retrospectively classifying their preoperative MRI. MATERIALS AND METHODS: This retrospective, institutional review board-approved study included 54 of 86 consecutive patients (47 men; average age, 44 years) enrolled in an ongoing prospective trial of surgically treated lumbar disk herniation who had preoperative MRI and documented intraoperative classification of the abnormal disk as protrusion, extrusion, or sequestration by the treating surgeon. Preoperative MRI was classified by 2 blinded radiologists; discrepancies were resolved by a third reader. Statistical analysis of interobserver agreement and imaging compared with surgical findings was performed. RESULTS: The readers disagreed on only 1 of the 54 cases. The third reader resolved the disagreement. Eight protrusions and 46 extrusions were found on imaging, with no sequestrations. At surgery, there were 13 protrusions and 40 extrusions, with 2 of the extrusions also containing sequestrations; the remaining case had only sequestration. There were 16 discrepancies between imaging and surgery, resulting in 70% agreement. CONCLUSIONS: This study, which was intended to validate the multisociety combined task force definitions of abnormal disk morphology by using MR imaging with a surgical criterion standard, found 70% agreement between imaging diagnosis and surgical findings. Although reasonable, this finding highlights differences that often exist between intraoperative and preoperative imaging findings of lumbar disk herniation.
Authors: David F Fardon; Alan L Williams; Edward J Dohring; F Reed Murtagh; Stephen L Gabriel Rothman; Gordon K Sze Journal: Spine (Phila Pa 1976) Date: 2014-11-15 Impact factor: 3.468
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: Jon D Lurie; Anna N A Tosteson; Tor D Tosteson; Eugene Carragee; John A Carrino; John Carrino; Jay Kaiser; Roberto T Blanco Sequeiros; Amy Rosen Lecomte; Margaret R Grove; Emily A Blood; Loretta H Pearson; Richard Herzog; James N Weinstein Journal: Spine (Phila Pa 1976) Date: 2008-04-20 Impact factor: 3.468