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Radiographic assessment of degenerative lumbar spinal stenosis: is MRI superior to CT?

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Abstract

Objective

To determine the reliability and dependability of magnetic resonance imaging (MRI) and computerized tomography (CT) in the assessment of lumbar spinal stenosis and correlate the qualitative assessment to both a quantitative assessment and functional outcome measures.

Summary of background data

Multiple studies have addressed the issue of CT and MRI imaging in lumbar spinal stenosis. None showed superiority of one modality.

Methods

We performed a standardized qualitative and quantitative review of CT and MRI scans of 54 patients. Intra-observer and inter-observer reliability was determined between three reviewer using Kappa coefficient. Agreement between the two modalities was analyzed. ODI and SF-36 outcomes were correlated with the imaging assessments.

Results

Almost perfect intra-observer reliability for MRI was achieved by the two expert reviewers (κ = 0.91 for surgeon and κ = 0.92 for neuro-radiologist). For CT, substantial intra-observer agreement was found for the surgeon (κ = 0.77) while the neuro-radiologist was higher (κ = 0.96). For both CT and MRI the standardized qualitative assessment used by the two expert reviewers had a better inter-observer reliability than that between the expert reviewers and the general reporting radiologist, who did not utilize a standardized assessment system. When the qualitative assessment was compared directly, CT overestimated the degree of stenosis 20–35 % of the time (p < 0.05) while MRI overestimated the degree of stenosis 2–11 % of the time (p < 0.05). No correlation was found between qualitative and quantitative analysis with functional status.

Conclusions

This study directly demonstrates that MRI is a more reliable tool than CT, but neither correlates with functional status. Both experience of the reader and the standardization of a qualitative assessment are influential to the reliability.

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References

  1. de Graaf I, Prak A, Bierma-Zeinstra S, Thomas S, Peul W, Koes B (2006) Diagnosis of lumbar spinal stenosis: a systematic review of the accuracy of diagnostic tests. Spine 31(10):1168–1176

    Article  PubMed  Google Scholar 

  2. Drew R, Bhandari M, Kulkarni AV, Louw D, Reddy K, Dunlop B (2000) Reliability in grading the severity of lumbar spinal stenosis. J Spinal Disord 13(3):253–258

    Article  CAS  PubMed  Google Scholar 

  3. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174

    Article  CAS  PubMed  Google Scholar 

  4. Lurie JD, Tosteson AN, Tosteson TD, Carragee E, Carrino JA, Kaiser J, Sequeiros RT, Lecomte AR, Grove MR, Blood EA, Pearson LH, Weinstein JN, Herzog R (2008) Reliability of readings of magnetic resonance imaging features of lumbar spinal stenosis. Spine 33(14):1605–1610

    Article  PubMed  PubMed Central  Google Scholar 

  5. Saint-Louis LA (2001) Lumbar spinal stenosis assessment with computed tomography, magnetic resonance imaging, and myelography. Clin Orthop Relat Res 384:122–136

    Article  Google Scholar 

  6. Gervaise A, Teixeira P, Villani N, Lecocq S, Louis M, Blum A (2013) CT dose optimisation and reduction in osteoarticular disease. Diagn Intervent Imaging 94(4):371–388

    Article  CAS  Google Scholar 

  7. Lonne G, Odegard B, Johnsen LG, Solberg TK, Kvistad KA, Nygaard OP (2014) MRI evaluation of lumbar spinal stenosis: is a rapid visual assessment as good as area measurement? Eur Spine J 23(6):1320–1324

    Article  PubMed  Google Scholar 

  8. Steurer J, Roner S, Gnannt R, Hodler J (2011) Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review. BMC Musculoskelet Disord 12:175

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kim YU, Kong YG, Lee J, Cheong Y, Kim S, Kim HK, Park JY, Suh JH (2015) Clinical symptoms of lumbar spinal stenosis associated with morphological parameters on magnetic resonance images. Eur Spine J 24(10):2236–2243

    Article  PubMed  Google Scholar 

  10. Kanbara S, Yukawa Y, Ito K, Machino M, Kato F (2014) Dynamic changes in the dural sac of patients with lumbar canal stenosis evaluated by multidetector-row computed tomography after myelography. Eur Spine J 23(1):74–79

    Article  PubMed  Google Scholar 

  11. Laudato PA, Kulik G, Schizas C (2015) Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis. Eur Spine J 24(10):2264–2268

    Article  CAS  PubMed  Google Scholar 

  12. Schnebel B, Kingston S, Watkins R, Dillin W (1989) Comparison of MRI to contrast CT in the diagnosis of spinal stenosis. Spine 14(3):332–337

    Article  CAS  PubMed  Google Scholar 

  13. Watters WC 3rd, Baisden J, Gilbert TJ, Kreiner S, Resnick DK, Bono CM, Ghiselli G, Heggeness MH, Mazanec DJ, O’Neill C, Reitman CA, Shaffer WO, Summers JT, Toton JF (2008) Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J 8(2):305–310

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Orthopaedics, Department of Surgery, University of Western Ontario, London, Canada

    Khalid Alsaleh, Kevin Roger Gurr & Christopher Stewart Bailey

  2. Orthopaedic Spine Program, Victoria Hospital, London Health Science Centre, London, Canada

    Khalid Alsaleh, M. Patricia Rosas-Arellano, Tanya Charyk Stewart, Kevin Roger Gurr & Christopher Stewart Bailey

  3. Department of Radiology, University of Western Ontario, London, Canada

    Derek Ho

  4. Department of Orthopedics (49), College of Medicine, King Saud University, P. O. Box 7805, Riyadh, 11472, Saudi Arabia

    Khalid Alsaleh

Authors
  1. Khalid Alsaleh
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  2. Derek Ho
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  3. M. Patricia Rosas-Arellano
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  4. Tanya Charyk Stewart
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  5. Kevin Roger Gurr
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  6. Christopher Stewart Bailey
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Corresponding author

Correspondence to Khalid Alsaleh.

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Conflict of interest

None.

Additional information

This project did not receive funding from outside the spine program at the London health sciences corporation.

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Alsaleh, K., Ho, D., Rosas-Arellano, M.P. et al. Radiographic assessment of degenerative lumbar spinal stenosis: is MRI superior to CT?. Eur Spine J 26, 362–367 (2017). https://doi.org/10.1007/s00586-016-4724-9

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  • DOI: https://doi.org/10.1007/s00586-016-4724-9

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