Manual and computerized measurement of coronal vertebral inclination on MRI images: a pilot study

A pilot study that presents a systematic approach for evaluating the variability of manual and computerized measurements of coronal vertebral inclination (CVI) on images acquired by magnetic resonance imaging (MRI).

Three observers identified the vertebral body corners of 28 vertebrae on two occasions on two-dimensional (2D) coronal MRI cross-sections, which served to evaluate CVI using six manual measurements (superior and inferior tangents, left and right tangents, mid-endplate and mid-wall lines). Computerized measurements were performed by evaluating CVI from the symmetry of vertebral anatomical structures of the same 28 vertebrae in 2D coronal MRI cross-sections and in three-dimensional (3D) MRI images.

In terms of standard deviation (SD), the mid-endplate lines proved to be the manual measurements with the lowest intra- (1.0° SD) and interobserver (1.4° SD) variability. The computerized measurements in 3D yielded even lower intra- (0.8° SD) and interobserver (1.3° SD) variability. The strongest inter-method agreement (1.2° SD) was found among lines parallel to vertebral endplates (superior tangents, inferior tangents, mid-endplate lines). The computerized measurements in 3D were most in agreement with the mid-endplate lines (1.9° SD). The estimated intra- and interobserver variabilities of standard Cobb angle measurements were equal to 1.6° SD and 2.5° SD, respectively, for manual measurements, and to 1.1° SD and 1.8° SD, respectively, for computerized measurements.

The mid-endplate lines proved to be the most reproducible and reliable manual CVI measurements. Computerized CVI measurements based on the evaluation of the symmetry of vertebral anatomical structures in 3D were more reproducible and reliable than manual measurements.