Validation of multisociety combined task force definitions of abnormal disk morphology
C H Cho1, L Hsu2, M L Ferrone3
1From the Departments of Radiology (C.H.C., L.H., A.A.Z.) ccho81@partners.org.
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.
Insights
Magnetic resonance imaging (MRI) showed 70% agreement with surgical findings for lumbar disk herniation (LDH) morphology after diskectomy. This study validated task force definitions for abnormal lumbar disk morphology using MRI compared to surgical outcomes.
Area of Science:
- Radiology
- Neurosurgery
- Orthopedics
Background:
- Multisociety task force defined abnormal lumbar disk morphology.
- Previous research lacked higher evidence for MRI validation in post-diskectomy patients.
Purpose of the Study:
- Validate MR imaging definitions for abnormal lumbar disk morphology.
- Assess MRI accuracy in patients who underwent diskectomy using surgical findings as the criterion standard.
Main Methods:
- Retrospective study of 54 patients with lumbar disk herniation who underwent diskectomy.
- Preoperative MRI was classified by two blinded radiologists, with discrepancies resolved by a third reader.
- Comparison of MRI findings with intraoperative surgical classification.
Main Results:
- Seventy percent agreement between preoperative MRI and surgical findings for lumbar disk morphology.
- Readers achieved high interobserver agreement (1 disagreement in 54 cases).
- Discrepancies noted in the classification of disk protrusion, extrusion, and sequestration.
Conclusions:
- MR imaging demonstrated 70% agreement with surgical findings for abnormal lumbar disk morphology.
- Highlights potential differences between preoperative imaging and intraoperative findings in lumbar disk herniation.
- Supports the use of MRI for evaluating disk morphology, while acknowledging limitations.
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