Inter- and intra-rater reliability of diffusion tensor imaging parameters in the normal pediatric spinal cord
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Updated: Apr 1, 2026
Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression
Published on: May 7, 2019
Nadia Barakat1, Pallav Shah1, Scott H Faro1
1Nadia Barakat, Pallav Shah, Scott H Faro, Devon Middleton, Feroze B Mohamed, Department of Radiology, Temple University, Philadelphia, PA 19140, United States.
Insights
This study found that using specific methods for drawing regions of interest in pediatric spinal cord diffusion tensor imaging (DTI) ensures reliable results. Careful methodology in DTI post-processing is crucial for accurate spinal cord analysis.
Area of Science:
- Neuroimaging
- Radiology
- Pediatric Imaging
Background:
- Diffusion Tensor Imaging (DTI) is vital for assessing white matter integrity.
- Spinal cord DTI in pediatric populations presents unique challenges for consistent analysis.
- Standardized methods for region of interest (ROI) placement are needed for reliable pediatric spinal cord DTI.
Purpose of the Study:
- To evaluate the reliability of two distinct ROI methods for pediatric spinal cord DTI.
- To compare inter- and intra-rater agreement for free-hand versus fixed-size ROIs.
- To determine the impact of ROI placement on DTI metrics in pediatric subjects.
Main Methods:
- DTI data from 10 healthy pediatric subjects were analyzed.
- Two neuroradiologists drew ROIs twice on cervical spine B0 maps using free-hand and fixed-size techniques.
- Agreement was assessed using intra-class correlation (ICC) and Cronbach's alpha for DTI parameters.
Main Results:
- Moderate to strong inter- and intra-rater agreement (ICC 0.5–0.84) was observed between ROI methods.
- While pixel counts differed significantly between raters for free-hand ROIs, DTI parameter values showed no significant differences.
- Fractional anisotropy (FA) exhibited the widest variability in ICC values (0.10–0.87).
Conclusions:
- High reproducibility is achievable in pediatric spinal cord DTI analysis.
- Establishing detailed post-processing methodologies, particularly for ROI placement, is essential for consistent DTI results.
- The findings support the use of standardized ROI techniques for reliable pediatric spinal cord DTI research.
Aim:
To assess inter- and intra-rater reliability (agreement) between two region of interest (ROI) methods in pediatric spinal cord diffusion tensor imaging (DTI).
Methods:
Inner-Field-of-View DTI data previously acquired from ten pediatric healthy subjects (mean age = 12.10 years) was used to assess for reliability. ROIs were drawn by two neuroradiologists on each subject data twice within a 3-mo interval. ROIs were placed on axial B0 maps along the cervical spine using free-hand and fixed-size ROIs. Agreement analyses for fractional anisotropy (FA), axial diffusivity, radial diffusivity and mean diffusivity were performed using intra-class-correlation (ICC) and Cronbach's alpha statistical methods.
Results:
Inter- and intra-rater agreement between the two ROI methods showed moderate (ICC = 0.5) to strong (ICC = 0.84). There were significant differences between raters in the number of pixels selected using free-hand ROIs (P < 0.05). However, no significant differences were observed in DTI parameter values. FA showed highest variability in ICC values (0.10-0.87). Cronbach's alpha showed moderate-high values for raters and ROI methods.
Conclusion:
The study showed that high reproducibility in spinal cord DTI can be achieved, and demonstrated the importance of setting detailed methodology for post-processing DTI data, specifically the placement of ROIs.
