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Facet arthropathy evaluation: CT or MRI?

Linda Berg1,2, Hanne Thoresen3, Gesche Neckelmann4

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European Radiology
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PubMed
Summary

Computed tomography (CT) offers moderate reliability for evaluating lumbar facet arthropathy, outperforming magnetic resonance imaging (MRI). Consistent grading of osteophytes/hypertrophy is crucial for improving diagnostic accuracy in spinal imaging.

Keywords:
Magnetic resonance imagingProstheses and implantsReproducibility of resultsTomography, X-ray computedZygapophyseal joint

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Area of Science:

  • Radiology
  • Spine Imaging
  • Osteoarthritis

Background:

  • Lumbar facet arthropathy (FA) evaluation is critical for diagnosing back pain.
  • The presence of lumbar disc prosthesis can complicate imaging assessment.
  • Reliability of CT and MRI in assessing FA requires further investigation.

Purpose of the Study:

  • To assess the interobserver reliability of CT and MRI for evaluating lumbar facet arthropathy.
  • To compare reliability in patients with and without lumbar disc prosthesis.
  • To estimate reliability for individual CT and MRI findings of facet arthropathy.

Main Methods:

  • 114 chronic back pain patients (with/without lumbar disc prosthesis) underwent metal-artifact reducing CT and MRI.
  • Three radiologists independently rated facet joint space narrowing, osteophyte/hypertrophy, erosions, subchondral cysts, and total grade FA.
  • Interobserver agreement was assessed using kappa statistics, including prevalence- and bias-adjusted kappa.

Main Results:

  • Moderate interobserver agreement for total grade FA with CT (kappa 0.47-0.48), poor to fair with MRI (kappa 0.20-0.32).
  • Agreement was higher for CT than MRI for osteophyte/hypertrophy and total grade FA.
  • Disc prosthesis presence did not significantly influence agreement; agreement was poorer for osteophyte/hypertrophy grading.

Conclusions:

  • Interobserver agreement for lumbar facet arthropathy is moderate with CT and better than with MRI.
  • Lumbar disc prosthesis does not affect agreement reliability.
  • Improved grading of facet arthropathy necessitates more consistent evaluation of osteophytes/hypertrophy.