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Short tau inversion recovery MRI of Modic changes: a reliability study
Per Martin Kristoffersen1,2, Nils Vetti1,2, Kjersti Storheim3,4
1Department of Radiology, Haukeland University Hospital, Bergen, Norway.
Background:
Limited reliability data exist for evaluation of spinal edema changes on magnetic resonance imaging (MRI) with short tau inversion recovery (STIR) sequences.
Purpose:
To assess the inter-observer reliability for evaluation of STIR signal increase related to Modic changes (MCs) on MRI of the lumbar spine.
Material And Methods:
We prospectively included 120 patients imaged to confirm their eligibility for the AIM (Antibiotics In Modic changes) trial. Three experienced radiologists independently evaluated MCs on T1-/T2-weighted fast spin-echo images and subsequently MC-related STIR signal increases. Inter-observer reliability was analyzed at four endplates (L4-S1) by calculating kappa values and means of differences with 95% limits of agreement.
Results:
Overall agreement (mean Fleiss' kappa for all endplates and observers) was very good for presence of STIR signal increase (0.86), and moderate for its categorized height (0.51), anteroposterior extent (0.48), and volume (0.56). For height of region with STIR signal increase measured in % points of vertebral body height, the largest mean of differences was 6.9 and widest range for limits of agreement was ±22.3 for all endplates combined. The corresponding numbers were 11.2 ± 34.5 for anteroposterior extent of the STIR signal increase measured in % points of anteroposterior endplate diameter and 0.9 ± 7.6 for its maximum measured intensity on a % point scale (0% = normal vertebral marrow intensity, 100% = cerebrospinal fluid intensity).
Conclusion:
Inter-observer reliability was very good for the presence and intensity of MC-related STIR signal increases, and moderate for their size.
Insights
Reliability for evaluating spinal edema on MRI using short tau inversion recovery (STIR) sequences is crucial. This study found very good inter-observer reliability for detecting STIR signal increases related to Modic changes, but moderate reliability for their size.
Area of Science:
- Radiology
- Spinal Imaging
- Medical Diagnostics
Background:
- Limited data exist on the reliability of assessing spinal edema changes using short tau inversion recovery (STIR) sequences on MRI.
- Accurate assessment of spinal edema is important for understanding conditions like Modic changes.
Purpose of the Study:
- To evaluate the inter-observer reliability of assessing STIR signal increases associated with Modic changes (MCs) in the lumbar spine using MRI.
- To provide reliability data for STIR sequence interpretation in spinal imaging.
Main Methods:
- Prospective inclusion of 120 patients for the AIM trial.
- Independent evaluation of Modic changes and STIR signal increases by three experienced radiologists.
- Analysis of inter-observer reliability using kappa values and limits of agreement at four lumbar endplates (L4-S1).
Main Results:
- Very good overall agreement (kappa=0.86) for the presence of STIR signal increase.
- Moderate agreement for the categorized height (kappa=0.51), anteroposterior extent (kappa=0.48), and volume (kappa=0.56) of STIR signal increases.
- Quantified differences and limits of agreement for height, extent, and intensity of STIR signal increases.
Conclusions:
- Inter-observer reliability is very good for detecting the presence and intensity of Modic change-related STIR signal increases.
- Reliability for assessing the size (height, extent, volume) of these STIR signal increases is moderate.
- Findings support the use of STIR sequences for evaluating spinal edema related to Modic changes, with awareness of limitations in size assessment.
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