Clin Orthop Surg.  2009 Mar;1(1):34-39. 10.4055/cios.2009.1.1.34.

Inter- and Intra-observer Reliability of MRI for Lumbar Lateral Disc Herniation

• Kim SW
• Yeom JS
• Park SK
• Chang BS
• Lee DH
• Lee JH
• Park KW
• Seo ES
• Lee CK

• KMID: 1127912
• DOI: http://doi.org/10.4055/cios.2009.1.1.34

Abstract

BACKGROUND: The authors analyzed inter- and intra-observer agreement with respect to interpretation of simple magnetic resonance T1- and T2-weighted axial and sagittal images for the diagnosis of lumbar lateral disc herniation, including foraminal and extraforaminal disc herniations.
METHODS
Forty-two patients in whom lumbar lateral disc herniation was suspected or confirmed by simple magnetic resonance imaging at one institute between May 2003 and December 2004 were included. The magnetic resonance images consisting of T1- and T2-weighted axial and sagittal images, and these were reviewed blindly and independently by three orthopaedic spine surgeons in a random manner. The images were interpreted as positive or negative for lateral disc herniation on 2 different occasions 3 months apart. Results were analyzed using Cohen's kappa statistic, and strengths of agreements were determined using the Landis and Koch criteria.
RESULTS
The kappa values for inter-observer agreement averaged 0.234 (0.282, 0.111, and 0.308 respectively) on the first occasion, and 0.166 (0.249, 0.111, and 0.137 respectively) on the second occasion, with an overall mean value of 0.200. Thus, the strength of agreement was only slight-to-fair according to the Landis and Koch criteria. Kappa values for intra-observer agreement averaged 0.479 (0.488, 0.491, and 0.459 respectively), indicating moderate agreement.
CONCLUSIONS
The present study indicates that simple magnetic resonance imaging is not a reliable imaging modality for diagnosing lumbar lateral disc herniation. Another imaging study with improved diagnostic values should be developed to diagnose this pathologic finding.

Keyword

Lumbar lateral disc herniation; Inter-observer reliability; Intra-observer reliability; Magnetic resonance imaging

MeSH Terms

Aged
Aged, 80 and over
Female
Humans
Intervertebral Disk Displacement/*pathology
Lumbar Vertebrae/*pathology
*Magnetic Resonance Imaging
Male
Middle Aged
Observer Variation
Single-Blind Method

Figure

• 

  Fig. 1 The axial (A) and sagittal (B) MR images of a 58 year-old man are shown. The white line in each figure indicates the sectioning plane for the other figure. A foraminal disc herniation on the left side at L5-S1 (arrowheads) was interpreted as positive for lateral disc herniation by all three observers during both image-reading sessions.

• 

  Fig. 2 The axial (A) and sagittal (B) MR images of a 58 year-old woman are shown. The white line in each figure indicates the sectioning plane for the other figure. An extraforaminal herniation on the right side at L5-S1 (arrowhead) was suspected from the axial image (A). The sagittal image obtained in the extraforaminal zone (arrowhead) was not helpful due to the lack of reliable anatomical landmarks (B). These images led to different interpretations among the three observers during both reading sessions, i.e., positive, negative, negative during the first, and positive, negative, and positive during the second. This patient achieved symptom improvement by a L5 root block; no further imaging study was done.

• 

  Fig. 3 MR (A, B) and CT-discography (C) images of a 56 year-old woman with extremely severe radiating pain on the left side. The MR images (A, B) did not clearly show if the patient had an LDH at L5-S1 (arrow-heads). The interpretations of the three observers were negative, negative, and positive on the first reading session and negative, negative, and negative during the second. CT-discography (C) revealed an extrafor-aminal herniation at L5-S1 (arrowhead).

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