Intra- and inter-subspecialty variability in lumbar spine MRI interpretation: A multi-reader study comparing musculoskeletal radiologists and neuroradiologists
Publication date: Available online 9 May 2019
Source: Current Problems in Diagnostic Radiology
Author(s): Nityanand Miskin, Glenn C. Gaviola, Raymond Y. Huang, Christine J. Kim, Thomas C. Lee, Kirstin M. Small, Ged G. Wieschhoff, Jacob C. Mandell

Background and Purpose

The purpose of this study is to assess the differences in degenerative spine MRI reporting between subspecialty-trained attending neuroradiologists and musculoskeletal radiologists at a single institution, academic medical center.

Materials and Methods

Fifty consecutive outpatient non-contrast lumbar spine examinations were selected from the PACS. Three musculoskeletal radiologists (MSK) and three neuroradiologists (NR) independently reviewed and interpreted the exams at the L4-L5 and L5-S1 levels in the same manner as in clinical practice. The assessment of neural foraminal stenosis (NFS) and spinal canal stenosis (SCS) was converted to a 5-point ordinal scale. The assessment of lateral recess stenosis (LRS) and facet osteoarthritis (FO) was recorded as present/absent. Inter-subspecialty and intra-subspecialty analysis was performed using Cohen's kappa coefficient with a binary matrix of all reader pairs.

Results

There was moderate inter-subspecialty agreement (k=0.527) for NFS and SCS (k=0.540). Inter-subspecialty agreement was slight for LRS (k=0.0818) and FO (k=0.153). The MSK group demonstrated greater intra-subspecialty agreement in assessment of NFS and SCS compared to the NR group, with non-overlapping confidence intervals. The NR group demonstrated greater nominal intra-subspecialty agreement in the assessment of both LRS and FO, although with non-overlapping confidence intervals.

Conclusion

There is moderate inter-subspecialty agreement between MSK radiologists and neuroradiologists in reporting the severity of NFS and SCS, although MSK radiologists demonstrated greater intra-subspecialty agreement. There is slight inter-subspecialty agreement for LRS and FO. The demonstration of differences in inter-reader agreement is a crucial first step to attempt to ameliorate these variabilities.