A Practical MRI Grading System for Lumbar Foraminal Stenosis
Top Cited Papers
- 1 April 2010
- journal article
- Published by American Roentgen Ray Society in American Journal of Roentgenology
- Vol. 194 (4), 1095-1098
- https://doi.org/10.2214/ajr.09.2772
Abstract
OBJECTIVE. This study aimed to evaluate the reproducibility of a new grading system for lumbar foraminal stenosis. MATERIALS AND METHODS. Four grades were developed for lumbar foraminal stenosis on the basis of sagittal MRI. Grade 0 refers to the absence of foraminal stenosis; grade 1 refers to mild foraminal stenosis showing perineural fat obliteration in the two opposing directions, vertical or transverse; grade 2 refers to moderate foraminal stenosis showing perineural fat obliteration in the four directions without morphologic change, both vertical and transverse directions; and grade 3 refers to severe foraminal stenosis showing nerve root collapse or morphologic change. A total of 576 foramina in 96 patients were analyzed (from L3–L4 to L5–S1). Two experienced radiologists independently assessed the sagittal MR images. Interobserver agreement between the two radiologists and intraobserver agreement by one reader were analyzed using kappa statistics. RESULTS. According to reader 1, grade 1 foraminal stenosis was found in 33 foramina, grade 2 in six, and grade 3 in seven. According to reader 2, grade 1 foraminal stenosis was found in 32 foramina, grade 2 in six, and grade 3 in eight. Interobserver agreement in the grading of foraminal stenosis between the two readers was found to be nearly perfect (κ value: right L3–L4, 1.0; left L3–L4, 0.905; right L4–L5, 0.929; left L4–L5, 0.942; right L5–S1, 0.919; and left L5–S1, 0.909). In intraobserver agreement by reader 1, grade 1 foraminal stenosis was found in 34 foramina, grade 2 in eight, and grade 3 in seven. Intraobserver agreement in the grading of foraminal stenosis was also found to be nearly perfect (κ value: right L3–L4, 0.883; left L3–L4, 1.00; right L4–L5, 0.957; left L4–L5, 0.885; right L5–S1, 0.800; and left L5–S1, 0.905). CONCLUSION. The new grading system for foraminal stenosis of the lumbar spine showed nearly perfect interobserver and intraobserver agreement and would be helpful for clinical study and routine practice.Keywords
This publication has 6 references indexed in Scilit:
- Spine UpdateSpine, 2000
- Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography.Radiology, 1998
- Morphometric Analysis of the Lumbosacral Nerve Roots and Dorsal Root Ganglia by Magnetic Resonance ImagingSpine, 1996
- Lumbar foraminal stenosisThe Journal of Bone & Joint Surgery, 1995
- Diagnosis and Operative Treatment of Intraforaminal and Extraforaminal Nerve Root CompressionSpine, 1991
- Normal and degenerative posterior spinal structures: MR imaging.Radiology, 1987