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Novel Application of the Pfirrmann Disc Degeneration Grading System to 9.4T MRI: Higher Reliability Compared to 3T MRI.
Spine 2018 December 12
STUDY DESIGN: Reliability Study.
OBJECTIVE: To evaluate the applicability and reliability of 9.4T MRI in the assessment of degenerative disc disease compared to 3T MRI.
SUMMARY OF BACKGROUND DATA: MRI is a reliable indicator of biochemical changes in the intervertebral disc (IVD) including hydration status, proteoglycan content and disc degeneration compared with anatomical and histological studies. High field 9.4T MRI has been shown to provide superior resolution and anatomical detail. However, it has not been tested against current standard MRI techniques.
METHODS: Disc degeneration was initiated in 36 skeletally mature ewes 6 months prior to necropsy via validated surgical IVD injury models using either scalpel injury or drill-bit injury techniques at lumbar spine levels L2/3 and L3/4 with L1/2, L4/5 and L5/6 serving as control discs. All ex vivo IVDs were examined with 9.4T MRI and 3T MRI. All scans were analysed using the Pfirrmann grading system by four independent observers. Intra- and interobserver reliability was assessed using kappa statistics and Spearman's correlation.
RESULTS: Inter- and intraobserver agreement for 9.4T MRI was excellent, both at κ 0.91 (p < 0.001). Comparatively, 3T interobserver reliability demonstrated substantial agreement at κ 0.61 (p < 0.001). Complete agreement was obtained in 92.7-100% of discs at 9.4T compared to 69.7-83.1% at 3T. A difference of one grade or more occurred in 6.7% at 9.4T and 39.3% at 3T. 9.4T MRI scored 97.3% of discs as grade 1-2 compared to 71.3% at 3T. 3T MRI tended to over-score the extent of disc degeneration with 28.6% of discs scored as grade 3 or higher compared with 2.7% at 9.4T MRI.
CONCLUSION: 9.4T MRI study of IVD degeneration using the Pfirrmann grading system demonstrated excellent inter- and intraobserver reliability. Comparatively, 3T MRI demonstrated a tendency to over score the extent of disc degeneration. This improved reliability of 9.4T MRI holds great potential for its clinical applications.
LEVEL OF EVIDENCE: 3.
OBJECTIVE: To evaluate the applicability and reliability of 9.4T MRI in the assessment of degenerative disc disease compared to 3T MRI.
SUMMARY OF BACKGROUND DATA: MRI is a reliable indicator of biochemical changes in the intervertebral disc (IVD) including hydration status, proteoglycan content and disc degeneration compared with anatomical and histological studies. High field 9.4T MRI has been shown to provide superior resolution and anatomical detail. However, it has not been tested against current standard MRI techniques.
METHODS: Disc degeneration was initiated in 36 skeletally mature ewes 6 months prior to necropsy via validated surgical IVD injury models using either scalpel injury or drill-bit injury techniques at lumbar spine levels L2/3 and L3/4 with L1/2, L4/5 and L5/6 serving as control discs. All ex vivo IVDs were examined with 9.4T MRI and 3T MRI. All scans were analysed using the Pfirrmann grading system by four independent observers. Intra- and interobserver reliability was assessed using kappa statistics and Spearman's correlation.
RESULTS: Inter- and intraobserver agreement for 9.4T MRI was excellent, both at κ 0.91 (p < 0.001). Comparatively, 3T interobserver reliability demonstrated substantial agreement at κ 0.61 (p < 0.001). Complete agreement was obtained in 92.7-100% of discs at 9.4T compared to 69.7-83.1% at 3T. A difference of one grade or more occurred in 6.7% at 9.4T and 39.3% at 3T. 9.4T MRI scored 97.3% of discs as grade 1-2 compared to 71.3% at 3T. 3T MRI tended to over-score the extent of disc degeneration with 28.6% of discs scored as grade 3 or higher compared with 2.7% at 9.4T MRI.
CONCLUSION: 9.4T MRI study of IVD degeneration using the Pfirrmann grading system demonstrated excellent inter- and intraobserver reliability. Comparatively, 3T MRI demonstrated a tendency to over score the extent of disc degeneration. This improved reliability of 9.4T MRI holds great potential for its clinical applications.
LEVEL OF EVIDENCE: 3.
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