Establishing the inter-rater reliability of spinal cord damage manual measurement using magnetic resonance imaging

Abstract

Study design Retrospective study. Objectives To establish the inter-rater reliability in the quantitative evaluation of spinal cord damage following cervical incomplete spinal cord injury (SCI) utilizing magnetic resonance imaging (MRI). MRI was used to perform manual measurements of the cranial and caudal boundaries of edema, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume in 10 participants with cervical incomplete SCI. Setting Academic university setting. Methods Structural MRIs of 10 participants with SCI were collected from Northwestern University's Neuromuscular Imaging and Research Lab. All manual measures were performed using OsiriX (Pixmeo Sarl, Geneva, Switzerland). Intraclass correlation coefficients (ICC) were used to determine inter-rater reliability across seven raters of varying experience.Results High-to-excellent inter-rater reliability was found for all measures. ICC values for cranial/caudal levels of involvement, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume were 0.99, 0.98, 0.90, 0.84, and 0.93, respectively. Conclusions Manual MRI measures of spinal cord damage are reliable between raters. Researchers and clinicians may confidently utilize manual MRI measures to quantify cord damage. Future research to predict functional recovery following SCI and better inform clinical management is warranted.

SCIseg: Automatic Segmentation of T2-weighted Intramedullary Lesions in Spinal Cord Injury

“…Lastly, we did not analyze the inter-rater variability as the data were gathered from multiple sites and there were no overlapping subjects across sites. Previous studies (37,38) have reported that MRI measures of spinal cord damage (e.g., edema length, midsagittal tissue bridge ratio, axial damage ratio) exhibit high-to-excellent levels of inter-rater reliability.…”

Peak Slope Ratio of the Recruitment Curves Compared to Muscle Evoked Potentials to Optimize Standing Configurations with Percutaneous Epidural Stimulation after Spinal Cord Injury

“…Axial damage ratio was calculated for each slice as Area lesion /Area cord , then the maximum ratio was used for each participant. In previous work, this method was demonstrated to have high inter- and intra-rater reliability [ 13 , 33 , 34 ]. Lesion length was measured using the midsagittal T2-weighted image as the most cranial to most caudal ends of the lesion hyperintensity [ 17 , 35 , 36 , 37 , 38 ].…”

“…Lesion length was measured using the midsagittal T2-weighted image as the most cranial to most caudal ends of the lesion hyperintensity [ 17 , 35 , 36 , 37 , 38 ]. This method has been demonstrated to have high inter- and intra-rater reliability based on previous work from a co-author’s laboratory [ 34 ].…”

Spinal cord pathology revealed by MRI in traumatic spinal cord injury

“…The lesion size and extent of spared tissue, assessed on midsagittal T2w images 3-4 weeks following SCI, predicts post-SCI recovery at 12 months follow-up in paraplegic patients of both traumatic and ischemic etiology [9,10,35]. Preserved tissue bridges can be accurately and reliably quantified from a time point of 3-4 weeks post-SCI when widespread and dynamically changing edema and hemorrhage have largely resolved [9,36]. Midsagittal tissue bridges are defined as the hypointense regions located ventrally and dorsally between the relatively hyperintense cystic cavity and the cerebrospinal fluid-filled spinal canal assessed on midsagittal T2w images (see Fig.…”

“…Midsagittal tissue bridges are defined as the hypointense regions located ventrally and dorsally between the relatively hyperintense cystic cavity and the cerebrospinal fluid-filled spinal canal assessed on midsagittal T2w images (see Fig. 2) [9,36]. While no injury-spared intramedullary neural tissue is observed in most sensorimotor complete SCI patients (i.e.…”