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Facet arthropathy evaluation: CT or MRI?

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To assess the reliability of lumbar facet arthropathy evaluation with computed tomography (CT) or magnetic resonance imaging (MRI) in patients with and without lumbar disc prosthesis and to estimate the reliability for individual CT and MRI findings indicating facet arthropathy.

Methods

Metal-artifact reducing CT and MRI protocols were performed at follow-up of 114 chronic back pain patients treated with (n = 66) or without (n = 48) lumbar disc prosthesis. Three experienced radiologists independently rated facet joint space narrowing, osteophyte/hypertrophy, erosions, subchondral cysts, and total grade facet arthropathy at each of the three lower lumbar levels on both CT and MRI, using Weishaupt et al’s rating system. CT and MRI examinations were randomly mixed and rated independently. Findings were dichotomized before analysis. Overall kappa and (due to low prevalence) prevalence- and bias-adjusted kappa were calculated to assess interobserver agreement.

Results

Interobserver agreement on total grade facet arthropathy was moderate at all levels with CT (kappa 0.47–0.48) and poor to fair with MRI (kappa 0.20–0.32). Mean prevalence- and bias-adjusted kappa was lower for osteophyte/hypertrophy versus other individual findings (CT 0.58 versus 0.79–0.86, MRI 0.35 versus 0.81–0.90), higher with CT versus MRI when rating osteophyte/hypertrophy (0.58 versus 0.35) and total grade facet arthropathy (0.54 versus 0.31), and generally similar at levels with versus levels without disc prosthesis.

Conclusion

Interobserver agreement on facet arthropathy was moderate with CT and better with CT than with MRI. Disc prosthesis did not influence agreement. A more reliable grading of facet arthropathy requires a more consistent evaluation of osteophytes/hypertrophy.

Key Points

• In this study, interobserver agreement on facet arthropathy (FA) severity—based on facet joint space narrowing, osteophyte/hypertrophy, erosions, and subchondral cysts—was better with CT versus MRI.

• Metal-artifact reducing CT and MRI protocols helped to improve visibility and maintain agreement when evaluating severity of FA at levels with metallic disc prosthesis.

• Agreement was poorer for severity of osteophytes/hypertrophy than for the other evaluated FA findings; improved agreement on total grade FA evaluated with CT or MRI thus requires more consistent grading of osteophytes/hypertrophy between different radiologists.

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Abbreviations

BW:

Pixel bandwidth

CT:

Computed tomography

DICOM:

Digital Imaging and Communications in Medicine

ETL:

Echo train length

FA:

Facet arthropathy

MRI:

Magnetic resonance imaging

NEX:

Number of excitations

PABAK:

Prevalence- and bias-adjusted kappa

PACS:

Picture Archiving and Communication System

TE:

Echo time

TR:

Repetition time

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Acknowledgments

Tone Berg Kjøndahl: punching data

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Nordland Hospital, Postbox 1480, 8092, Bodø, Norway

    Linda Berg & Hanne Thoresen

  2. Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037, Tromsø, Norway

    Linda Berg

  3. Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway

    Gesche Neckelmann & Ansgar Espeland

  4. Department of Surgery, Innlandet Hospital Gjøvik, Kyrre Grepps gate 11, 2819, Gjøvik, Norway

    Håvard Furunes

  5. University of Oslo, Postbox 1072 Blindern, 0316, Oslo, Norway

    Håvard Furunes

  6. Oslo University Hospital Ullevål, FORMI, Building 37B, Postbox 4950 Nydalen, 0424, Oslo, Norway

    Håvard Furunes

  7. Division of Orthopaedic Surgery, Oslo University Hospital, Postbox 4950 Nydalen, 0424, Oslo, Norway

    Christian Hellum

  8. Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway

    Ansgar Espeland

Authors
  1. Linda Berg
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  2. Hanne Thoresen
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  3. Gesche Neckelmann
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  4. Håvard Furunes
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  5. Christian Hellum
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  6. Ansgar Espeland
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Corresponding author

Correspondence to Linda Berg.

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Guarantor

The scientific guarantor of this publication is Ansgar Espeland.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Spine 2018 on adjacent level disc degeneration at 8-year follow-up of these RCT cohorts [30]. That publication contained no data on facet arthropathy. Other publications from the original RCT included baseline and 2-year data [19] and also reliability data [15, 27], but not any CT data and not any data on facet arthropathy evaluated using the same system as in the present manuscript. The most relevant earlier reports are referenced in the manuscript [4, 11, 19, 27].

Methodology

• retrospective

• cross-sectional study

• multicenter study

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Berg, L., Thoresen, H., Neckelmann, G. et al. Facet arthropathy evaluation: CT or MRI?. Eur Radiol 29, 4990–4998 (2019). https://doi.org/10.1007/s00330-019-06047-5

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  • DOI: https://doi.org/10.1007/s00330-019-06047-5

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