Abstract
Four MRI variables have recently been suggested to be independently associated with a diagnosis of thoracolumbar intervertebral disk extrusion or protrusion. Midline intervertebral disk herniation, and partial intervertebral disk degeneration were associated with intervertebral disk protrusion, while presence of a single intervertebral disk herniation and disk material dispersed beyond the boundaries of the intervertebral disk space were associated with intervertebral disk extrusion. The aim of this retrospective, cross-sectional study was to determine whether using these MRI variables improves differentiation between thoracolumbar intervertebral disk extrusions and protrusions. Eighty large breed dogs with surgically confirmed thoracolumbar intervertebral disk extrusions or protrusions were included. Randomized MRI studies were presented on two occasions to six blinded observers, which were divided into three experience categories. During the first assessment, observers made a presumptive diagnosis of thoracolumbar intervertebral disk extrusion or protrusion without guidelines. During the second assessment they were asked to make a presumptive diagnosis with the aid of guidelines. Agreement was evaluated by Kappa-statistics. Diagnostic accuracy significantly improved from 70.8 to 79.6% and interobserver agreement for making a diagnosis of intervertebral disk extrusion or intervertebral disk protrusion improved from fair (κ = 0.27) to moderate (κ = 0.41) after using the proposed guidelines. Diagnostic accuracy was significantly influenced by degree of observer experience. Intraobserver agreement for the assessed variables ranged from fair to excellent and interobserver agreement ranged from fair to moderate. The results of this study suggest that the proposed imaging guidelines can aid in differentiating thoracolumbar intervertebral disk extrusions from protrusions.
Highlights
This study evaluated the accuracy, reliability and reproducibility of MRI guidelines to improve the differentiation of thoracolumbar intervertebral disk extrusion and disk protrusion in large breed dogs
The results of this study suggest that applying the proposed guidelines improves the accuracy and inter-observer agreement of diagnosing thoracolumbar intervertebral disk extrusion and intervertebral disk protrusion
The results of this study indicate further that accuracy of assessing spinal MRI studies is influenced by the observer’s degree of training and experience
Summary
During the first round of assessments, the observers were asked for each MRI study to make a presumptive diagnosis of thoracolumbar intervertebral disk extrusion or protrusion without any guidelines. They learnt how to use the imaging viewing software, were instructed about the pathophysiological differences between intervertebral disk extrusions and protrusions, and were handed a recent review manuscript discussing intervertebral disk disease in chondrodystrophic and non-chondrodystrophic dog breeds.[5] After the first round of assessments they received illustrated guidelines with examples of the proposed MRI
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