Reliability and validity of lumbar disc height quantification methods using magnetic resonance images.

Abstract

Disc height has been a focus of research on disc degeneration and low back pain (LBP). However, choosing an appropriate method to quantify disc height remains controversial. The aim of the present study was to determine the reliability and construct validity of disc height quantification methods. Repeated semi-automatic measurements of L4-5 and L5-S1 discs were obtained from 43 T2-weighted mid-sagittal 3T magnetic resonance (MR) images of 22 subjects with LBP (43±13 years), blinded to prior measurements. Heights were calculated with area-based methods (using 60%, 80% and 100% of the disc width), and point-based methods (Hurxthal's, Dabbs' and combining the two). Intra-class correlation coefficients (ICC) and standard error of measurement (SEM) were estimated. Construct validity was assessed using correlation coefficients. Intra-rater ICC(3,1) of the area-based disc height measurements ranged from 0.84 to 0.99 with an inter-rater ICC(2,1) of 0.99. Measurements with point-based methods had lower intra- and inter-rater reliability ranging between 0.76 and 0.96 and between 0.84 and 0.98, respectively. Inter-rater SEM varied between 0.2 and 0.3 mm for area-based methods and between 0.3 and 0.7 mm for point-based methods. Excluding Dabbs', high correlations (r>0.9) were observed between methods. Area-based height measurements using partial disc width demonstrated excellent reliability and construct validity and outperformed point-based methods.