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MR Image–based Grading of Lumbar Nerve Root Compromise due to Disk Herniation: Reliability Study with Surgical Correlation¹

¹ From the Departments of Radiology (C.W.A.P., M.R.S., M.Z., J.H.) and Spinal Surgery (C.D., N.B.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland. Supported in part by a grant from the Swiss National Science Foundation (32–52927.97). Received October 9, 2002; revision requested December 17; final revision received May 28, 2003; accepted June 25. Address correspondence to C.W.A.P. (e-mail: christian@pfirrmann.ch).

A system for grading lumbar nerve root compromise (no compromise, contact of disk material with nerve root, deviation of nerve root, and compression of nerve root) was tested in the interpretation of routine magnetic resonance images of 500 lumbar nerve roots in 250 symptomatic patients. Intra- and interobserver reliability was assessed for three independent observers. In the 94 nerve roots evaluated at surgery, surgical grading was correlated with image-based grading. statistics indicated substantial agreement between different readings by the same observer and between different observers (for intraobserver agreement, = 0.72–0.77; for interobserver agreement, = 0.62–0.67). Correlation of image-based grading with surgical grading was high (r = 0.86). The image-based grading system enabled reliable evaluation and reporting of nerve root compromise.

© RSNA, 2003

Index terms: Nerves, roots, 339.499 • Nerves, spinal • Spine, intervertebral disks, 336.783 • Spine, MR, 33.12141

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