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Comparison of Computed Tomography Myelography and Magnetic Resonance Imaging in the Evaluation of Cervical Spondylotic Myelopathy and Radiculopathy

Shafaie, Farid F., MD*; Wippold, Franz J. II, MD*†; Gado, Mokhtar, MD*; Pilgram, Thomas K., PhD*; Riew, K. Daniel, MD


Study Design. A cross-sectional retrospective radiologic study.

Objectives. To establish concordance rates between interpretations of computed tomography myelography and magnetic resonance imaging in patients with degenerative cervical spine disease.

Summary of Background Data. Observed discrepancies in interpretation of computed tomography myelography and magnetic resonance imaging question the reliability of comparisons between these two methods.

Methods. This study blindly and randomly evaluated cervical computed tomography myelography and magnetic resonance imaging in 20 patients referred for clinically diagnosed cervical spondylotic radiculopathy, myelopathy, or both. The discovertebral joints, facet joints, lateral recesses, cord size, spinal canal, and neural foramina also were evaluated with graded scales. All results were subjected to the kappa statistic for strength of agreement.

Results. Agreement for interpretation of the discovertebral junction occurred in 144 of 240 sites (60%), indicating only moderately good intermethod concordance (κ = 0.44). Intermethod agreement on the characterization of facet joint disease was only moderately good (143 of 160 sites; 89.4%; κ = 0.52), and on characterization of lateral recess disease was poor (125 of 160 sites; 78.1%; κ = 0.20). On degree of spinal canal compromise, there was agreement within one grade in 199 of 240 sites (82.9%; κ = 0.42). Intermethod agreement on neural foraminal encroachment and cord size was only moderately good (κ = 0.42 and 0.46, respectively). Computed tomography myelography tended to upgrade the spinal canal narrowing and neural foraminal encroachment.

Conclusions. For most parameters of interpretation, the degree of concordance between computed tomography myelography and magnetic resonance imaging is only moderately good, with discrepancies noted especially in the differentiation of disc and bony pathology. These methods should be viewed as complementary studies.

From the *Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, Missouri, the †Department of Radiology/Nuclear Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, and the ‡Department of the Orthopedic Surgery, Washington University Medical Center, St. Louis, Missouri.

Acknowledgment date: August 5, 1998.

First revision date: October 16, 1998.

Acceptance date: December 2, 1998.

Address reprint requests to

F. J. Wippold II, MD

Mallinckrodt Institute of Radiology

Washington University Medical Center

510 S. Kingshighway Boulevard

St. Louis, MO 63110

Presented at the 35th annual meeting of the American Society of Neuroradiology 21 May 1997.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Defense.

Device status category: 11.

© 1999 by Lippincott Williams & Wilkins