Cerebellar tonsil ectopia measurement in type i Chiari malformation patients show poor inter-operator reliability

Braden J. Lawrence, Aintzane Urbizu, Philip A. Allen, Francis Loth, R. Shane Tubbs, Alexander C. Bunck, Jan Robert Kröger, Brandon G. Rocque, Casey Madura, Jason A. Chen, Mark Luciano, Richard G. Ellenbogen, John N. Oshinski, Bermans J. Iskandar, Bryn A. Martin

Research output: Contribution to journalArticle

Abstract

Background: Type 1 Chiari malformation (CM-I) has been historically defined by cerebellar tonsillar position (TP) greater than 3-5 mm below the foramen magnum (FM). Often, the radiographic findings are highly variable, which may influence the clinical course and patient outcome. In this study, we evaluate the inter-operator reliability (reproducibility) of MRI-based measurement of TP in CM-I patients and healthy controls. Methods: Thirty-three T2-weighted MRI sets were obtained for 23 CM-I patients (11 symptomatic and 12 asymptomatic) and 10 healthy controls. TP inferior to the FM was measured in the mid-sagittal plane by seven expert operators with reference to McRae's line. Overall agreement between the operators was quantified by intraclass correlation coefficient (ICC). Results: The mean and standard deviation of cerebellar TP measurements for asymptomatic (CM-Ia) and symptomatic (CM-Is) patients in mid-sagittal plane was 6.38 ± 2.19 and 9.57 ± 2.63 mm, respectively. TP measurements for healthy controls was 0.48 ± 2.88 mm. The average range of TP measurements for all data sets analyzed was 7.7 mm. Overall operator agreement for TP measurements was relatively high with an ICC of 0.83. Conclusion: The results demonstrated a large average range (7.7 mm) of measurements among the seven expert operators and support that, if economically feasible, two radiologists should make independent measurements before radiologic diagnosis of CM-I and surgery is contemplated. In the future, an objective diagnostic parameter for CM-I that utilizes automated algorithms and results in smaller inter-operator variation may improve patient selection.

Original languageEnglish (US)
Article number118
JournalFluids and Barriers of the CNS
Volume15
Issue number1
DOIs
StatePublished - Dec 17 2018

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Palatine Tonsil
Foramen Magnum
Arnold-Chiari Malformation
Patient Selection

Keywords

  • Cerebellar tonsil
  • Inter-operator reliability
  • Morphometric
  • MRI
  • Syringomyelia
  • Type 1 Chiari malformation

ASJC Scopus subject areas

  • Neurology
  • Developmental Neuroscience
  • Cellular and Molecular Neuroscience

Cite this

Lawrence, B. J., Urbizu, A., Allen, P. A., Loth, F., Tubbs, R. S., Bunck, A. C., ... Martin, B. A. (2018). Cerebellar tonsil ectopia measurement in type i Chiari malformation patients show poor inter-operator reliability. Fluids and Barriers of the CNS, 15(1), [118]. https://doi.org/10.1186/s12987-018-0118-1

Cerebellar tonsil ectopia measurement in type i Chiari malformation patients show poor inter-operator reliability. / Lawrence, Braden J.; Urbizu, Aintzane; Allen, Philip A.; Loth, Francis; Tubbs, R. Shane; Bunck, Alexander C.; Kröger, Jan Robert; Rocque, Brandon G.; Madura, Casey; Chen, Jason A.; Luciano, Mark; Ellenbogen, Richard G.; Oshinski, John N.; Iskandar, Bermans J.; Martin, Bryn A.

In: Fluids and Barriers of the CNS, Vol. 15, No. 1, 118, 17.12.2018.

Research output: Contribution to journalArticle

Lawrence, BJ, Urbizu, A, Allen, PA, Loth, F, Tubbs, RS, Bunck, AC, Kröger, JR, Rocque, BG, Madura, C, Chen, JA, Luciano, M, Ellenbogen, RG, Oshinski, JN, Iskandar, BJ & Martin, BA 2018, 'Cerebellar tonsil ectopia measurement in type i Chiari malformation patients show poor inter-operator reliability', Fluids and Barriers of the CNS, vol. 15, no. 1, 118. https://doi.org/10.1186/s12987-018-0118-1
Lawrence, Braden J. ; Urbizu, Aintzane ; Allen, Philip A. ; Loth, Francis ; Tubbs, R. Shane ; Bunck, Alexander C. ; Kröger, Jan Robert ; Rocque, Brandon G. ; Madura, Casey ; Chen, Jason A. ; Luciano, Mark ; Ellenbogen, Richard G. ; Oshinski, John N. ; Iskandar, Bermans J. ; Martin, Bryn A. / Cerebellar tonsil ectopia measurement in type i Chiari malformation patients show poor inter-operator reliability. In: Fluids and Barriers of the CNS. 2018 ; Vol. 15, No. 1.
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abstract = "Background: Type 1 Chiari malformation (CM-I) has been historically defined by cerebellar tonsillar position (TP) greater than 3-5 mm below the foramen magnum (FM). Often, the radiographic findings are highly variable, which may influence the clinical course and patient outcome. In this study, we evaluate the inter-operator reliability (reproducibility) of MRI-based measurement of TP in CM-I patients and healthy controls. Methods: Thirty-three T2-weighted MRI sets were obtained for 23 CM-I patients (11 symptomatic and 12 asymptomatic) and 10 healthy controls. TP inferior to the FM was measured in the mid-sagittal plane by seven expert operators with reference to McRae's line. Overall agreement between the operators was quantified by intraclass correlation coefficient (ICC). Results: The mean and standard deviation of cerebellar TP measurements for asymptomatic (CM-Ia) and symptomatic (CM-Is) patients in mid-sagittal plane was 6.38 ± 2.19 and 9.57 ± 2.63 mm, respectively. TP measurements for healthy controls was 0.48 ± 2.88 mm. The average range of TP measurements for all data sets analyzed was 7.7 mm. Overall operator agreement for TP measurements was relatively high with an ICC of 0.83. Conclusion: The results demonstrated a large average range (7.7 mm) of measurements among the seven expert operators and support that, if economically feasible, two radiologists should make independent measurements before radiologic diagnosis of CM-I and surgery is contemplated. In the future, an objective diagnostic parameter for CM-I that utilizes automated algorithms and results in smaller inter-operator variation may improve patient selection.",
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T1 - Cerebellar tonsil ectopia measurement in type i Chiari malformation patients show poor inter-operator reliability

AU - Lawrence, Braden J.

AU - Urbizu, Aintzane

AU - Allen, Philip A.

AU - Loth, Francis

AU - Tubbs, R. Shane

AU - Bunck, Alexander C.

AU - Kröger, Jan Robert

AU - Rocque, Brandon G.

AU - Madura, Casey

AU - Chen, Jason A.

AU - Luciano, Mark

AU - Ellenbogen, Richard G.

AU - Oshinski, John N.

AU - Iskandar, Bermans J.

AU - Martin, Bryn A.

PY - 2018/12/17

Y1 - 2018/12/17

N2 - Background: Type 1 Chiari malformation (CM-I) has been historically defined by cerebellar tonsillar position (TP) greater than 3-5 mm below the foramen magnum (FM). Often, the radiographic findings are highly variable, which may influence the clinical course and patient outcome. In this study, we evaluate the inter-operator reliability (reproducibility) of MRI-based measurement of TP in CM-I patients and healthy controls. Methods: Thirty-three T2-weighted MRI sets were obtained for 23 CM-I patients (11 symptomatic and 12 asymptomatic) and 10 healthy controls. TP inferior to the FM was measured in the mid-sagittal plane by seven expert operators with reference to McRae's line. Overall agreement between the operators was quantified by intraclass correlation coefficient (ICC). Results: The mean and standard deviation of cerebellar TP measurements for asymptomatic (CM-Ia) and symptomatic (CM-Is) patients in mid-sagittal plane was 6.38 ± 2.19 and 9.57 ± 2.63 mm, respectively. TP measurements for healthy controls was 0.48 ± 2.88 mm. The average range of TP measurements for all data sets analyzed was 7.7 mm. Overall operator agreement for TP measurements was relatively high with an ICC of 0.83. Conclusion: The results demonstrated a large average range (7.7 mm) of measurements among the seven expert operators and support that, if economically feasible, two radiologists should make independent measurements before radiologic diagnosis of CM-I and surgery is contemplated. In the future, an objective diagnostic parameter for CM-I that utilizes automated algorithms and results in smaller inter-operator variation may improve patient selection.

AB - Background: Type 1 Chiari malformation (CM-I) has been historically defined by cerebellar tonsillar position (TP) greater than 3-5 mm below the foramen magnum (FM). Often, the radiographic findings are highly variable, which may influence the clinical course and patient outcome. In this study, we evaluate the inter-operator reliability (reproducibility) of MRI-based measurement of TP in CM-I patients and healthy controls. Methods: Thirty-three T2-weighted MRI sets were obtained for 23 CM-I patients (11 symptomatic and 12 asymptomatic) and 10 healthy controls. TP inferior to the FM was measured in the mid-sagittal plane by seven expert operators with reference to McRae's line. Overall agreement between the operators was quantified by intraclass correlation coefficient (ICC). Results: The mean and standard deviation of cerebellar TP measurements for asymptomatic (CM-Ia) and symptomatic (CM-Is) patients in mid-sagittal plane was 6.38 ± 2.19 and 9.57 ± 2.63 mm, respectively. TP measurements for healthy controls was 0.48 ± 2.88 mm. The average range of TP measurements for all data sets analyzed was 7.7 mm. Overall operator agreement for TP measurements was relatively high with an ICC of 0.83. Conclusion: The results demonstrated a large average range (7.7 mm) of measurements among the seven expert operators and support that, if economically feasible, two radiologists should make independent measurements before radiologic diagnosis of CM-I and surgery is contemplated. In the future, an objective diagnostic parameter for CM-I that utilizes automated algorithms and results in smaller inter-operator variation may improve patient selection.

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KW - Inter-operator reliability

KW - Morphometric

KW - MRI

KW - Syringomyelia

KW - Type 1 Chiari malformation

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