Diagnostic Accuracy of CT for Metastatic Epidural Spinal Cord Compression
Background: Early diagnosis of metastatic epidural spinal cord compression (MESCC) is vital to expedite therapy and prevent paralysis. Staging CT is performed routinely in cancer patients and presents an opportunity for earlier diagnosis. Methods: This retrospective study included 123 CT scans from...
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MDPI AG
2022-08-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/17/4231 |
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| author | James Thomas Patrick Decourcy Hallinan Shuliang Ge Lei Zhu Wenqiao Zhang Yi Ting Lim Yee Liang Thian Pooja Jagmohan Tricia Kuah Desmond Shi Wei Lim Xi Zhen Low Ee Chin Teo Nesaretnam Barr Kumarakulasinghe Qai Ven Yap Yiong Huak Chan Jiong Hao Tan Naresh Kumar Balamurugan A. Vellayappan Beng Chin Ooi Swee Tian Quek Andrew Makmur |
| author_facet | James Thomas Patrick Decourcy Hallinan Shuliang Ge Lei Zhu Wenqiao Zhang Yi Ting Lim Yee Liang Thian Pooja Jagmohan Tricia Kuah Desmond Shi Wei Lim Xi Zhen Low Ee Chin Teo Nesaretnam Barr Kumarakulasinghe Qai Ven Yap Yiong Huak Chan Jiong Hao Tan Naresh Kumar Balamurugan A. Vellayappan Beng Chin Ooi Swee Tian Quek Andrew Makmur |
| author_sort | James Thomas Patrick Decourcy Hallinan |
| collection | DOAJ |
| description | Background: Early diagnosis of metastatic epidural spinal cord compression (MESCC) is vital to expedite therapy and prevent paralysis. Staging CT is performed routinely in cancer patients and presents an opportunity for earlier diagnosis. Methods: This retrospective study included 123 CT scans from 101 patients who underwent spine MRI within 30 days, excluding 549 CT scans from 216 patients due to CT performed post-MRI, non-contrast CT, or a gap greater than 30 days between modalities. Reference standard MESCC gradings on CT were provided in consensus via two spine radiologists (11 and 7 years of experience) analyzing the MRI scans. CT scans were labeled using the original reports and by three radiologists (3, 13, and 14 years of experience) using dedicated CT windowing. Results: For normal/none versus low/high-grade MESCC per CT scan, all radiologists demonstrated almost perfect agreement with kappa values ranging from 0.866 (95% CI 0.787–0.945) to 0.947 (95% CI 0.899–0.995), compared to slight agreement for the reports (kappa = 0.095, 95%CI −0.098–0.287). Radiologists also showed high sensitivities ranging from 91.51 (95% CI 84.49–96.04) to 98.11 (95% CI 93.35–99.77), compared to 44.34 (95% CI 34.69–54.31) for the reports. Conclusion: Dedicated radiologist review for MESCC on CT showed high interobserver agreement and sensitivity compared to the current standard of care. |
| first_indexed | 2024-03-10T01:58:29Z |
| format | Article |
| id | doaj.art-0951830727be4d39827c12a56346afc5 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T01:58:29Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-0951830727be4d39827c12a56346afc52023-11-23T12:52:01ZengMDPI AGCancers2072-66942022-08-011417423110.3390/cancers14174231Diagnostic Accuracy of CT for Metastatic Epidural Spinal Cord CompressionJames Thomas Patrick Decourcy Hallinan0Shuliang Ge1Lei Zhu2Wenqiao Zhang3Yi Ting Lim4Yee Liang Thian5Pooja Jagmohan6Tricia Kuah7Desmond Shi Wei Lim8Xi Zhen Low9Ee Chin Teo10Nesaretnam Barr Kumarakulasinghe11Qai Ven Yap12Yiong Huak Chan13Jiong Hao Tan14Naresh Kumar15Balamurugan A. Vellayappan16Beng Chin Ooi17Swee Tian Quek18Andrew Makmur19Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, SingaporeDepartment of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, SingaporeDepartment of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, SingaporeDepartment of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, SingaporeDepartment of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, SingaporeDepartment of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, SingaporeDepartment of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, SingaporeDepartment of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, SingaporeDepartment of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, SingaporeDepartment of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, SingaporeDepartment of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, SingaporeNational University Cancer Institute, NUH Medical Centre (NUHMC), Levels 8–10, 5 Lower Kent Ridge Road, Singapore 119074, SingaporeBiostatistics Unit, Yong Loo Lin School of Medicine, 10 Medical Drive, Singapore 117597, SingaporeBiostatistics Unit, Yong Loo Lin School of Medicine, 10 Medical Drive, Singapore 117597, SingaporeUniversity Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, SingaporeUniversity Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, SingaporeDepartment of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore 119074, SingaporeDepartment of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, SingaporeDepartment of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, SingaporeDepartment of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, SingaporeBackground: Early diagnosis of metastatic epidural spinal cord compression (MESCC) is vital to expedite therapy and prevent paralysis. Staging CT is performed routinely in cancer patients and presents an opportunity for earlier diagnosis. Methods: This retrospective study included 123 CT scans from 101 patients who underwent spine MRI within 30 days, excluding 549 CT scans from 216 patients due to CT performed post-MRI, non-contrast CT, or a gap greater than 30 days between modalities. Reference standard MESCC gradings on CT were provided in consensus via two spine radiologists (11 and 7 years of experience) analyzing the MRI scans. CT scans were labeled using the original reports and by three radiologists (3, 13, and 14 years of experience) using dedicated CT windowing. Results: For normal/none versus low/high-grade MESCC per CT scan, all radiologists demonstrated almost perfect agreement with kappa values ranging from 0.866 (95% CI 0.787–0.945) to 0.947 (95% CI 0.899–0.995), compared to slight agreement for the reports (kappa = 0.095, 95%CI −0.098–0.287). Radiologists also showed high sensitivities ranging from 91.51 (95% CI 84.49–96.04) to 98.11 (95% CI 93.35–99.77), compared to 44.34 (95% CI 34.69–54.31) for the reports. Conclusion: Dedicated radiologist review for MESCC on CT showed high interobserver agreement and sensitivity compared to the current standard of care.https://www.mdpi.com/2072-6694/14/17/4231metastatic spinal cord compressionepidural spinal cord compressionmetastatic epidural spinal cord compressionspinal metastatic diseasespinal metastases classificationmagnetic resonance imaging |
| spellingShingle | James Thomas Patrick Decourcy Hallinan Shuliang Ge Lei Zhu Wenqiao Zhang Yi Ting Lim Yee Liang Thian Pooja Jagmohan Tricia Kuah Desmond Shi Wei Lim Xi Zhen Low Ee Chin Teo Nesaretnam Barr Kumarakulasinghe Qai Ven Yap Yiong Huak Chan Jiong Hao Tan Naresh Kumar Balamurugan A. Vellayappan Beng Chin Ooi Swee Tian Quek Andrew Makmur Diagnostic Accuracy of CT for Metastatic Epidural Spinal Cord Compression Cancers metastatic spinal cord compression epidural spinal cord compression metastatic epidural spinal cord compression spinal metastatic disease spinal metastases classification magnetic resonance imaging |
| title | Diagnostic Accuracy of CT for Metastatic Epidural Spinal Cord Compression |
| title_full | Diagnostic Accuracy of CT for Metastatic Epidural Spinal Cord Compression |
| title_fullStr | Diagnostic Accuracy of CT for Metastatic Epidural Spinal Cord Compression |
| title_full_unstemmed | Diagnostic Accuracy of CT for Metastatic Epidural Spinal Cord Compression |
| title_short | Diagnostic Accuracy of CT for Metastatic Epidural Spinal Cord Compression |
| title_sort | diagnostic accuracy of ct for metastatic epidural spinal cord compression |
| topic | metastatic spinal cord compression epidural spinal cord compression metastatic epidural spinal cord compression spinal metastatic disease spinal metastases classification magnetic resonance imaging |
| url | https://www.mdpi.com/2072-6694/14/17/4231 |
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