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Title: Diagnostic Accuracy of CT for Metastatic Epidural Spinal Cord Compression
Authors: Hallinan, James Thomas Patrick Decourcy 
Ge, Shuliang
Zhu, Lei 
Zhang, Wenqiao 
Lim, Yi Ting 
Thian, Yee Liang 
Jagmohan, Pooja 
Kuah, Tricia
Lim, Desmond Shi Wei
Low, Xi Zhen
Teo, Ee Chin
Kumarakulasinghe, Nesaretnam Barr
Yap, Qai Ven 
Chan, Yiong Huak 
Tan, Jiong Hao
Kumar, Naresh 
Vellayappan, Balamurugan A 
Ooi, Beng Chin 
Quek, Swee Tian 
Makmur, Andrew
Keywords: Science & Technology
Life Sciences & Biomedicine
metastatic spinal cord compression
epidural spinal cord compression
metastatic epidural spinal cord compression
spinal metastatic disease
spinal metastases classification
magnetic resonance imaging
computed tomography
spine oncology study group
Bilsky classification
Issue Date: 1-Sep-2022
Publisher: MDPI
Citation: Hallinan, James Thomas Patrick Decourcy, Ge, Shuliang, Zhu, Lei, Zhang, Wenqiao, Lim, Yi Ting, Thian, Yee Liang, Jagmohan, Pooja, Kuah, Tricia, Lim, Desmond Shi Wei, Low, Xi Zhen, Teo, Ee Chin, Kumarakulasinghe, Nesaretnam Barr, Yap, Qai Ven, Chan, Yiong Huak, Tan, Jiong Hao, Kumar, Naresh, Vellayappan, Balamurugan A, Ooi, Beng Chin, Quek, Swee Tian, Makmur, Andrew (2022-09-01). Diagnostic Accuracy of CT for Metastatic Epidural Spinal Cord Compression. CANCERS 14 (17). ScholarBank@NUS Repository.
Abstract: 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.
Source Title: CANCERS
ISSN: 20726694
DOI: 10.3390/cancers14174231
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