Analyze Diet
Journal of veterinary internal medicine2014; 28(6); 1860-1870; doi: 10.1111/jvim.12431

Repeatability and intra- and inter-observer agreement of cervical vertebral sagittal diameter ratios in horses with neurological disease.

Abstract: Sagittal ratio values (SRVs) of cervical vertebrae are used for ante-mortem diagnosis of cervical vertebral stenotic myelopathy, but intraobserver and interobserver variability in measurement may influence radiographic interpretation of vertebral stenosis in horses with neurological disease. Objective: To determine intraobserver repeatability in SRVs, intra- and interobserver agreement in SRVs and whether or not agreement was influenced by animal age. Methods: Forty-two horses (>1 year old) with neurological disease from which laterolateral computed radiographic images of C2-C7 were obtained. Methods: Four observers made measurements from C2 to C7 for each horse and interobserver agreement for intra- and intervertebral SRVs was determined using Bland-Altman analysis (acceptable agreement: limits of agreement [LOA] ≤ 0.05) on all horses and those ≤3 (n = 25) and >3 (n = 17) years old. Each observer also made repeated measurements for 10 horses and intraobserver repeatability and agreement were determined. Results: Adequate intraobserver repeatability was achieved for 6 sites. Within observers, paired measurements had a median difference ≤5.7%, but a large range in differences often occurred, most frequently at intervertebral sites. For C5, C6, C7, and C3-4, LOA ≤ 0.05 were achieved by at least 1 observer. With the exception of C5 for 1 pair, LOA were >0.05 for interobserver agreement, regardless of animal age. LOA were largest at intervertebral sites. Conclusions: Within and between observers, measurement error may limit the diagnostic accuracy of SRVs and result in discrepancies of diagnosis and treatment and warrants consideration when used clinically in horses with neurological disease.
Publication Date: 2014-11-21 PubMed ID: 25410955PubMed Central: PMC4895627DOI: 10.1111/jvim.12431Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
  • Journal Article
  • Research Support
  • Non-U.S. Gov't

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research article is about how measurement inaccuracies between different observers, and even the same observer at different times, may limit the diagnostic accuracy of sagittal ratio values for diagnosing cervical vertebral stenotic myelopathy, a neurological disease in horses.

Objectives and Methods

  • The study aimed to assess the repeatability of cervical vertebral sagittal ratio values (SRVs) within the same observer (intraobserver) and the agreement between different observers (interobserver).
  • SRVs are a tool used in the diagnosis of a specific neurologic condition in horses, cervical vertebral stenotic myelopathy.
  • The researchers also wanted to find out if age influenced these measurements.
  • The study involved 42 horses diagnosed with a neurological disease. For all of these horses, computed radiographic images of the cervical vertebrae from C2 to C7 were obtained, and four different observers took measurements.
  • Intra- and inter-observer agreement was determined using a statistical method known as Bland-Altman analysis, where the acceptable limits of agreement (LOA) were set at a maximum difference of 0.05.

Results

  • Intraobserver repeatability was good for each observer in 6 specific sites. The median difference for measurements made by the same observer was less than or equal to 5.7%.
  • However, there was significant variability in these measurements, with a large range of differences often occurring.
  • This inconsistency was seen most frequently at sites between the vertebrae (intervertebral sites).
  • Interobserver agreement was generally unachievable, with LOA exceeding the acceptable 0.05 in all instances apart from one case at C5 vertebrae and at C3-4 intervertebral site.
  • The largest discrepancies between observers were found at intervertebral sites.
  • There was no association found between animal age and agreement in measurements.

Conclusions

  • The research highlights that inconsistencies in measurements, both within the same observer and between different observers, could potentially limit the diagnostic accuracy of SRVs.
  • The authors suggest that these discrepancies could cause confusion or inaccuracies in diagnosing and treating horses with neurological conditions.
  • Therefore, these findings could have important implications for the use of SRVs in veterinary practice and should be taken into account when making clinical decisions related to horses with neurological disease.

Cite This Article

APA
Hughes KJ, Laidlaw EH, Reed SM, Keen J, Abbott JB, Trevail T, Hammond G, Parkin TD, Love S. (2014). Repeatability and intra- and inter-observer agreement of cervical vertebral sagittal diameter ratios in horses with neurological disease. J Vet Intern Med, 28(6), 1860-1870. https://doi.org/10.1111/jvim.12431

Publication

ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 28
Issue: 6
Pages: 1860-1870

Researcher Affiliations

Hughes, K J
  • Weipers Centre for Equine Welfare, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia.
Laidlaw, E H
    Reed, S M
      Keen, J
        Abbott, J B
          Trevail, T
            Hammond, G
              Parkin, T D H
                Love, S

                  MeSH Terms

                  • Age Factors
                  • Animals
                  • Cervical Vertebrae / diagnostic imaging
                  • Cervical Vertebrae / pathology
                  • Female
                  • Horse Diseases / diagnosis
                  • Horse Diseases / diagnostic imaging
                  • Horse Diseases / pathology
                  • Horses
                  • Humans
                  • Male
                  • Nervous System Diseases / diagnosis
                  • Nervous System Diseases / diagnostic imaging
                  • Nervous System Diseases / pathology
                  • Nervous System Diseases / veterinary
                  • Observer Variation
                  • Radiography
                  • Reproducibility of Results
                  • Spinal Stenosis / diagnosis
                  • Spinal Stenosis / diagnostic imaging
                  • Spinal Stenosis / pathology
                  • Spinal Stenosis / veterinary

                  Grant Funding

                  • Wellcome Trust

                  References

                  This article includes 26 references
                  1. Nout YS, Reed SM. Cervical vertebral stenotic myelopathy. Equine Vet Educ 2003;15:212–223.
                  2. Oswald J, Love S, Parkin TD, Hughes KJ. Prevalence of cervical vertebral stenotic myelopathy in a population of thoroughbred horses.. Vet Rec 2010 Jan 16;166(3):82-3.
                    pubmed: 20081180doi: 10.1136/vr.b4781google scholar: lookup
                  3. Levine JM, Ngheim PP, Levine GJ, Cohen ND. Associations of sex, breed, and age with cervical vertebral compressive myelopathy in horses: 811 cases (1974-2007).. J Am Vet Med Assoc 2008 Nov 1;233(9):1453-8.
                    pubmed: 18980501doi: 10.2460/javma.233.9.1453google scholar: lookup
                  4. Levine JM, Scrivani PV, Divers TJ, Furr M, Mayhew IJ, Reed S, Levine GJ, Foreman JH, Boudreau C, Credille BC, Tennent-Brown B, Cohen ND. Multicenter case-control study of signalment, diagnostic features, and outcome associated with cervical vertebral malformation-malarticulation in horses.. J Am Vet Med Assoc 2010 Oct 1;237(7):812-22.
                    pubmed: 20919847doi: 10.2460/javma.237.7.812google scholar: lookup
                  5. Levine JM, Adam E, MacKay RJ, Walker MA, Frederick JD, Cohen ND. Confirmed and presumptive cervical vertebral compressive myelopathy in older horses: a retrospective study (1992-2004).. J Vet Intern Med 2007 Jul-Aug;21(4):812-9.
                  6. Moore BR, Reed SM, Biller DS, Kohn CW, Weisbrode SE. Assessment of vertebral canal diameter and bony malformations of the cervical part of the spine in horses with cervical stenotic myelopathy.. Am J Vet Res 1994 Jan;55(1):5-13.
                    pubmed: 8141496
                  7. Mayhew IG, Donawick WJ, Green SL, Galligan DT, Stanley EK, Osborne J. Diagnosis and prediction of cervical vertebral malformation in thoroughbred foals based on semi-quantitative radiographic indicators.. Equine Vet J 1993 Sep;25(5):435-40.
                  8. Papageorges M, Gavin PR, Sande RD. Radiographic and myelographic examination of the cervical vertebral column in 306 ataxic horses. Vet Radiol 1987;28:53–59.
                  9. Hahn CN, Handel I, Green SL, Bronsvoort MB, Mayhew IG. Assessment of the utility of using intra- and intervertebral minimum sagittal diameter ratios in the diagnosis of cervical vertebral malformation in horses.. Vet Radiol Ultrasound 2008 Jan-Feb;49(1):1-6.
                  10. Scrivani PV, Levine JM, Holmes NL, Furr M, Divers TJ, Cohen ND. Observer agreement study of cervical-vertebral ratios in horses.. Equine Vet J 2011 Jul;43(4):399-403.
                  11. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement.. Lancet 1986 Feb 8;1(8476):307-10.
                    pubmed: 2868172
                  12. Conover GL, Hildebolt CF, Yokoyama-Crothers N. Comparison of linear measurements made from storage phosphor and dental radiographs.. Dentomaxillofac Radiol 1996 Nov;25(5):268-73.
                    pubmed: 9161181doi: 10.1259/dmfr.25.5.9161181google scholar: lookup
                  13. Cederberg RA, Tidwell E, Frederiksen NL, Benson BW. Endodontic working length assessment. Comparison of storage phosphor digital imaging and radiographic film.. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998 Mar;85(3):325-8.
                    pubmed: 9540092doi: 10.1016/s1079-2104(98)90017-8google scholar: lookup
                  14. Hudson NPH, Mayhew IG. Radiographic and myelographic assessment of the equine cervical vertebral column and spinal cord. Equine Vet Educ 2005;17:34–38.
                  15. Swee RG, Gray JE, Beabout JW, McLeod RA, Cooper KL, Bond JR, Wenger DE. Screen-film versus computed radiography imaging of the hand: a direct comparison.. AJR Am J Roentgenol 1997 Feb;168(2):539-42.
                    pubmed: 9016243doi: 10.2214/ajr.168.2.9016243google scholar: lookup
                  16. Kottamasu SR, Kuhns LR, Stringer DA. Pediatric musculoskeletal computed radiography.. Pediatr Radiol 1997 Jul;27(7):563-75.
                    pubmed: 9211947doi: 10.1007/s002470050184google scholar: lookup
                  17. Shaw CC, Wang T, King JL, Breitenstein DS, Chang TS, Harris KM, Baratz AB, Ganott MA, Reginella R, Sumkin JH, Gur D. Computed radiography versus screen-film mammography in detection of simulated microcalcifications: a receiver operating characteristic study based on phantom images.. Acad Radiol 1998 Mar;5(3):173-80.
                    pubmed: 9522883doi: 10.1016/s1076-6332(98)80281-xgoogle scholar: lookup
                  18. Weatherburn GC, Ridout D, Strickland NH, Robins P, Glastonbury CM, Curati W, Harvey C, Shadbolt C. A comparison of conventional film, CR hard copy and PACS soft copy images of the chest: analyses of ROC curves and inter-observer agreement.. Eur J Radiol 2003 Sep;47(3):206-14.
                    pubmed: 12927664doi: 10.1016/s0720-048x(02)00214-0google scholar: lookup
                  19. Alexander K, Joly H, Blond L, D'Anjou MA, Nadeau MÈ, Olive J, Beauchamp G. A comparison of computed tomography, computed radiography, and film-screen radiography for the detection of canine pulmonary nodules.. Vet Radiol Ultrasound 2012 May-Jun;53(3):258-65.
                  20. Marolf A, Blaik M, Ackerman N, Watson E, Gibson N, Thompson M. Comparison of computed radiography and conventional radiography in detection of small volume pneumoperitoneum.. Vet Radiol Ultrasound 2008 May-Jun;49(3):227-32.
                  21. Wilson AJ, Mann FA, West OC, McEnery KW, Murphy WA Jr. Evaluation of the injured cervical spine: comparison of conventional and storage phosphor radiography with a hybrid cassette.. Radiology 1994 Nov;193(2):419-22.
                  22. Mayhew IG, Green SL. Accuracy of diagnosing CVM from radiographs. In: Proceedings of the 39th Annual Congress of the British Equine Veterinary Association. Birmingham: Equine Veterinary Journal Ltd; 2000:74–75.
                  23. Brage ME, Bennett CR, Whitehurst JB, Getty PJ, Toledano A. Observer reliability in ankle radiographic measurements.. Foot Ankle Int 1997 Jun;18(6):324-9.
                    pubmed: 9208288doi: 10.1177/107110079701800602google scholar: lookup
                  24. Ornetti P, Maillefert JF, Paternotte S, Dougados M, Gossec L. Influence of the experience of the reader on reliability of joint space width measurement. A cross-sectional multiple reading study in hip osteoarthritis.. Joint Bone Spine 2011 Oct;78(5):499-505.
                    pubmed: 21183377doi: 10.1016/j.jbspin.2010.10.014google scholar: lookup
                  25. Bolte H, Jahnke T, Schäfer FK, Wenke R, Hoffmann B, Freitag-Wolf S, Dicken V, Kuhnigk JM, Lohmann J, Voss S, Knöss N, Heller M, Biederer J. Interobserver-variability of lung nodule volumetry considering different segmentation algorithms and observer training levels.. Eur J Radiol 2007 Nov;64(2):285-95.
                    pubmed: 17433595doi: 10.1016/j.ejrad.2007.02.031google scholar: lookup
                  26. Schäfer CB, Sokiranski R, Strayle M, Linstedt-Hilden M, Dietz K, Deusch H, Hoffmann W, Claussen CD. [The value of the supine chest x-ray with digital luminescence radiography in relation to the experience of the observer. A ROC analysis in CT-validated cases].. Rofo 1994 Jul;161(1):25-30.
                    pubmed: 8043760doi: 10.1055/s-2008-1032487google scholar: lookup

                  Citations

                  This article has been cited 7 times.
                  1. Rijckaert J, Pardon B, Saey V, Raes E, Van Ham L, Ducatelle R, van Loon G, Deprez P. Determination of magnetic motor evoked potential latency time cutoff values for detection of spinal cord dysfunction in horses. J Vet Intern Med 2019 Sep;33(5):2312-2318.
                    doi: 10.1111/jvim.15576pubmed: 31490026google scholar: lookup
                  2. Szklarz M, Lipinska A, Slowikowska M, Niedzwiedz A, Marycz K, Janeczek M. Comparison of the clinical and radiographic appearance of the cervical vertebrae with histological and anatomical findings in an eight-month old warmblood stallion suffering from cervical vertebral stenotic myelopathy (CVSM). BMC Vet Res 2019 Aug 15;15(1):296.
                    doi: 10.1186/s12917-019-2047-xpubmed: 31416466google scholar: lookup
                  3. Rijckaert J, Pardon B, Van Ham L, Joosten P, van Loon G, Deprez P. Magnetic motor evoked potentials of cervical muscles in horses. BMC Vet Res 2018 Sep 24;14(1):290.
                    doi: 10.1186/s12917-018-1620-zpubmed: 30249249google scholar: lookup
                  4. Yamada K, Sato F, Hada T, Horiuchi N, Ikeda H, Nishihara K, Sasaki N, Kobayashi Y, Nambo Y. Quantitative evaluation of cervical cord compression by computed tomographic myelography in Thoroughbred foals. J Equine Sci 2016;27(4):143-148.
                    doi: 10.1294/jes.27.143pubmed: 27974873google scholar: lookup
                  5. Hellige M, Schröder C, Seehusen F, Cavalleri JM, Rohn K, Stadler P, Geburek F. Computed tomographic myelography of the cranial cervical spine in Warmblood horses with no spinal pathology-Inter- and intravertebral ratios and distribution of contrast columns in neutral and flexed cervical spine. Equine Vet J 2025 Sep;57(5):1375-1386.
                    doi: 10.1111/evj.14552pubmed: 40551666google scholar: lookup
                  6. England D, Newsom L, White C, McKenzie E. Retrospective radiographic myelogram measurements and long-term outcomes in horses undergoing cervical interbody fusion surgery: 22 cases. PLoS One 2025;20(5):e0323083.
                    doi: 10.1371/journal.pone.0323083pubmed: 40333898google scholar: lookup
                  7. Journée SL, Journée HL, Bergmann W, Chantziaras I, Vanderperren K, Raes E, Reed SM, de Bruijn CM, Berends HI, Delesalle CJG. Evaluation of the diagnostic value of transcranial electrical stimulation (TES) to assess neuronal functional integrity in horses. Front Neurosci 2024;18:1342803.
                    doi: 10.3389/fnins.2024.1342803pubmed: 38665290google scholar: lookup