• Menekse Salar Barim, M Fehmi Capanoglu, Richard F Sesek, Sean Gallagher, Mark C Schall, Ronald J Beyers, and Gerard A Davis.
• Division of Field Studies and Engineering (DFSE), Engineering and Physical Hazards Branch (EPHB), Human Factors and Ergonomics Team (HFET), National Institute of Occupational Safety and Health (NIOSH), 1090 Tusculum Avenue, Cincinnati, OH, 45226, USA. oih9@cdc.gov.
• Eur Spine J. 2025 Jan 19.

BackgroundMagnetic resonance imaging (MRI) is increasingly used to estimate the geometric dimensions of lower lumbar vertebrae. While MRI-based measurements have demonstrated good reliability with interclass correlation coefficients (ICCs) of 0.80 or higher, many evaluations focus solely on the comparison of identical MRI images. This approach primarily reflects analyst dexterity and does not assess the reliability of the entire process, including imaging and image selection.ObjectiveTo evaluate the inter- and intra-rater reliability of the entire process of using MRI to measure biomechanically relevant lumbar spinal characteristics, incorporating imaging, image selection, and analysis.MethodsA dataset of 144 low-back MRI scans was analyzed. Reliability assessments were performed under different conditions: (1) identical scans rated by the same analyst at different times (intra-rater reliability) and (2) distinct scans of the same subject obtained by different MRI operators and analyzed by different analysts (inter-rater reliability). Mean absolute differences in measurements were calculated, and sources of variability, such as breathing artifacts, were noted.ResultsLarger discrepancies were observed when comparing distinct scans analyzed by different MRI operators and analysts. In the "worst-case" scenario, where both the MRI operator and analyst differed, a 4.05% mean absolute difference was noted for anterior endplate measurements. This was higher than the 2.76% difference observed when analysts re-rated their own scans after one month. Despite these discrepancies, the variability in measurements was relatively low and primarily attributed to factors like breathing artifacts.ConclusionThe process of using MRI to derive biomechanical measures, particularly for bony structures, demonstrates robust reliability. Variability in measurements is minimal even under challenging conditions, supporting the use of MRI for biomechanical assessments.© 2025. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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