Inter- and Intrarater Reliability of the Manjila and Semaan Classification System when Assessing Jugular Bulb Position

Abstract

Objectives

This study evaluates the inter- and intrarater reliability of the Manjila and Semaan classification system for the anatomical position of the jugular bulb. The classification system, proposed in 2018, aims to address inconsistencies in reporting that impact communication between radiologists and skull base surgeons and affect surgical planning.

Design

Bilateral jugular bulb positions on 50 consecutive computed tomography (CT) venography examinations were assessed by two neuroradiology attending physicians, two neuroradiology fellows, and two radiology residents.

Setting

The study was conducted in a clinical radiology setting on an Ambra PACS workstation.

Participants

Consecutive patients who underwent clinical CT venography examinations between August 3, 2021, and January 29, 2022, and met the inclusion criteria were included in the analysis.

Main Outcome Measures

Inter- and intrarater reliability were assessed using kappa values, Kendall's coefficient of concordance (W), and Spearman's rho.

Results

Interrater agreement, measured by kappa values, showed moderate to substantial agreement for bilateral jugular bulb position types. Kendall's W indicated substantial to almost-perfect interrater agreement. Intrarater agreement was almost perfect according to kappa values and was high in monotonicity, as indicated by Spearman's rho.

Conclusion

The Manjila and Semaan classification system demonstrated high inter- and intrarater reliability across a spectrum of experience levels. Adopting this classification could enhance clinical communication and improve surgical planning.

Keywords

high-riding jugular bulb - internal auditory canal - jugular bulb anatomy - jugular dehiscence - jugular diverticulum - pulsatile tinnitus - semicircular canal - skull base

Previous Presentation

Portions of this research were presented as a poster at the 55th Annual Western Neuroradiological Society Meeting, Scottsdale, Arizona, October 19–22, 2023.

Publikationsverlauf

Eingereicht: 30. September 2024

Angenommen: 21. März 2025

Artikel online veröffentlicht:
21. April 2025

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