Krakenes J, Kaale B R, Moen G, Nordli H, Gilhus N E, Rorvik J
Section of Neuroradiology, Department of Radiology, Haukeland University Hospital, University of Bergen Medical School, 5021 Bergen, Norway.
Neuroradiology. 2002 Jul;44(7):617-24. doi: 10.1007/s00234-002-0799-6. Epub 2002 Jun 8.
Our aim was to characterise and classify structural changes in the alar ligaments in the late stage of whiplash injuries by use of a new MRI protocol, and to evaluate the reliability and the validity of this classification. We studied 92 whiplash-injured and 30 uninjured individuals who underwent proton density-weighted MRI of the craniovertebral junction in three orthogonal planes. Changes in the alar ligaments (grades 0-3) based on the ratio between the high signal area and the total cross-sectional area were rated twice at a 4-month interval, independently by three radiologists. Inter- and intraobserver statistics were calculated by ordinary and weighted kappa. Cases classified differently were reviewed to identify potential causes for disagreement. The alar ligaments were satisfactorily demonstrated in all cases (244 ligaments in 122 individuals). The lesions, 2-9 years after the injury, varied from small high-signal spots to high signal throughout the cross-sectional area. Signal was highest near the condylar insertion in 82 of 94 ligaments, indicating a lesion near that insertion, and near the dental insertion in eight, indicating a medial lesion. No grade 2 or 3 lesion was found in the control group. At least two observers assigned the same grade to 214 ligaments (87.7%) on the second occasion. In 30 ligaments (12.3%) this agreement was not obtained. Pair-wise interobserver agreement (weighted kappa) was fair to moderate (0.31-0.54) in the first grading, improving to moderate (0.49-0.57) in the second. Intraobserver agreement (weighted kappa) was moderate to good (0.43-0.70). Whiplash trauma can cause permanent damage to the alar ligaments, which can be shown by high-resolution proton density-weighted MRI. Reliability of classification of alar ligament lesions needs to be improved.
我们的目的是通过使用一种新的MRI方案来描述和分类挥鞭样损伤后期寰椎横韧带的结构变化，并评估这种分类的可靠性和有效性。我们研究了92例挥鞭样损伤患者和30例未受伤个体，他们在三个正交平面上接受了颅颈交界区的质子密度加权MRI检查。由三位放射科医生独立地对基于高信号区域与总横截面积之比的寰椎横韧带变化（0 - 3级）进行了两次评估，间隔时间为4个月。观察者间和观察者内的统计数据通过普通和加权kappa计算得出。对分类不同的病例进行了复查，以确定分歧的潜在原因。在所有病例（122例个体中的244条韧带）中，寰椎横韧带均得到了满意的显示。损伤后2 - 9年的病变范围从小的高信号点到整个横截面积的高信号不等。94条韧带中有82条在髁突附着处附近信号最高，表明该附着处附近有病变，8条在齿突附着处附近信号最高，表明有内侧病变。在对照组中未发现2级或3级病变。第二次评估时，至少有两位观察者对214条韧带（87.7%）给出了相同的分级。在30条韧带（12.3%）中未达成这种一致性。观察者间的两两一致性（加权kappa）在第一次分级时为一般到中等（0.31 - 0.54），在第二次分级时提高到中等（0.49 - 0.57）。观察者内一致性（加权kappa）为中等至良好（0.43 - 0.70）。挥鞭样创伤可导致寰椎横韧带的永久性损伤，高分辨率质子密度加权MRI可显示这种损伤。寰椎横韧带损伤分类的可靠性需要提高。
