Davids Jon R, Chamberlin Eric, Blackhurst Dawn W
Motion Analysis Laboratory, Shriners Hospital for Children, 950 West Faris Road, Greenville, SC 29605, USA.
J Bone Joint Surg Am. 2004 Oct;86(10):2187-95. doi: 10.2106/00004623-200410000-00009.
The use of magnetic resonance imaging has led to the diagnosis of abnormalities of the central nervous system associated with apparent idiopathic scoliosis. The indications for magnetic resonance imaging for presumed adolescent idiopathic scoliosis have not been established.
One thousand, two hundred and eighty children with presumed adolescent idiopathic scoliosis were evaluated over a ten-year period. Magnetic resonance imaging of the central nervous system (brainstem and spinal cord) was performed for specific patients, on the basis of the presence of selected indicators determined from the clinical history, physical examination, and plain radiographic examination of the spine. The medical records were reviewed to determine the specific indicators, the results of the imaging studies, and the subsequent treatment.
Magnetic resonance imaging was ordered for 274 (21%) of the 1280 children who were evaluated. Abnormal findings were seen in twenty-seven (10%) of the 274 patients who underwent imaging, or 2% of the entire cohort. The most valuable single indicator of an abnormal finding on magnetic resonance imaging was absence of thoracic apical segment lordosis: eight of thirty-nine patients with that indicator had an abnormal finding on magnetic resonance imaging. The optimal diagnostic yield for a single category of indicators occurred when an atypical curve pattern was the only indicator: six of fifty-eight patients in whom this was the case had an abnormal finding on magnetic resonance imaging. None of the twenty children in whom pain was the only indicator category had an abnormal imaging study. The optimal diagnostic yield occurred when both an atypical curve pattern and neurological indicators were present: thirteen (25%) of fifty-three patients in whom this was the case had an abnormal finding on magnetic resonance imaging. Thirteen of the twenty-seven patients received surgical treatment for the abnormality of the central nervous system revealed by the imaging.
The correct use of diagnostic tests is an important component of effective medical practice. An abnormality of the central nervous system is present in approximately 10% of patients with presumed adolescent idiopathic scoliosis in whom only subtle abnormalities are identified on the basis of the clinical history, physical examination, or radiographic examination. Knowledge of the diagnostic value of the specific clinical indicators, considered individually and in combination, can help the clinician to determine more effectively when advanced imaging of the central nervous system should be performed.
磁共振成像的应用已使与明显特发性脊柱侧凸相关的中枢神经系统异常得以诊断。对于青少年特发性脊柱侧凸，磁共振成像的适应证尚未确定。
在十年期间对1280例疑似青少年特发性脊柱侧凸的儿童进行了评估。根据临床病史、体格检查和脊柱平片检查确定的特定指标，对特定患者进行中枢神经系统（脑干和脊髓）的磁共振成像检查。回顾病历以确定具体指标、成像研究结果及后续治疗情况。
在接受评估的1280例儿童中，有274例（21%）接受了磁共振成像检查。在接受成像检查的274例患者中，有27例（10%）发现异常，占整个队列的2%。磁共振成像发现异常的最有价值的单一指标是胸顶段无脊柱前凸：39例有该指标的患者中有8例磁共振成像发现异常。当非典型曲线模式是唯一指标时，单一类别的指标具有最佳诊断率：58例属于这种情况的患者中有6例磁共振成像发现异常。在仅以疼痛为唯一指标类别的20例儿童中，无一例成像检查异常。当同时存在非典型曲线模式和神经学指标时，诊断率最佳：53例属于这种情况的患者中有13例（25%）磁共振成像发现异常。27例患者中有13例因成像显示的中枢神经系统异常接受了手术治疗。
正确使用诊断检查是有效医疗实践的重要组成部分。在临床病史、体格检查或影像学检查仅发现细微异常的疑似青少年特发性脊柱侧凸患者中，约10%存在中枢神经系统异常。了解特定临床指标单独及联合使用时的诊断价值，有助于临床医生更有效地确定何时应进行中枢神经系统的高级成像检查。
