Song Kyung-Jin, Choi Byung-Wan, Kim Gyu-Hyung, Kim Jung-Ryul
Department of Orthopedic Surgery, School of Medicine, Institute for Medical Science, Chonbuk National University Hospital, Chonbuk National University, Jeonju, Korea.
J Spinal Disord Tech. 2009 Jul;22(5):353-7. doi: 10.1097/BSD.0b013e31817df78e.
STUDY DESIGN: A radiographic review of 50 patients (29 radiculopathy and 21 myelopathy) who had undergone the anterior cervical discectomy and fusion was performed by 3 observers retrospectively. OBJECTIVE: To compare the accuracy between magnetic resonance imaging (MRI) and postmyelographic computed tomography (CTM) in degenerative cervical spine disease by assessing the degree of interobserver and intraobserver agreement. SUMMARY OF BACKGROUND DATA: The assessment of degenerative cervical spinal disease is still demanding. Now MRI is accepted as a primary diagnostic tool for degenerative cervical spine disease. Compared with MRI, usage of CTM has diminished, but it is usually reserved for the patients for whom MRI results were ambiguous or technically suboptimal. METHODS: We retrospectively reviewed MRIs and CTMs of 50 patients (29 radiculopathy and 21 myelopathy) who had undergone the anterior cervical discectomy and fusion procedure. Using an assessment scale, 3 observers examined 5 parameters: spinal canal narrowing, foraminal stenosis, bony abnormality, intervertebral disk herniation, and nerve root compression. The degree of severity was graded using a 4-point scale for each item. Intraobserver, interobserver agreement, and the accentuation of each image were analyzed. RESULTS: Intraclass correlation coefficiency statistical analysis showed moderate intraobserver agreement (Cronbach's alpha=0.63) and interobserver agreement (0.52). There was no significant difference in intraobserver, interobserver agreement between MRI (0.58) and CTM (0.57). Compared between MRI and CTM, disc abnormality and nerve root compression on MRI and foraminal stenosis and bony lesion on CTM showed better agreement. CONCLUSIONS: CTM was still useful in diagnosis of the foraminal stenosis and bony lesion comparing with MRI but showed limitation in disc abnormality and nerve root compression. So even though CTM may provide valuable additional information in difficult or ambiguous cases, it also requires universal standards and sound experience for constant and objective information.
研究设计：3名观察者对50例行颈椎前路椎间盘切除融合术的患者（29例神经根病患者和21例脊髓病患者）进行了影像学回顾性研究。 目的：通过评估观察者间和观察者内的一致性程度，比较磁共振成像（MRI）和脊髓造影后计算机断层扫描（CTM）在退行性颈椎疾病中的准确性。 背景数据总结：退行性颈椎疾病的评估仍然具有挑战性。目前，MRI被公认为退行性颈椎疾病的主要诊断工具。与MRI相比，CTM的使用有所减少，但通常保留给MRI结果不明确或技术欠佳的患者。 方法：我们回顾性分析了50例行颈椎前路椎间盘切除融合术患者（29例神经根病患者和21例脊髓病患者）的MRI和CTM图像。3名观察者使用评估量表检查5个参数：椎管狭窄、椎间孔狭窄、骨质异常、椎间盘突出和神经根受压。每项严重程度采用4分制进行分级。分析观察者内、观察者间的一致性以及每张图像的清晰度。 结果：组内相关系数统计分析显示观察者内一致性中等（Cronbach's α=0.63），观察者间一致性为0.52。MRI（0.58）和CTM（0.57）的观察者内、观察者间一致性无显著差异。MRI和CTM比较，MRI上的椎间盘异常和神经根受压与CTM上的椎间孔狭窄和骨质病变显示出更好的一致性。 结论：与MRI相比CTM在椎间孔狭窄和骨质病变的诊断中仍然有用，但在椎间盘异常和神经根受压方面存在局限性。因此，尽管CTM在困难或不明确的病例中可能提供有价值的额外信息，但它也需要通用标准和丰富经验以获得持续、客观的信息。
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