The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Spine (Phila Pa 1976). 2009 Nov 1;34(23):E841-7. doi: 10.1097/BRS.0b013e3181bd11be.
Prospective diagnostic imaging study.
To determine the accuracy of magnetic resonance imaging (MRI) in diagnosing injury of the posterior ligamentous complex (PLC) in patients with thoracolumbar trauma.
Treatment decisions in thoracolumbar injury patients are currently based on the status of the PLC. It is, therefore, important to understand the accuracy of MRI in diagnosing varying degrees of PLC injury. Prior studies report that MRI is up to 100% sensitive for diagnosing PCL injury.
Patients with an acute injury from T1 to L3 who required posterior surgery were prospectively studied. A musculoskeletal radiologist, based on the preoperative MRI findings, characterized each of the 6 components of the PLC as intact, incompletely disrupted, or disrupted. During the surgical procedure, the surgeon identified each component of the PLC as intact, incompletely disrupted, or disrupted. The radiologist's interpretation and surgical findings were compared.
Forty-two patients with 62 levels of injury were studied. There were 33 males (78.6%) and 9 females (21.4%), and the average age was 35.7 years. According to the kappa score, there was a moderate level of agreement between the radiologist's interpretation and the intraoperative findings for all PLC components except the thoracolumbar fascia, for which there was slight agreement. The sensitivity for the various PLC components ranged from 79% (left facet capsule) to 90% (interspinous ligament). The specificity ranged from 53% (thoracolumbar fascia) to 65% (ligamentum flavum). There was less agreement between the radiologist and surgeon for the patients with less severe neurologic compromise, i.e., those patients with an AIS grade of either D or E.
The sensitivity and specificity of MRI for diagnosing injury of the PLC are lower than previously reported in the literature. The integrity of the PLC as determined by MRI should not be used in isolation to determine treatment.
前瞻性诊断影像学研究。
确定磁共振成像（MRI）在诊断胸腰椎创伤患者后韧带复合体（PLC）损伤中的准确性。
目前，胸腰椎损伤患者的治疗决策基于 PLC 的状况。因此，了解 MRI 诊断 PLC 不同程度损伤的准确性非常重要。先前的研究报告称，MRI 对诊断 PCL 损伤的敏感性高达 100%。
前瞻性研究了因急性损伤而需要后路手术的 T1 至 L3 患者。一位肌肉骨骼放射科医生根据术前 MRI 结果，将 PLC 的 6 个组成部分描述为完整、不完全破裂或破裂。在手术过程中，外科医生确定了 PLC 的每个组成部分是否完整、不完全破裂或破裂。比较放射科医生的解释和手术结果。
研究了 42 名患者的 62 个损伤水平。男性 33 名（78.6%），女性 9 名（21.4%），平均年龄为 35.7 岁。根据kappa 评分，除胸腰筋膜外，放射科医生的解释与术中发现之间存在中等程度的一致性，而胸腰筋膜的一致性则较低。各种 PLC 成分的敏感性范围从 79%（左侧小关节囊）到 90%（棘间韧带）。特异性范围从 53%（胸腰筋膜）到 65%（黄韧带）。对于神经功能缺损程度较轻的患者，即 AIS 分级为 D 或 E 的患者，放射科医生和外科医生之间的一致性较差。
MRI 诊断 PLC 损伤的敏感性和特异性低于文献报道。不应单独使用 MRI 确定 PLC 的完整性来确定治疗方案。
