创伤性颈椎失稳性损伤：磁共振成像与手术结果的相关性。
Traumatic cervical discoligamentous injuries: correlation of magnetic resonance imaging and operative findings.
机构信息
Department of Neurosurgery, The Alfred Hospital, Department of Surgery, Monash University, Melbourne, Australia.
出版信息
Spine (Phila Pa 1976). 2009 Dec 1;34(25):2754-9. doi: 10.1097/BRS.0b013e3181b6170b.
STUDY DESIGN
Retrospective review using prospectively collected data.
OBJECTIVE
The purpose of the study was to investigate the diagnostic properties of cervical magnetic resonance imaging (MRI) in detecting surgically verified disruptions of the anterior longitudinal ligament (ALL), intervertebral disc, and posterior longitudinal ligament (PLL).
SUMMARY OF BACKGROUND DATA
Cervical MRI findings commonly provide the basis for the decision to stabilize cervical injury operatively. The correlation of cervical MRI findings with direct visualization of the cervical discoligamentous structures during operative management is a subject of debate.
METHODS
The cervical spine MRI scans of patients who subsequently underwent anterior surgical stabilization after traumatic discoligamentous injury of the cervical spine were reviewed. The level and severity of ALL, disc and PLL disruption was compared with surgical findings. The sensitivity, specificity, positive and negative predictive values of MRI in the detection of surgically verified injuries were calculated.
RESULTS
The MRI and surgical findings were compared on 31 consecutive patients, with the kappa values for ALL, intervertebral disc, and PLL disruption measuring 0.22, 0.25, and 0.31, respectively. MRI scans provided reasonable sensitivity to disc disruption (0.81) but poor sensitivity to ALL (0.48) and PLL (0.50) injury. Specificity for ALL and PLL disruption was 1.00 and 0.87, respectively, but 0.00 for disc disruption. The positive predictive value of MRI for ALL and intervertebral disc injury was 1.00 and 0.96, respectively, but 0.63 for PLL disruption. The false-negative rates for disruption of the ALL, disc and PLL were 0.52, 0.19, and 0.50, respectively.
CONCLUSION
The ability of cervical MRI to detect surgically verified disruptions of the ALL, intervertebral disc, and PLL varied depending on the structure examined. MRI was sensitive but not specific for disc injury, and specific but not sensitive to ALL and PLL disruption. In this series, the comparison of cervical MRI and operative findings indicated that MRI was reliable only when positive for ALL and disc injury, and a reasonably reliable indicator of PLL status only when negative for PLL injury. Additionally, the high false-negative rates for ALL and PLL injury are concerning.
研究设计
回顾性研究，使用前瞻性收集的数据。
目的
本研究旨在探讨颈椎磁共振成像（MRI）在检测手术证实的前纵韧带（ALL）、椎间盘和后纵韧带（PLL）断裂中的诊断性能。
背景资料概要
颈椎 MRI 检查结果通常为颈椎损伤手术治疗的决策提供依据。颈椎 MRI 检查结果与手术中直接观察颈椎韧带结构的相关性一直存在争议。
方法
对因创伤性颈椎韧带复合体损伤而行前路手术固定的患者的颈椎 MRI 扫描进行回顾性分析。比较 ALL、椎间盘和 PLL 断裂的水平和严重程度与手术结果。计算 MRI 在检测手术证实损伤中的敏感性、特异性、阳性预测值和阴性预测值。
结果
在 31 例连续患者中比较 MRI 和手术结果，ALL、椎间盘和 PLL 断裂的kappa 值分别为 0.22、0.25 和 0.31。MRI 对椎间盘破裂具有合理的敏感性（0.81），但对 ALL（0.48）和 PLL（0.50）损伤的敏感性较低。ALL 和 PLL 断裂的特异性分别为 1.00 和 0.87，而椎间盘破裂的特异性为 0.00。MRI 对 ALL 和椎间盘损伤的阳性预测值分别为 1.00 和 0.96，而对 PLL 损伤的阳性预测值为 0.63。ALL、椎间盘和 PLL 断裂的假阴性率分别为 0.52、0.19 和 0.50。
结论
颈椎 MRI 检测 ALL、椎间盘和 PLL 手术证实的断裂的能力因所检查的结构而异。MRI 对椎间盘损伤敏感但特异性差，对 ALL 和 PLL 断裂特异性高但敏感性差。在本系列中，颈椎 MRI 与手术结果的比较表明，只有当 ALL 和椎间盘损伤阳性时，MRI 才可靠，只有当 PLL 损伤阴性时，MRI 才是 PLL 状态的可靠指标。此外，ALL 和 PLL 损伤的高假阴性率令人担忧。
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