Hettlich Bianca F, Fosgate Geoffrey T, Levine Jonathan M, Young Benjamin D, Kerwin Sharon C, Walker Michael, Griffin Jay, Maierl Johann
Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA.
Vet Surg. 2010 Aug;39(6):680-7. doi: 10.1111/j.1532-950X.2010.00697.x. Epub 2010 Apr 29.
To compare the accuracy of radiography and computed tomography (CT) in predicting implant position in relation to the vertebral canal in the cervical and thoracolumbar vertebral column.
In vitro imaging and anatomic study.
Medium-sized canine cadaver vertebral columns (n=12).
Steinmann pins were inserted into cervical and thoracolumbar vertebrae based on established landmarks but without predetermination of vertebral canal violation. Radiographs and CT images were obtained and evaluated by 6 individuals. A random subset of pins was evaluated for ability to distinguish left from right pins on radiographs. The ability to correctly identify vertebral canal penetration for all pins was assessed both on radiographs and CT. Spines were then anatomically prepared and visual examination of pin penetration into the canal served as the gold standard.
Left/right accuracy was 93.1%. Overall sensitivity of radiographs and CT to detect vertebral canal penetration by an implant were significantly different and estimated as 50.7% and 93.4%, respectively (P<.0001). Sensitivity was significantly higher for complete versus partial penetration and for radiologists compared with nonradiologists for both imaging modalities. Overall specificity of radiographs and CT to detect vertebral canal penetration was 82.9% and 86.4%, respectively (P=.049).
CT was superior to radiographic assessment and is the recommended imaging modality to assess penetration into the vertebral canal.
CT is significantly more accurate in identifying vertebral canal violation by Steinmann pins and should be performed postoperatively to assess implant position.
比较X线摄影和计算机断层扫描（CT）在预测颈椎及胸腰椎植入物相对于椎管的位置方面的准确性。
体外成像与解剖学研究。
中型犬尸体脊柱（n = 12）。
根据既定标志将斯氏针插入颈椎和胸腰椎，但不预先确定是否侵犯椎管。获取X线片和CT图像，并由6名人员进行评估。随机抽取一组针，评估在X线片上区分左右针的能力。在X线片和CT上评估所有针正确识别椎管穿透的能力。然后对脊柱进行解剖制备，以针穿透椎管的视觉检查作为金标准。
左右辨别准确率为93.1%。X线片和CT检测植入物椎管穿透的总体敏感性有显著差异，分别估计为50.7%和93.4%（P <.0001）。对于两种成像方式，完全穿透与部分穿透相比，以及放射科医生与非放射科医生相比，敏感性显著更高。X线片和CT检测椎管穿透的总体特异性分别为82.9%和86.4%（P = 0.049）。
CT优于X线评估，是评估椎管穿透的推荐成像方式。
CT在识别斯氏针侵犯椎管方面明显更准确，术后应进行CT检查以评估植入物位置。
