Malhotra Ajay, Wu Xiao, Kalra Vivek B, Nardini Holly K Grossetta, Liu Renu, Abbed Khalid M, Forman Howard P
Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA.
Research and Education Librarian, Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA.
Eur Radiol. 2017 Mar;27(3):1148-1160. doi: 10.1007/s00330-016-4426-z. Epub 2016 Jun 22.
To quantify the rate of unstable injuries detected by MRI missed on CT in blunt cervical spine (CS) trauma patients and assess the utility of MRI in CS clearance.
We undertook a systematic review of worldwide evidence across five major medical databases and performed a meta-analysis. Studies were included if they reported the number of unstable injuries or gave enough details for inference. Variables assessed included severity, CT/MRI specifications, imaging timing, and outcome/follow-up. Pooled incidences of unstable injury on follow-up weighted by inverse-of-variance among all included and obtunded or alert patients were reported.
Of 428 unique citations, 23 proved eligible, with 5,286 patients found, and 16 unstable injuries reported in five studies. The overall pooled incidence is 0.0029 %. Among studies reporting only obtunded patients, the pooled incidence is 0.017 %. In alert patients, the incidence is 0.011 %. All reported positive findings were critically reviewed, and only 11 could be considered truly unstable.
There is significant heterogeneity in the literature regarding the use of imaging after a negative CT. The finding rate on MRI for unstable injury is extremely low in obtunded and alert patients. Although MRI is frequently performed, its utility and cost-effectiveness needs further study.
• There were 16 unstable injuries on follow-up MRI among 5286 patients. • The positive finding rate among obtunded patients was 0.12 %. • The positive finding rate among alert, awake patients was 0.72 %. • MRI has a high false-positive rate; its utility mandates further studies. • The use and role of "confirmatory" tests shows wide variations.
量化钝性颈椎创伤患者中CT漏诊而MRI检测出的不稳定损伤发生率，并评估MRI在颈椎损伤排除中的作用。
我们对五个主要医学数据库中的全球证据进行了系统评价，并进行了荟萃分析。如果研究报告了不稳定损伤的数量或给出了足够的细节以供推断，则纳入研究。评估的变量包括严重程度、CT/MRI规格、成像时间以及结果/随访情况。报告了所有纳入患者以及昏迷或清醒患者中按方差倒数加权的随访期间不稳定损伤的合并发生率。
在428篇独特的文献中，23篇被证明符合条件，共纳入5286例患者，五项研究报告了16例不稳定损伤。总体合并发生率为0.0029%。在仅报告昏迷患者的研究中，合并发生率为0.017%。在清醒患者中，发生率为0.011%。对所有报告的阳性结果进行了严格审查，只有11例可被认为是真正不稳定的。
关于CT阴性后成像的使用，文献中存在显著异质性。在昏迷和清醒患者中，MRI检测不稳定损伤的发现率极低。尽管MRI经常被使用，但其效用和成本效益需要进一步研究。
• 5286例患者中，随访MRI发现16例不稳定损伤。• 昏迷患者中的阳性发现率为0.12%。• 清醒患者中的阳性发现率为0.72%。• MRI假阳性率高；其效用有待进一步研究。• “确认性”检查的使用和作用差异很大。
