Wang Fei, Sun Xu, Mao Saihu, Liu Zhen, Qiao Jun, Zhu Feng, Zhu Zezhang, Pan Tao, Chen Ling, Zhao Qinghua, Qiu Yong
Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
Clin Spine Surg. 2017 Apr;30(3):124-128. doi: 10.1097/BSD.0000000000000027.
This study is of a retrospective radiographic design.
The objective of the study was to compare supine magnetic resonance images (MRI) with standing x-ray scanning in the evaluation of the sagittal alignment of the upper thoracic spine.
X-ray films have been reported to be inaccurate in evaluating the proximal thoracic sagittal alignment because of poor visibility of the upper thoracic region. Previous studies have demonstrated the feasibility of supine MRI in evaluating spinal deformities in the coronal plane. However, no study has addressed the use of MRI for evaluating the sagittal alignment of the upper thoracic region.
Ninety-six adolescents with idiopathic thoracolumbar/lumbar scoliosis were enrolled. The visibility of the upper thoracic spine landmarks from C7 to T6 in the lateral standing x-ray films was first graded. For patients with moderate or good clarity of the landmarks of each vertebra from C7 to T6 on x-ray films, the vertebral sagittal angles from T1 to T5 and the angle of T2-T5 kyphosis were measured by 3 observers on standing x-ray films and supine MRI images, respectively. Intraclass correlation coefficients were used to determine the intraobserver, interobserver, and method reliability. The paired t test was performed to compare the measurements between the 2 methods.
The visibility of the upper thoracic region in x-ray films was generally unsatisfactory, especially for T1 and T2, whereas all the vertebrae were clear in MRI images. Only 50 patients' x-ray films were graded as moderate or good visibility in the upper thoracic spine. Measurements on MRI images gave excellent intraobserver and interobserver reliability (0.914-0.924 and 0.838-0.920, respectively), which were better than that on x-ray films (0.767-0.891 and 0.713-0.883, respectively). No significant difference was found between the 2 modalities in terms of sagittal angles of T3, T4, and T5 (P=0.680, 0.595, and 0.239, respectively) and T2-T5 kyphosis (P=0.105).
With excellent measurement reproducibility, a supine MRI image may serve as a valid alternative to a standing x-ray film for the measurement for T3, T4, and T5 sagittal angles and for the evaluation of upper thoracic kyphosis.
本研究为回顾性影像学设计。
本研究的目的是比较仰卧位磁共振成像（MRI）与站立位X线扫描在上胸椎矢状面排列评估中的应用。
由于上胸椎区域可视性差，X线片在评估近端胸椎矢状面排列方面据报道不准确。先前的研究已证明仰卧位MRI在评估冠状面脊柱畸形方面的可行性。然而，尚无研究探讨MRI在评估上胸椎区域矢状面排列中的应用。
纳入96例特发性胸腰段/腰段脊柱侧凸青少年患者。首先对站立位侧位X线片中C7至T6上胸椎标志的可视性进行分级。对于X线片上C7至T6每个椎体标志清晰度为中等或良好的患者，由3名观察者分别在站立位X线片和仰卧位MRI图像上测量T1至T5的椎体矢状角以及T2 - T5后凸角。组内相关系数用于确定观察者内、观察者间以及测量方法的可靠性。采用配对t检验比较两种方法的测量结果。
X线片中上胸椎区域的可视性总体上不令人满意，尤其是T1和T2，而MRI图像中所有椎体均清晰可见。只有50例患者的X线片上胸椎可视性分级为中等或良好。MRI图像测量的观察者内和观察者间可靠性极佳（分别为0.914 - 0.924和0.838 - 0.920），优于X线片测量结果（分别为0.767 - 0.891和0.713 - 0.883）。在T3、T4和T5的矢状角（分别为P = 0.�80、P = 0.595和P = 0.239）以及T2 - T5后凸角（P = 0.105）方面，两种检查方式之间未发现显著差异。
仰卧位MRI图像具有出色的测量可重复性，可作为站立位X线片用于测量T3、T4和T5矢状角以及评估上胸椎后凸的有效替代方法。
