单独使用计算机断层扫描（CT）加磁共振成像（MRI）评估颈椎损伤的效用：倾向评分匹配分析。
Utility of Adding Magnetic Resonance Imaging to Computed Tomography Alone in the Evaluation of Cervical Spine Injury: A Propensity-Matched Analysis.
机构信息
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA.
出版信息
Spine (Phila Pa 1976). 2018 Feb 1;43(3):179-184. doi: 10.1097/BRS.0000000000002285.
STUDY DESIGN
Adult patients who received computed tomography (CT) alone or CT-magnetic resonance imaging (MRI) for the evaluation of cervical spine injury.
OBJECTIVE
To evaluate the utility of CT-MRI in the diagnosis of cervical spine injury using propensity-matched techniques.
SUMMARY OF BACKGROUND DATA
The optimal evaluation (CT alone vs. CT and MRI) for patients with suspected cervical spine injury in the setting of blunt trauma remains controversial.
METHODS
The primary outcome was the identification of a cervical spine injury, with decision for surgery and change in management considered secondarily. A propensity score was developed based on the likelihood of receiving evaluation with CT-MRI, and this score was used to balance the cohorts and develop two groups of patients around whom there was a degree of clinical equipoise in terms of the imaging protocol. Logistic regression was used to evaluate for significant differences in injury detection in patients evaluated with CT alone as compared to those receiving CT-MRI.
RESULTS
Between 2007 and 2014, 8060 patients were evaluated using CT and 693 with CT-MRI. Following propensity-score matching, each cohort contained 668 patients. There were no significant differences between the two groups in baseline characteristics. The odds of identifying a cervical spine injury were significantly higher in the CT-MRI group, even after adjusting for prior injury recognition on CT (odds ratios 2.6; 95% confidence interval 1.7-4.0; P < 0.001). However, only 53/668 patients (8%) in the CT-MRI group had injuries identified on MRI not previously recognized by CT. Only a minority of these patients (n = 5/668, 1%) necessitated surgical intervention.
CONCLUSION
In this propensity-matched cohort, the addition of MRI to CT alone identified missed injuries at a rate of 8%. Only a minority of these were serious enough to warrant surgery. This speaks against the standard addition of MRI to CT-alone protocols in cervical spine evaluation after trauma.
LEVEL OF EVIDENCE
研究设计
接受单独 CT 或 CT-磁共振成像（MRI）评估颈椎损伤的成年患者。
目的
使用倾向匹配技术评估 CT-MRI 在诊断颈椎损伤中的作用。
背景资料概要
在钝性创伤的情况下，对于疑似颈椎损伤的患者，最佳评估（单独 CT 与 CT 和 MRI）仍存在争议。
方法
主要结果是确定颈椎损伤，次要结果是确定手术决策和治疗方案的改变。根据接受 CT-MRI 评估的可能性制定倾向评分，并使用该评分平衡队列并围绕成像方案在临床上具有一定均衡性的两组患者进行分组。使用逻辑回归评估单独接受 CT 评估的患者与接受 CT-MRI 评估的患者在损伤检测方面是否存在显著差异。
结果
2007 年至 2014 年间，8060 例患者接受 CT 检查，693 例患者接受 CT-MRI 检查。在进行倾向评分匹配后，每个队列均包含 668 例患者。两组患者的基线特征无显著差异。即使在调整 CT 上先前识别的损伤后，CT-MRI 组识别颈椎损伤的可能性仍明显更高（比值比 2.6；95%置信区间 1.7-4.0；P < 0.001）。然而，仅在 CT-MRI 组的 668 例患者中有 53 例（8%）在 MRI 上发现了 CT 先前未识别的损伤。这些患者中只有少数（n = 5/668，1%）需要手术干预。
结论
在这项倾向匹配队列研究中，CT 联合 MRI 比单独 CT 检查识别出的遗漏损伤率为 8%。只有少数（1%）严重到需要手术治疗。这表明在创伤后颈椎评估中，不应该常规将 MRI 加在 CT 单独检查方案中。
证据水平
3。
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