Ross Andrew B, Chan Brian Y, Yi Paul H, Repplinger Michael D, Vanness David J, Lee Kenneth S
Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, Clinical Sciences Center, 600 Highland Avenue, Madison, WI, 53792-3252, USA.
Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
Skeletal Radiol. 2019 Jan;48(1):103-108. doi: 10.1007/s00256-018-3004-7. Epub 2018 Jun 18.
To determine the diagnostic accuracy of an abbreviated, two-sequence MRI protocol using limited pulse sequences for the detection of radiographically occult hip and pelvis fractures in the elderly compared to the complete MRI examination.
One hundred and eleven consecutive emergency department patients age 65 or older who had undergone MRI to evaluate for clinically suspected hip fracture after negative radiographs were included in the study. The large field-of-view coronal T1 and STIR sequences were isolated from the complete six-sequence MRI protocol and reviewed independently in a blinded fashion by two musculoskeletal fellowship-trained radiologists who recorded presence or absence of fractures of the proximal femora or pelvis, fracture type, and presence or absence of soft tissue injury. Test accuracy was calculated with 95% confidence intervals and accuracy of fracture classification for the abbreviated protocol was compared to that made on the basis of the full exam.
For proximal femoral fractures, the abbreviated protocol had a pooled sensitivity and specificity for the two readers of 100 and 97%, respectively. For pelvic fractures, sensitivity was 92% and specificity was 98%. The kappa coefficient for fracture classification was 0.90 for reader 1 and 0.88 for reader 2, indicating excellent agreement for both readers in fracture classification compared to the classification made based on the complete MRI protocol.
An abbreviated MRI protocol that includes only coronal T1 and STIR sequences maintains high sensitivity and specificity for hip and pelvis fracture detection and fracture classification.
与完整的MRI检查相比，确定使用有限脉冲序列的简化双序列MRI方案对老年患者隐匿性髋部和骨盆骨折的诊断准确性。
本研究纳入了111例连续的急诊科患者，年龄在65岁及以上，这些患者在X线片阴性后接受了MRI检查以评估临床疑似髋部骨折。从完整的六序列MRI方案中分离出大视野冠状位T1和短T1反转恢复（STIR）序列，并由两名接受过肌肉骨骼影像学培训的放射科医生以盲法独立进行评估，他们记录股骨近端或骨盆是否存在骨折、骨折类型以及是否存在软组织损伤。计算测试准确性的95%置信区间，并将简化方案的骨折分类准确性与基于完整检查得出的结果进行比较。
对于股骨近端骨折，简化方案对两位阅片者的合并敏感度和特异度分别为100%和97%。对于骨盆骨折，敏感度为92%，特异度为98%。阅片者1的骨折分类kappa系数为0.90，阅片者2为0.88，表明与基于完整MRI方案的分类相比，两位阅片者在骨折分类方面具有高度一致性。
仅包括冠状位T1和STIR序列的简化MRI方案在髋部和骨盆骨折检测及骨折分类方面保持了较高的敏感度和特异度。
