Dyas Adam R, Niemeier Thomas E, Mcgwin Gerald, Theiss Steven M
Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Craniovertebr Junction Spine. 2018 Oct-Dec;9(4):241-245. doi: 10.4103/jcvjs.JCVJS_81_18.
The objective of this study is to evaluate the the reliability of magnetic resonance imaging (MRI) in diagnosing alar ligament disruption in patients with potential atlanto-occipital dissociation (AOD).
Three-blinded readers performed retrospective review on 6 patients with intra-operative confirmed atlanto-occipital dissocation in addition to a comparison cohort of patients with other cervical injuries that did not involve the atlanto-occipital articulation. Ligament integrity was graded from 1 to 3 as described by Krakenes . The right and left ligaments were assessed separately. Inter-observer agreement by patient, by group (AOD vs. non-AOD), and intra-observer agreement was calculated using weighted Cohen's kappa.
Interobserver agreement of alar ligament grade for individual patients ranged from slight to fair (κ = 0.05-0.30). Interobserver agreement of alar ligament grade for each group (AOD vs. non-AOD) ranged from fair to substantial (κ = 0.37-0.66). No statistically significant difference in categorical analysis of groups (AOD vs. non-AOD) and grade (0-1 vs. 2-3) was observed. Intraobserver agreement of individual patient's alar ligament grade ranged from moderate to substantial (κ = 0.50-0.62).
The use of MRI to detect upper cervical ligament injuries in AOD is imperfect. Our results show inconsistent and unsatisfactory interobserver and intraobserver reliability in evaluation of alar ligament injuries. While MRI has immense potential for detection of ligamentous injury at the craniovertebral junction, standardized algorithms for its use and interpretation need to be developed.
本研究的目的是评估磁共振成像（MRI）在诊断潜在寰枕关节脱位（AOD）患者翼状韧带损伤中的可靠性。
三位盲法阅片者对6例术中确诊为寰枕关节脱位的患者进行回顾性研究，并与一组未涉及寰枕关节的其他颈椎损伤患者进行比较。按照克拉肯内斯的描述，韧带完整性分为1至3级。左右韧带分别进行评估。使用加权科恩kappa系数计算患者间、组间（AOD与非AOD）的观察者间一致性以及观察者内一致性。
个体患者翼状韧带分级的观察者间一致性从轻微到一般（κ = 0.05 - 0.30）。每组（AOD与非AOD）翼状韧带分级的观察者间一致性从一般到高度（κ = 0.37 - 0.66）。在组间（AOD与非AOD）和分级（0 - 1级与2 - 3级）的分类分析中未观察到统计学显著差异。个体患者翼状韧带分级的观察者内一致性从中度到高度（κ = 0.50 - 0.62）。
使用MRI检测AOD患者的上颈椎韧带损伤并不完美。我们的结果显示，在评估翼状韧带损伤时，观察者间和观察者内的可靠性不一致且不令人满意。虽然MRI在检测颅颈交界区韧带损伤方面有巨大潜力，但需要开发其使用和解读的标准化算法。
