Department of Neurosurgery, Harran University Faculty of Medicine, Şanlıurfa, Turkey.
Department of Neurosurgery, BHT Clinic Istanbul TEMA Hospital, İstanbul, Turkey.
Clin Neurol Neurosurg. 2022 Nov;222:107424. doi: 10.1016/j.clineuro.2022.107424. Epub 2022 Aug 24.
Classically, pelvic incidence (PI) and other spinopelvic sagittal parameters are measured using plain x-ray obtained with the patient standing. However, it is difficult to obtain a perfect mid-sagittal appearance of the sacral endplate and superimposition of both femoral heads from a plain x-ray. Overlapping of the iliac wings also could obscure the appearance of the sacral endplate. Recent studies showed that MRI was more reliable than x-ray for evaluating some spinal sagittal parameters. To our knowledge, measurements of spinopelvic sagittal parameters using supine MRI have not been reported previously. We assessed the validity and reliability of measurements of spinopelvic sagittal parameters from standing lateral x-rays and supine magnetic resonance imaging (MRI).
We recruited 26 asymptomatic volunteers for this study. Standing lateral lumbosacral radiographs, including femoral heads and spinopelvic MRI images with coronal images of the femoral heads were performed. The anatomic reference point required to measure PI was found on coronal MRI images and transferred to the midline sagittal MRI using the bladder wall as a second reference point. PI, sacral slope (SS), and pelvic tilt (PT) were measured on x-ray and MRI images. Validity and reliability of results also were tested.
Of 14 males and 12 females (average age, 31.30), PI was obtained from x-ray and MRI in 52. ± 6.89 and 51.42 ± 6.43, respectively. From standing x-ray to supine MRI, PT decreased by 3.16°, while SS increased 2.5°. A paired t-test showed a significant difference between PT values from x-ray and MRI. The correlation was highest between the x-ray and MRI measurements of PI, PT, and SS, respectively. Intraobserver and interobserver reliabilities were between 0.88 and 0.96 on x-ray and MRI. All reliabilities were excellent, although MRI values were higher.
MRI was more reliable in the measurement of spinopelvic parameters than classic standing x-ray examination. Higher reliability and being radiation-free could make MRI a good alternative to standing x-ray.
经典的骨盆入射角（PI）和其他脊柱骨盆矢状参数是通过站立位的普通 X 射线测量得到的。然而，从普通 X 射线中很难获得骶骨终板的完美正中矢状面和两个股骨头的叠加。髂骨翼的重叠也可能使骶骨终板的外观变得模糊。最近的研究表明，MRI 比 X 射线更可靠地评估一些脊柱矢状参数。据我们所知，目前还没有关于使用仰卧位 MRI 测量脊柱骨盆矢状参数的报道。我们评估了站立位侧位 X 射线和仰卧位磁共振成像（MRI）测量脊柱骨盆矢状参数的有效性和可靠性。
我们招募了 26 名无症状志愿者进行这项研究。进行了站立位腰骶侧位 X 射线和冠状位股骨头 MRI 图像的检查。在冠状 MRI 图像上找到测量 PI 所需的解剖参考点，并使用膀胱壁作为第二个参考点将其转移到正中矢状 MRI 上。在 X 射线和 MRI 图像上测量 PI、骶骨倾斜度（SS）和骨盆倾斜度（PT）。还测试了结果的有效性和可靠性。
在 14 名男性和 12 名女性（平均年龄 31.30 岁）中，分别从 X 射线和 MRI 获得了 52.±6.89°和 51.42±6.43°的 PI。从站立位 X 射线到仰卧位 MRI，PT 减少了 3.16°，而 SS 增加了 2.5°。配对 t 检验显示 X 射线和 MRI 的 PT 值之间存在显著差异。X 射线和 MRI 测量的 PI、PT 和 SS 之间的相关性最高。X 射线和 MRI 测量的 PI、PT 和 SS 的观察者内和观察者间可靠性分别在 0.88 到 0.96 之间。虽然 MRI 值较高，但所有可靠性均为优秀。
与传统站立位 X 射线检查相比，MRI 在脊柱骨盆参数测量方面更可靠。更高的可靠性和无辐射性可能使 MRI 成为站立位 X 射线的良好替代方法。
