School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia.
Macquarie University Hospital, Macquarie Park, NSW, Australia.
Radiol Med. 2023 Mar;128(3):330-339. doi: 10.1007/s11547-023-01588-8. Epub 2023 Jan 30.
To establish reference ranges for four most commonly used diagnostic measures of craniocervical instability (CCI) in three cervical sagittal positions. This necessitated development of a reliable measurement protocol using upright, dynamic MRI (udMRI), to determine differences in the extent of motion between positions, and whether age and sex correlate with these measures.
Deidentified udMRIs of 50 adults, referred for reasons other than CCI, were captured at three positions (maximal flexion, maximal extension and neutral). Images were analyzed, providing measures of basion-axial interval, basion-axial angle, basion-dens interval (BDI) and the Grabb-Oakes line (GOL) for all three positions (12 measures per participant). All measures were independently recorded by a radiologist and neurosurgeon to determine their reliability. Descriptive statistics, correlations, paired and independent t-tests were used. Mean (± 2 SD) identified the reference range for all four measures at each craniocervical position.
The revised measurement protocol produced inter-rater reliability indices of 0.69-0.97 (moderate-excellent). Fifty adults' (50% male; mean age 41.2 years (± 9.7)) reference ranges for all twelve measures were reported. Except for the BDI and GOL when moving between neutral and full flexion, significant extents of movement were identified between the three craniocervical positions for all four measures (p ≤ 0.005). Only a minor effect of age was found.
This is the first study to provide a rigorous standardized protocol for four diagnostic measures of CCI. Reference ranges are established at mid and ends of sagittal cervical range corresponding to where exacerbations of signs and symptoms are commonly reported.
在三个颈椎矢状位确定四种最常用的颅颈不稳（CCI）诊断测量方法的参考范围。这需要开发一种可靠的测量方案，使用直立、动态 MRI（udMRI）来确定位置之间运动范围的差异，以及年龄和性别是否与这些测量方法相关。
对 50 名因非 CCI 而转诊的成年人进行了 udMRI 检查，分别在三个位置（最大前屈、最大伸展和中立位）进行拍摄。对图像进行了分析，提供了基底-轴间距、基底-轴角、基底-齿状突间距（BDI）和 Grabb-Oakes 线（GOL）在所有三个位置的测量值（每位参与者 12 个测量值）。所有测量值均由放射科医生和神经外科医生独立记录，以确定其可靠性。使用描述性统计、相关性、配对和独立 t 检验进行分析。四个测量值在每个颅颈位置的参考范围用平均值（± 2SD）表示。
修订后的测量方案产生了 0.69-0.97（中等-优秀）的组内可靠性指数。报告了 50 名成年人（50%为男性；平均年龄为 41.2±9.7 岁）所有 12 个测量值的参考范围。除了中立位和完全前屈位之间的 BDI 和 GOL 外，所有四个测量值在三个颅颈位置之间都存在显著的运动范围（p≤0.005）。仅发现年龄有轻微影响。
这是第一项提供四种 CCI 诊断测量方法严格标准化方案的研究。参考范围在颈椎矢状位的中段和末端建立，与通常报告症状和体征加重的位置相对应。
