Fischer Gregor, Schlosser Tom P C, Dietrich Tobias J, Kim Olaf Chan-Hi, Zdravkovic Vilijam, Martens Benjamin, Fehlings Michael G, Jans Lennart, Vereecke Elke, Stienen Martin N, Hejrati Nader
Department of Neurosurgery, Cantonal Hospital of St.Gallen, St.Gallen, Switzerland.
Spine Center of Eastern Switzerland, Cantonal Hospital of St.Gallen, St.Gallen, Switzerland.
Eur Radiol. 2025 May 7. doi: 10.1007/s00330-025-11644-8.
Efficient evaluation of soft tissues and bony structures following cervical spine trauma is critical. We sought to evaluate the diagnostic validity of magnetic resonance imaging (MRI)-based synthetic CT (sCT) compared with conventional computed tomography (CT) for cervical spine injuries.
In a prospective, multicenter study, patients with cervical spine injuries underwent CT and MRI within 48 h after injury. A panel of five clinicians independently reviewed the images for diagnostic accuracy, lesion characterization (AO Spine classification), and soft tissue trauma. Fracture visibility, anterior (AVH) and posterior wall height (PVH), vertebral body angle (VBA), segmental kyphosis (SK), with corresponding interobserver reliability (intraclass correlation coefficients (ICC)) and intermodal differences (Fleiss' Kappa), were recorded. The accuracy of estimating Hounsfield unit (HU) values and mean cortical surface distances were measured.
Thirty-seven patients (44 cervical spine fractures) were enrolled. sCT demonstrated a sensitivity of 97.3% for visualizing fractures. Intermodal agreement regarding injury classification indicated almost perfect agreement (κ = 0.922; p < 0.001). Inter-reader ICCs were good to excellent (CT vs. sCT): AVH (0.88, 0.87); PVH (0.87, 0.88); VBA (0.78, 0.76); SK (0.77, 0.93). Intermodal agreement showed a mean absolute difference of 0.3 mm (AVH), 0.3 mm (PVH), 1.15° (VBA) and 0.51° (SK), respectively. MRI visualized additional soft tissue trauma in 56.8% of patients. Voxelwise comparisons of sCT showed good to excellent agreement with CT in terms of HUs (mean absolute error of 20 (SD ± 62)) and a mean absolute cortical surface distance of 0.45 mm (SD ± 0.13).
sCT is a promising, radiation-free imaging technique for diagnosing cervical spine injuries with similar accuracy to CT.
Question Assessing the accuracy of MRI-based synthetic CT (sCT) for fracture visualization and classification in comparison to the gold standard of CT for cervical spine injuries. Findings sCT demonstrated a 97.3% sensitivity in detecting fractures and exhibited near-perfect intermodal agreement in classifying injuries according to the AO Spine classification system. Clinical relevance sCT is a promising, radiation-free imaging modality that offers comparable accuracy to CT in visualizing and classifying cervical spine injuries. The combination of conventional MRI sequences for soft tissue evaluation with sCT reconstruction for bone visualization provides comprehensive diagnostic information.
对颈椎创伤后的软组织和骨骼结构进行有效评估至关重要。我们试图评估基于磁共振成像（MRI）的合成CT（sCT）与传统计算机断层扫描（CT）在诊断颈椎损伤方面的有效性。
在一项前瞻性多中心研究中，颈椎损伤患者在受伤后48小时内接受了CT和MRI检查。由五名临床医生组成的小组独立审查图像，以评估诊断准确性、损伤特征（AO脊柱分类）和软组织创伤情况。记录骨折的可视性、前壁高度（AVH）和后壁高度（PVH）、椎体角度（VBA）、节段性后凸（SK），以及相应的观察者间可靠性（组内相关系数（ICC））和多模态差异（Fleiss' Kappa）。测量估计亨氏单位（HU）值和平均皮质表面距离的准确性。
纳入了37例患者（44处颈椎骨折）。sCT显示骨折可视化的敏感性为97.3%。关于损伤分类的多模态一致性显示几乎完全一致（κ = 0.922；p < 0.001）。读者间的ICC良好至优秀（CT与sCT相比）：AVH（0.88，0.87）；PVH（0.87，0.88）；VBA（0.78，0.76）；SK（0.77，0.93）。多模态一致性显示平均绝对差异分别为0.3毫米（AVH）、0.3毫米（PVH）、1.15°（VBA）和0.51°（SK）。MRI在56.8%的患者中发现了额外的软组织创伤。sCT与CT在体素层面的比较显示，在HU方面一致性良好至优秀（平均绝对误差为20（标准差±62）），平均绝对皮质表面距离为0.45毫米（标准差±0.13）。
sCT是一种有前景的无辐射成像技术，在诊断颈椎损伤方面与CT具有相似的准确性。
问题 评估基于MRI的合成CT（sCT）在骨折可视化和分类方面相对于颈椎损伤CT金标准的准确性。发现 sCT在检测骨折方面显示出97.3%的敏感性，并且在根据AO脊柱分类系统对损伤进行分类时表现出近乎完美的多模态一致性。临床意义 sCT是一种有前景的无辐射成像方式，在颈椎损伤的可视化和分类方面提供与CT相当的准确性。将用于软组织评估的传统MRI序列与用于骨骼可视化的sCT重建相结合可提供全面的诊断信息。
