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【medical-news】磁共振和CT诊断颈椎关节突性关节炎

Comparison of Magnetic Resonance Imaging and Computed Tomography in Predicting Facet Arthrosis in the Cervical Spine
Lehman, Ronald A. Jr; Helgeson, Melvin D.; Keeler, Kathryn A.; Bunmaprasert, Torphong; Riew, K Daniel

Abstract
Study Design. Retrospective review.

Objective. To determine the ability of magnetic resonance imaging (MRI) and computed tomography (CT) to predict the presence of cervical facet arthrosis.

Summary of Background Data. In the Food and Drug Administration Investigational Device Exemption trials of cervical disc arthroplasty (CDA), the presence of facet arthrosis on CT was a contraindication to the insertion of a CDA. Most surgeons routinely obtain an MRI, but not necessarily a CT before performing surgery in the cervical spine. We sought to determine if the MRI alone is adequate to assess for the presence of facet arthrosis.

Methods. Three experienced spine surgeons retrospectively evaluated CT scans and MRIs of the same patients, obtained within 30 days of each other in a blinded, random fashion. Reviewers graded each of the MRI and CT scan as normal or abnormal on 3 separate occasions and if the facet was abnormal, each reviewer graded the degree of arthrosis. The radiologist's evaluation for each study was compared with our results.

Results. Of 594 facets analyzed, 43.1% were categorized as normal on CT, and of those, MRI concordance was only 63.7% with moderate/substantial intermethod agreement. Furthermore, MRI was concordant only 15.9% of the time in patients with ankylosed facet joints on CT. CT inter-rater reliability showed substantial agreement for diagnoses of both normal and ankylosis and fair agreement for lesser degrees of facet arthrosis. MRI inter-rater reliability showed fair/moderate agreement in normal and ankylosed segments and only slight agreement with lesser degrees of facet arthrosis. CT intrarater reliability showed substantial agreement in normal or ankylosed joints, but only fair agreement for all other categories; MRI showed only fair agreement.

Conclusion. The ability of MRI to adequately determine the presence or amount of facet arthrosis is not reliable. Additionally, for abnormal facets, MRI was not reliable in adequately determining the degree of arthrosis. Our data suggest that computed tomography remains necessary in diagnosing facet arthrosis before CDA.

本人已认领该文编译,48小时后若未提交译文,请其他战友自由认领 Comparison of Magnetic Resonance Imaging and Computed Tomography in Predicting Facet Arthrosis in the Cervical Spine
磁共振和CT诊断颈椎关节突性关节炎的比较
Abstract
摘要
Study Design. Retrospective review.
研究设计:回顾性调查
Objective. To determine the ability of magnetic resonance imaging (MRI) and computed tomography (CT) to predict the presence of cervical facet arthrosis.
目的:为了探讨磁共振和CT诊断颈椎小关节性关节病的能力。
Summary of Background Data. In the Food and Drug Administration Investigational Device Exemption trials of cervical disc arthroplasty (CDA), the presence of facet arthrosis on CT was a contraindication to the insertion of a CDA. Most surgeons routinely obtain an MRI, but not necessarily a CT before performing surgery in the cervical spine. We sought to determine if the MRI alone is adequate to assess for the presence of facet arthrosis.
背景数据摘要:在美国食物药品管理局研究性器械豁免关于颈椎间盘关节成形术的试验中,CT上小关节突性关节炎的存在是放置人工颈椎间盘的禁忌症。多数外科医师常规通过MRI来获取这一信息,但是在进行颈椎手术之前没必要进行CT检查。如果单纯MRI足以评估小关节突性关节炎,我们可以确诊。
Methods. Three experienced spine surgeons retrospectively evaluated CT scans and MRIs of the same patients, obtained within 30 days of each other in a blinded, random fashion. Reviewers graded each of the MRI and CT scan as normal or abnormal on 3 separate occasions and if the facet was abnormal, each reviewer graded the degree of arthrosis. The radiologist's evaluation for each study was compared with our results.
方法:三位有经验的脊柱外科医师分别对相同患者的CT扫描和MRI进行评估,按盲法,随机的原则在一个月内获取每个病人资料。在三个互不相关的时间评估者将每个CT扫描和MRI分级为正常或异常,如果小关节是异常的,每个评估者对关节炎的病变程度进行分级。每个研究中将影像科的评估与我们的结果进行比较。
Results. Of 594 facets analyzed, 43.1% were categorized as normal on CT, and of those, MRI concordance was only 63.7% with moderate/substantial intermethod agreement. Furthermore, MRI was concordant only 15.9% of the time in patients with ankylosed facet joints on CT. CT inter-rater reliability showed substantial agreement for diagnoses of both normal and ankylosis and fair agreement for lesser degrees of facet arthrosis. MRI inter-rater reliability showed fair/moderate agreement in normal and ankylosed segments and only slight agreement with lesser degrees of facet arthrosis. CT intrarater reliability showed substantial agreement in normal or ankylosed joints, but only fair agreement for all other categories; MRI showed only fair agreement.

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作者:admin@医学,生命科学    2011-02-28 17:12
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