不同MRI特征在下颈椎韧带结构损伤中的诊断价值  

Diagnostic value of different MRI features in subaxial cervical ligament injury

作　　者：朱锴[1] 陈其昕[1] 李方财[1] 徐侃[1] 陈维善[1] 吴琼华[1] 

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009

出　　处：《浙江医学》2008年第7期671-674,共4页Zhejiang Medical Journal

摘　　要：目的探讨不同MRI影像特征判断下颈椎韧带结构损伤的可靠性。方法术前对132例下颈椎损伤患者行MRI检查并由两位观察者分别以T1加权像连续中断(T1D)、T2加权像纵形高信号(T2L)、T2加权像横形高信号(T2T)作为标准来判断前纵韧带、后纵韧带损伤,然后与术中探查结果进行比较,观察者间的一致性采用Kappa检验(Kappa值≥0.75说明一致性较为理想,Kappa值<0.4说明一致性较差);以术中所见作为金标准,计算不同MRI特征诊断前纵韧带、后纵韧带损伤的敏感性、特异性、准确性、阳性预测值及阴性预测值。结果采用T1D判断前、后纵韧带损伤,两观察者间一致程度不够理想(Kappa值分别为0.112、0.285),且敏感性(50.1%～58.3%、52.3%～73.0%)、特异性(30.3%～40.4%、47.2%～48.6%)、准确性(47.0%～48.4%、48.4%～54.1%)等均较低;采用T2L进行判断,虽然两观察者一致程度尚可(Kappa值分别为0.667、0.537)、特异性(78.8～85.9%、90.3～97.2%)也较高,但其敏感性(39.4～50.0%、23.8～49.2%)较低。而采用T2T,不但两观察者间一致程度相当满意(Kappa值分别为0.852、0.799),而且均具有较高的敏感性(88.9～91.7%、82.6～90.5%)、特异性(88.9～97.0%、97.2～98.6%)、准确性(88.9～93.5%、91.7～96.8%)、阳性预测值(93.6～98.2%、88.1～90.0%)及阴性预测值(81.5～86.5%、95.0～95.9%)。结论MRI表现中韧带的T1D、T2L特征均不能作为判断下颈椎前、后纵韧带损伤的可靠标准,但T2T特征可以准确地判断前、后纵韧带损伤,有助于评价脊柱的稳定性。Objective To evaluate the reliability of different MRI features in diagnosis of subaxial cervical ligment injury. Methods MRI was performed in 132 patients with subaxial cervical spinal injury before operation. MRI features of discontinuity on sagittal T1-weighted image （T1D）,longitudinal high signal intensity on sagittal T2-weighted image（T2L）, transversal high or intermediate signal intensity on sagittal T2-weighted image （T2T）was used to assess the status of anterior longitudinal ligament （ALL） and posterior longitudinal ligament （PLL） by two observers. The imaging results were compared with operational findings; the inter-observer consistency was determined by the kappa value. The sensitivity, specificity, accuracy, positive and negative predictive value of different MRI features in detection of ALL and PLL injury were calculated using operative findings as the gold standard. Results Inter-observer consistency of T1D for the assessment of ALL and PLL injury was not satisfactory （Kappa value=0.112, 0.285）, and the sensitivity, specificity, accuracy, positive and negative predictive value of T1D was low. For T2L, the inter-observer consistency was fair （Kappa value=0.667, 0.537）, and there was a high specificity （78.8 - 85.9%, 90.3 - 97.2%）, however, the sensitivity was only 39.4 - 50.0% and 23.8 - 49.2%. By contrast, the inter-observer consistency of T2T for the assessment of ALL and PLL injury was excellent （Kappa value= 0.852, 0.799）, and there was high sensitivity, specificity, accuracy, positive and negative predictive value. Conclusion The TID and T2L of MRI cannot be used as reliable indicators of ligament injury in subaxial cervical spine. However, the T2T of MRI is recommended for detection of ALL and PLL injury in subaxial cervical spine and would be helpful in assessing the stability of spine.

关 键 词：颈椎 韧带 损伤 MRI 

分 类 号：R686.5[医药卫生—骨科学] R445.2[医药卫生—外科学]