颈椎间盘损伤影像学诊断的可靠性和一致性分析  

Reliability and agreement of tthe diagnosis criteria for cervical intervertebralhe disc injury based on the manifestmanifestations of X-Ray, CT and MRI examinations

作　　者：管恩超 蒋盛旦[1] 王宇仁[1] 李波[1] 郑新峰[1] 蒋雷生[1] 

机构地区：[1]上海交通大学医学院附属新华医院,上海200092

出　　处：《中华骨与关节外科杂志》2017年第5期361-367,共7页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:颈椎过伸性损伤是骨科常见的损伤,常会导致颈椎间盘破裂,从而造成颈椎不稳等继发性损害,早期、及时、准确的诊断对患者的救治及康复有重要意义。目的:评价颈椎X线、CT和MRI的特征性影像学表现对颈椎间盘损伤的诊断价值。方法:选取2013年11月至2016年7月因颈椎过伸伤而行颈椎前路手术的患者44例。所有患者术前均有完整的颈椎X线、CT和MRI检查,无明显的颈椎骨折脱位表现。根据指定的X线、CT和MRI影像学特征为诊断标准,3名医师分别阅读所有患者的影像学资料,对每例患者有无颈椎间盘损伤做出判断。将判断结果与术中记录结果进行比较。诊断者间的一致性采用Kappa检验。以术中记录作为金标准,分别计算根据X线、CT和MRI影像学特征作为诊断标准诊断颈椎间盘损伤的敏感性、特异性、准确性、阳性预测值和阴性预测值。结果:相较于MRI,X线和CT的各项诊断指标的可靠性和一致性均较低,但椎前软组织影增厚对于诊断颈椎间盘损伤有着较高的特异性和准确性(分别为89.6%~94.8%和80.6%~83.9%)。以T1D为标准诊断颈椎间盘损伤时,3名医师间的一致性尚可(Kappa值分别为0.217、0.267、0.318),敏感性和阳性预测值较低(分别为43.8%~63.5%和25.9%~33.3%)。以T2L为标准诊断颈椎间盘损伤时,3名医师间的一致性中等(Kappa值分别为0.490、0.439、0.420),敏感性和阳性预测值较T1D高(分别为68.8%~75.0%和35.5%~42.4%)。以T2T为标准诊断颈椎间盘损伤时,3名医师间的一致性较好(Kappa值分别为0.669、0.656、0.614),并且其敏感性(81.3%~87.5%)、特异性(93.5%~96.1%)、准确性(92.4%~93.5%)、阳性预测值(73.7%~81.3%)和阴性预测值(96.0%~97.3%)均较高。结论:当X线、CT出现椎前软组织影增厚时,应高度怀疑颈椎间盘损伤。以MRI的T2T为标准诊断颈椎间盘破裂损伤较准确可靠,MRI对于排除颈椎间盘损伤比X线、CT具有优势,但优势Background：Background： The hyperextension injury of the cervical spine is a common injury, which usually leads to cervical intervertebral disc rupture and may result in cervical instability and other secondary lesions. Early, timely and accurate diagnosis will contribute to good clinical outcomes of treatment and recovery. Objective： To evaluate the reliability and agreement of the characteristic findings on X Ray, CT and MRI examinations for the diagnosis of cervical intervertebral disc injury. Methods： A total of 44 patients who had hyperextension injury of the cervical spine and underwent anterior approach operations between November 2013 and July 2016 were included in this study. Each of these patients had complete documentations of preoperative images including X ray, CT and MRI, but no apparent evidence of vertebral fractures or dislocations. Characteristic findings were defined as diagnostic criteria for cervical intervertebral disc injury. The imaging documentations were read by three physicians separately, and the diagnosis was compared with intraoperative findings. Inter observer agreement for each assessment was determined using the Kappa statistic. The sensitivity, specificity, accuracy, positive and negative predictive values of different image features in detecting cervical disc injury were calculated. The intraoperative findings were used as the gold standard. Results： The reliability and inter observer agreement of each diagnostic criterion in X Ray and CT for the assessment of cervical disc injury were lower than those in MRI. Thickening of the soft tissue anterior to the vertebral body had both high specificity（89.6% 94.8%） and accuracy（80.6% 83.9%） in assessment of the cervical disc injury. Inter observer agreement of discontinuity on sagittal T1–weighted image（T1D） for the assessment of cervical disc injury was fair（Kappa value was 0.217, 0.267 and 0.318）, and its sensitivity（43.8% 63.5%） and positive predictive value（25.9% 33.3%） were relatively low. For lo

关 键 词：颈椎过伸伤 颈椎间盘 损伤 影像学 

分 类 号：R687.3[医药卫生—骨科学]