DR及DTS在寰枢关节半脱位诊断及分型中的价值研究  

The Value of DR and DTS in the Diagnosis and Classification of Atlantoaxial Subluxation

作　　者：曾桔 陈君蓉[1] 李向阳 ZENG Ju;CHEN Jun-rong;LI Xiang-yang(Department of Medical Imaging,Sichuan Provincial Orthopedics Hospital,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川省骨科医院医学影像科,四川成都610041

出　　处：《中国CT和MRI杂志》2024年第1期145-148,共4页Chinese Journal of CT and MRI

基　　金：成都市医学会课题(2021087)。

摘　　要：目的观察寰枢关节半脱位的影像学表现,探讨DR和X线数字化断层融合成像(DTS)技术在其诊断及分型中的价值。方法回顾性收集67例经临床及影像学检查诊断为寰枢关节半脱位的患者,分析其CT影像学表现,比较寰枢关节X线张口正位+侧位片、断层正位+侧位片的图像质量、诊断准确率、诊断一致性。结果寰椎关节前脱位的患者共有6例,侧方脱位40例,旋转脱位17例,复合脱位4例。有57%的DR片能用于诊断,有94%的DTS片能用于诊断,差异有统计学意义(P<0.05)。DR图像的诊断总准确率为42%,DTS图像的诊断总准确率为81%,差异具有统计学意义(P<0.05)。DR图像的诊断总准确率为24%,DTS图像的诊断总准确率为76%,差异具有统计学意义(P<0.05)。DR片诊断侧方脱位的准确率最高,为38%,诊断前脱位的准确率为17%。DTS片诊断前断脱位的准确率最高,为100%,诊断侧方脱位的准确率为92%,诊断旋转脱位的准确率为29%,诊断复合脱位的准确率为75%。二者诊断前脱位的诊确率没有统计学差异,而诊断侧方脱位的准确率差异具有统计学意义(P<0.05)。DR片诊断寰枢关节半脱位的一致性差(Kappa=0.28,P<0.05),DTS片的诊断一致性中等(Kappa=0.68,P<0.05)。结论DTS图像质量明显优于DR,在寰枢关节半脱位诊断及分型中的准确率、一致性也明显高于后者。Objective To observe the imaging findings of atlanto-axial joint subluxation and discusses the value of DR and Digital tomosynthesis(DTS)in the diagnosis and classification.Methods Retrospectively collected 67 cases diagnosed as atlanto-axial joint subluxation through clinical and radiographic examinations,analyzed CT imaging manifestations,and compared the image quality,diagnostic accuracy and diagnostic consistency of atlantoaxial joint X-ray AP film of open mouth view+lateral film,and tomographic AP film+lateral film.Results There were 6 cases of anterior dislocation of atlas,40 cases of lateral dislocation,17 cases of rotational dislocation and 4 cases of compound dislocation.57%of DR images and 94%of DTS images can be used for diagnosis,with a statistically significant difference(P<0.05).The total diagnostic accuracy of DR images was 42%,and the total diagnostic accuracy of DTS images was 81%,with a statistically significant difference(P<0.05).The total diagnostic accuracy of DR images was 24%,and the total diagnostic accuracy of DTS images was 76%,with a statistically significant difference(P<0.05).The accuracy rate of lateral dislocation on DR images was the highest(38%),and the accuracy rate of diagnosing atlantoaxial anterior dislocation was 17%.The accuracy of DTS images in diagnosing dislocation before diagnosis was the highest,100%,92%for lateral dislocation,29%for rotational dislocation and 75%for compound dislocation.There was no statistical difference in the accuracy of diagnosis of anterior dislocation between the two groups,but there was significant difference in the accuracy of diagnosis of lateral dislocation(P<0.05).The consistency of DR images in the diagnosis of atlantoaxial subluxation was poor(Kappa=0.27,P<0.05),and the consistency of DTS images was moderate(Kappa=0.68,P<0.05).Conclusion The image quality of DTS is obviously better than that of DR,and its accuracy and consistency in the diagnosis and classification of atlantoaxial subluxation are also significantly higher than that of the

关 键 词：寰枢关节半脱位 X线数字化断层融合成像技术 诊断 一致性 

分 类 号：R44[医药卫生—诊断学]