Background:The hyperextension injury of the cervical spine is a common injury, which usually leads to cervi-cal 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 ap-proach 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 dis-locations. Characteristic findings were defined as diagnostic criteria for cervical intervertebral disc injury. The imaging doc-umentations were read by three physicians separately, and the diagnosis was compared with intraoperative findings. Inter-ob-server agreement for each assessment was determined using the Kappa statistic. The sensitivity, specificity, accuracy, posi-tive and negative predictive values of different image features in detecting cervical disc injury were calculated. The intraop-erative findings were used as the gold standard. Results:The reliability and inter-observer agreement of each diagnostic cri-terion in X-Ray and CT for the assessment of cervical disc injury were lower than those in MRI. Thickening of the soft tis-sue 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 longitudinal high signal intensity on sagittal T2–weighted image (T2L), the inter-observer agreement was moderate (Kappa value was 0.490, 0.439 and 0.420), and its sensitivity (68.8%-75.0%) and positive predictive value (35.5%-42.4%) were higher than those in T1D. However, the inter-observer agreement of transversal high or intermediate signal intensity on sagittal T2-weighted image (T2T) for the assessment of cervical disc injury was good (Kappa value was 0.669, 0.656 and 0.614), and its sensitivity (81.3%-87.5%), specificity (93.5%-96.1%), accuracy (92.4%-93.5%), positive predictive value (73.7%-81.3%) and negative predictive value (96.0%-97.3%) were all high. Conclusions:When thickening of the soft tissue anterior to the vertebral body is noted in X-Ray and CT images, cervi-cal disc injury may be highly suspected. T2T of MRI is a reliable indicator for cervical disc injury. MRI seems to be more predictable than X-Ray and CT in excluding the cervical disc injury, but this advantage was not statistically significant.%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,但优势不明显.
展开▼
