全脊柱核磁共振成像法评估青少年特发性脊柱侧凸的可行性研究

Whole spinal magnetic resonance imaging Cobb measurements for adolescent idiopathic scoliosis

目的探讨全脊柱MRI检查法测量Cobb角的可行性。方法 2名研究者分别对60例青少年特发性脊柱侧凸（AIS）的后前位及侧位X线片和全脊柱MRI片测量主弯及次弯Cobb角、T5-T12后凸、顶椎旋转,记录测量时间和测量的上下端椎,2名研究者在1周后进行重复测量。对比X线片和MRI测量结果使用Pearson相关法,而研究者之间和研究者内部进行可靠性评估。结果研究发现在所有X线片和MRI测量结果之间具有显著相关性（P=0.01）;主弯Cobb角（R=0.912）,代偿弯角度（R=0.826）,后凸（R=0.939）。X线片和MRI测量结果的研究者组间主弯Cobb角的可靠性分别是R=0.958,0.889;代偿弯Cobb角的可靠性分别是R=0.948,0.858;椎体旋转R=0.954是有显著性的。X线片和MRI测量结果的研究者组内主弯Cobb角的可靠性分别是R=0.965,0.966;代偿弯Cobb角R=0.949,0.944,均有显著性。结论研究结果示MRI能够获得的冠状面和矢状面测量结果与传统X线片测量结果有高度相关性。另外,MRI除具有可靠的椎体旋转测量外,MRI最大优势就是无辐射,并可替代用于AIS诊断性评估。

Objective To determine if a whole spinal magnetic resonance imaging（MRI） protocol could produce reliable spinal curvature images and measurements compared with traditional radiograph. Methods Sixty consecutive patients with a diagnosis of AIS were enrolled. Subjects received anterior-posterior radiograph and whole spinal MRI imaging followed within 1 week. Two independent observers performed all Cobb angle, T5-T12 kyphosis, and vertebral rotation measurements for comparison. The Pearson correlation method was performed to compare radiograph to MRI measurements, while inter-rater and intrarater correlations were performed to assess reliability. Results We found outstanding correlation between all plain film radiography and whole spinal MRI measurements（P =0.01）; major Cobb angles（R =0.912）, minor Cobb angles（R =0.826）, and kyphosis（R =0.939）. Inter-rater reliability for both radiographical and whole spinal MRI measurements of major Cobb angles（R =0.958, 0.889, respectively）, minor Cobb angles（R =0.948, 0.858, respectively）, and vertebral rotation（R =0.954） were outstanding. Intrarater reliability for both radiographical and MRI measurements of major Cobb angles（ R =0.965, 0.966,respectively） and minor Cobb angles（R =0.949, 0.944, respectively） were also outstanding. Conclusion Our results show that whole spinal MRI is capable of producing coronal and sagittal plane measurements that are highly correlate with traditional plain film radiographical measurements. Further more, in addition to reliable vertebral rotation measurements, makes whole spinal MRI a valuable, radiation-free alternative/substitute for diagnostic evaluation in AIS.