椎体压缩性骨折四种影像学诊断的一致性研究

目的：对比分析MRI、CT侧位定位像、CT重建图像和X线平片诊断椎体压缩性骨折的一致性。方法回顾性分析2014年1月1日至2014年4月30日，我院同时行胸椎或腰椎MRI和CT检查的患者50例（398个椎体），以及同时行MRI和X线平片检查的患者70例（480个椎体），覆盖T4～L5椎体范围，运用半定量分级方法，按椎体压缩程度分为0～3级，分别统计MRI-CT组和MRI-X线平片组中MRI、CT侧位定位像、CT重建图像、X线平片的各级椎体的个数，采用kappa分析得到MRI与CT侧位定位像、CT重建图像诊断压缩性骨折≥1级和≥2级的椎体的一致性，然后分析 MRI 与 X 线平片诊断压缩性骨折≥1级和≥2级的椎体的一致性；两组分别以 MRI 为标准，0级为阴性结果，≥1级为阳性结果，计算侧位 CT 定位像、CT重建图像和X线平片诊断椎体压缩性骨折的敏感性和特异性。结果 MRI与CT侧位定位像诊断≥1级椎体有中等程度的一致性（ k＝0.583），诊断≥2级椎体有好的一致性（ k＝0.818）；MRI与CT重建图像诊断≥1级和≥2级椎体均有好的一致性（ k＝0.836和0.961）；MRI与X线平片诊断≥1级椎体有中等程度一致性（ k＝0.651），诊断≥2级椎体有好的一致性（ k＝0.862）；MRI-CT组中CT侧位定位像诊断椎体压缩性骨折的敏感性和特异性分别为55.2%和97.1%，CT重建图像诊断的敏感性和特异性分别为81.6%和98.5%；MRI-X线平片组中X线平片诊断椎体压缩性骨折的敏感性和特异性分别为62.5%和96.7%。结论 MRI和CT重建图像诊断椎体骨折的一致性最高；相对 MRI，CT 重建图像诊断椎体压缩性骨折的敏感性和特异性均较高，而CT侧位定位像和X线平片的特异性较高，敏感性较低。

Research on the consistency of four imaging methods in the diagnosis of vertebral compression fractures

Objective To analyze the consistency of magnetic resonance （ MRI ）, lateral scout images of computed tomography （ CT ）, reformation images of CT and X-ray plain iflms in the diagnosis of vertebral compression fractures.Methods From January 1, 2014 to April 30, 2014, 50 patients （ 398 vertebral bodies ） underwent thoracic or lumbar spine MRI and CT examinations and 70 patients （ 480 vertebral bodies ） had spine MRI and X-ray examinations, whose clinical data were retrospectivley analyzed. The vertebral body from T4 to L5 were involved. The semi-quantitative （ SQ ） method was used to classify the fractures as grade 0 to 3 according to the degree of vertebral compression. The number of vertebral bodies at different grades were respectively counted in all the patients based on the MRI, lateral scout images of CT, reformation images of CT and X-ray plain iflms. A Kappa analysis was used to assess the consistency between MRI and lateral scout images of CT and between MRI and reformation images of CT in the diagnosis of compression fractures≥ geade 1 and≥ grade 2. And then the consistency between MRI and X-ray plain iflms were assessed in the diagnosis of compression fractures≥ geade 1 and≥ grade 2. MRI was considered as the standard in the diagnosis of fractures, and grade 0 was taken as negative resultes and≥ geade 1 as positive results. Finally, the sensibility and specificity of scout images and reformation images of CT and X-ray plane films were calculated in the diagnosis of vertebral compression fractures.Results A fair consistency existed between MRI and lateral scout images of CT in the diagnosis of fractures≥ grade 1 （k=0.583 ）, and a good consistency in the diagnosis of fractures≥ grade 2 （k=0.818 ）. A good consistency was noticed between MRI and reformation images of CT in the diagnosis of fractures≥ grade 1 and 2 （k=0.836 andk=0.961 ）. A fair consistency was found between MRI and X-ray plain iflms in the diagnosis of fractures≥ grade 1 （k=0.651 ）, and a