흉요추부 골절에서 자기공명영상의 임상적 중요성 (Clinical Importance of Mri in Thoracolumbar spinal fracture)

서지정보

· 발행기관 : 대한척추외과학회
· 수록지 정보 : 대한척추외과학회지 / 15권 / 2호 / 67 ~ 72페이지
· 저자명 : 노정호, 정남수, 박정욱, 신동선, 전창훈

초록

Study Design:Retrospective radiologic assessmentObjectives:To assess the clinical importance of MRI for the diagnosis of posterior spinal ligament complex injuries in thora-columbar fractures.Summary ofLiterature Review:Evaluation of spinal instability is important in thoracolumbar fractures. When simple radiogra-phy and CT alone are performed, spinal instability may be missed, especially that involving the posterior spinal ligament com-plex.Materials and Methods:Eighty-seven patients who were evaluated using simple radiography, computed tomography (CT), andmagnetic resonance imaging (MRI) between March 1994 and March 2003 were included in the study. The local kyphotic anglewas measured on lateral radiography, and it was then compared to the fracture pattern on MRI. Statistical analysis was per-formed using ANOVA.Results:There was no correlation between the local kyphotic angle on radiography and fracture involvement on MRI (p=0.106).In 41 patients who were found to have involvement of the anterior column on CT, 25 had anterior column involvement, 4 hadmiddle column involvement, and 12 had posterior column involvement on MRI. In 36 patients who were found to haveinvolvement of the middle column on CT, 17 had involvement of the middle column and 19 had involvement of the posteriorcolumn on MRI. The fractures of the ten patients who were found to have posterior column involvement on CT were all seenon MRI. The coincidence of fracture patterns between CT and MRI, which was evaluated using Cohen's Kappa analysis, was0.434. The sensitivity of CT compared with MRI was 0.741 in the middle column and 0.243 in the posterior column.Conclusions:Many thoracolumbar fractures are missed on both simple radiography and CT. MRI is essential for accurate diag-nosis of posterior spinal ligament complex injuries, especially when there is involvement above the middle column, or whencanal encroachment is seen on CT.

영어초록

Study Design:Retrospective radiologic assessmentObjectives:To assess the clinical importance of MRI for the diagnosis of posterior spinal ligament complex injuries in thora-columbar fractures.Summary ofLiterature Review:Evaluation of spinal instability is important in thoracolumbar fractures. When simple radiogra-phy and CT alone are performed, spinal instability may be missed, especially that involving the posterior spinal ligament com-plex.Materials and Methods:Eighty-seven patients who were evaluated using simple radiography, computed tomography (CT), andmagnetic resonance imaging (MRI) between March 1994 and March 2003 were included in the study. The local kyphotic anglewas measured on lateral radiography, and it was then compared to the fracture pattern on MRI. Statistical analysis was per-formed using ANOVA.Results:There was no correlation between the local kyphotic angle on radiography and fracture involvement on MRI (p=0.106).In 41 patients who were found to have involvement of the anterior column on CT, 25 had anterior column involvement, 4 hadmiddle column involvement, and 12 had posterior column involvement on MRI. In 36 patients who were found to haveinvolvement of the middle column on CT, 17 had involvement of the middle column and 19 had involvement of the posteriorcolumn on MRI. The fractures of the ten patients who were found to have posterior column involvement on CT were all seenon MRI. The coincidence of fracture patterns between CT and MRI, which was evaluated using Cohen's Kappa analysis, was0.434. The sensitivity of CT compared with MRI was 0.741 in the middle column and 0.243 in the posterior column.Conclusions:Many thoracolumbar fractures are missed on both simple radiography and CT. MRI is essential for accurate diag-nosis of posterior spinal ligament complex injuries, especially when there is involvement above the middle column, or whencanal encroachment is seen on CT.

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