Comparison of diagnostic accuracy of Magnetic Resonance Imaging and Multidetector Computed Tomography in the detection of pelvic fractures
Comparison of diagnostic accuracy of Magnetic Resonance Imaging and Multidetector Computed Tomography in the detection of pelvic fractures
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DOI：
10.1016/j.ejrad.2011.07.012
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发表时间：
2012-09-01
影响因子：
3.3
通讯作者：
Grossterlinden, L. G.
中科院分区：
文献类型：
--
作者：
Henes, F. O.;Nuechtern, J. V.;Grossterlinden, L. G.
目的：比较磁共振成像（MRI）和多排螺旋CT（MDCT）在急性骨盆骨折检测的诊断准确性和观察者间的可靠性。材料和方法：在38例连续患者（平均年龄74.7岁）与骨盆前骨折的常规X线，骨盆MRI和MDCT进行进一步评估骨盆环骨折。两名放射科医生独立读取所有数据集。根据每种方法的平均得分计算灵敏度和特异性。采用配对比例检验（McNemar）比较CT和MRI的敏感性。两种方法的诊断有效性通过观察者间变异性使用kappa统计进行评估。结果：共发现骨折122处，其中骶骨骨折37处，耻骨骨折58处，髋臼骨折22处，坐骨骨折1处，髂骨骨折4处。平均而言，MRI检测到96.3%，而CT检测到77%的骨折。关于灵敏度，MRI被证明明显优于MDCT（观察者1，p = 0.0009;观察者2，p = 0.0003）。特别是，MRI在骶骨骨折的描述方面表现更好，敏感性达到98.6%，而CT为66.1%。观察者间的变异性被确定为非常好的（k = 0.955 MRI和0.902 MDCT）。结论：MRI达到一个显着高于CT在检测急性骨盆骨折，特别是骶骨骨折的敏感性。特别是对于怀疑骶骨骨折且MDCT结果呈阴性的老年患者，MRI可能被视为诊断检查的下一步。(C)2011爱思唯尔爱尔兰有限公司保留所有权利。
Objective: To compare diagnostic accuracy and interobserver reliability of Magnetic Resonance Imaging (MRI) and Multidetector Computed Tomography (MDCT) in the detection of acute pelvic fractures.Materials and methods: In 38 consecutive patients (mean age 74.7 years) with a positive finding of anterior pelvis fracture in the conventional X-rays, pelvic MRI and MDCT were performed for further evaluation of pelvic ring fractures. Two radiologists independently read all data sets. Sensitivity and specificity were calculated based on mean scores for each method. Sensitivities of CT and MRI were compared using a paired proportion test (McNemar). Diagnostic validity of both methods was assessed by the interobserver variability using kappa statistics. Combined clinical data and findings from all imaging studies served as the reference standard.Results: 122 fractures were identified in the reference standard (37 sacral, 58 pubic, 22 acetabular, 1 ischial, 4 ilial). On average, MRI detected 96.3% whereas CT detected 77% of all fractures. With regard to sensitivity, MRI proved to be significantly better compared to MDCT (observer 1, p = 0.0009; observer 2, p = 0.0003 by observer 2). In particular, MRI performed better in the depiction of sacral fractures, reaching a sensitivity of 98.6% compared to 66.1% at CT. The interobserver variability was determined to be very good (k = 0.955 for MRI and 0.902 for MDCT).Conclusion: MRI reaches a significantly higher sensitivity than CT in the detection of acute pelvic fractures, particularly of the sacrum. Especially in elderly patients with suspicion of a sacral fracture and negative results at MDCT, MRI may be considered as the next step in diagnostic workup. (C) 2011 Elsevier Ireland Ltd. All rights reserved.