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Measurement of Thoracic Inlet Alignment on MRI: Reliability and the Influence of Body Position.
Clinical Spine Surgery 2016 June 29
STUDY DESIGN: A retrospective radiographic study.
OBJECTIVE: To investigate the reliability of using MRI to measure thoracic outlet parameters and whether supine MRI could supersede upright X-ray in measuring these parameters.
SUMMARY OF BACKGROUND DATA: In X-ray, overlapped soft and bony tissues make sternum contour invisible. Thus, measuring thoracic inlet alignment in X-ray may be inaccurate. MRI could clearly show anatomy around thoracic inlet.
METHODS: One hundred and twenty-four adolescents with idiopathic thoracolumbar/lumbar scoliosis were recruited. The visibility of T1 upper end plate and the upper end of sternum in the lateral standing X-ray films was rated. For patients with moderate or good clarity forT1 upper end plate and the upper end of sternum on X-ray films, thoracic inlet angle (TIA), T1 slope (T1S) and neck tilt (NT) were measured by 3 observers on standing X-ray films and supine MR images, respectively. Intraclass correlation coefficients were used to determine the intraobserver, interobserver and method reliability. Paired t test was performed to compare the measurements between the two methods. The correlation coefficients between the two methods were analyzed by regression analysis.
RESULTS: The visibility of thoracic inlet region in X-ray films was unsatisfactory, whereas all the landmarks were clear in MR images. Only 81 patients' X-ray films were graded as moderate or good visibility in the thoracic inlet region. Both the intraobserver ICC and interobserver ICC were better in the MRI set than in the X-ray set in all the observers for three TI parameters. Paired t test demonstrated that no significant difference was noted in terms of TIA, T1S and TN (P=0.572, 0.203 and 0.637, respectively). Regression analysis demonstrated high correlation coefficients for TIA, T1S and NT (R=0.612, 0.629 and 0.722, respectively).
CONCLUSION: MRI serves as a good substitute for X-ray scans with regard to the measurement of TI alignment, with superior reliability.
OBJECTIVE: To investigate the reliability of using MRI to measure thoracic outlet parameters and whether supine MRI could supersede upright X-ray in measuring these parameters.
SUMMARY OF BACKGROUND DATA: In X-ray, overlapped soft and bony tissues make sternum contour invisible. Thus, measuring thoracic inlet alignment in X-ray may be inaccurate. MRI could clearly show anatomy around thoracic inlet.
METHODS: One hundred and twenty-four adolescents with idiopathic thoracolumbar/lumbar scoliosis were recruited. The visibility of T1 upper end plate and the upper end of sternum in the lateral standing X-ray films was rated. For patients with moderate or good clarity forT1 upper end plate and the upper end of sternum on X-ray films, thoracic inlet angle (TIA), T1 slope (T1S) and neck tilt (NT) were measured by 3 observers on standing X-ray films and supine MR images, respectively. Intraclass correlation coefficients were used to determine the intraobserver, interobserver and method reliability. Paired t test was performed to compare the measurements between the two methods. The correlation coefficients between the two methods were analyzed by regression analysis.
RESULTS: The visibility of thoracic inlet region in X-ray films was unsatisfactory, whereas all the landmarks were clear in MR images. Only 81 patients' X-ray films were graded as moderate or good visibility in the thoracic inlet region. Both the intraobserver ICC and interobserver ICC were better in the MRI set than in the X-ray set in all the observers for three TI parameters. Paired t test demonstrated that no significant difference was noted in terms of TIA, T1S and TN (P=0.572, 0.203 and 0.637, respectively). Regression analysis demonstrated high correlation coefficients for TIA, T1S and NT (R=0.612, 0.629 and 0.722, respectively).
CONCLUSION: MRI serves as a good substitute for X-ray scans with regard to the measurement of TI alignment, with superior reliability.
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