Rattanaporn Chamnan1,2, Kunlavit Chantarasirirat1,3, Permsak Paholpak1,4, Kevin Wiley1, Zorica Buser5,6, Jeffrey C Wang1. 1. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-4513, Los Angeles, CA, 90033, USA. 2. Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand. 3. Department of Orthopaedic Surgery, Somdech Phra Pinklao Hospital, 504 Taksin Road, Bukkalo Thonburi, Bangkok, Thailand. 4. Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 5. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-4513, Los Angeles, CA, 90033, USA. zbuser@usc.edu. 6. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St., HC4 - Suite 5400A., Los Angeles, CA, 90003, USA. zbuser@usc.edu.
Abstract
PURPOSE: To evaluate the reliability and validity of the multi-positional magnetic resonance imaging in measuring occipitocervical parameters using the standard cervical dynamic radiographs as a reference. METHODS: Patients were included if they underwent both dynamic radiograph and cervical multi-positional MRI within a 2-week interval from January 2013 to December 2016. Twelve occipitocervical parameters were measured on both image modalities in all positions (neutral, flexion and extension): Posterior Atlanto-Dental Interval, Anterior Atlanto-Dental Interval (AADI), Dens-to-McRae distance, Dens-to-McGregor distance, Occipito-atlantal Cobb angle (C01 angle), Occipito-axis Cobb angle (C02 Cobb angle), Atlas-axis Cobb angle (C12 angle), Redlund-Johnell, Modified Ranawat, Clivus canal angle, Occiput inclination, and Occiput cervical distance. Pearson correlation and linear regression analysis were used to evaluate the correlation of both modalities for each parameter. A p value of < 0.05 was considered statistically significant. RESULTS: Cervical images of 70 patients were measured and analyzed. There was a significant positive correlation between dynamic X-ray and multi-positional MRI for all parameters (p < 0.05) except AADI. Dens-to-McGregor distance and Redlund-Johnell parameter demonstrated a very strong correlation in the neutral position (r = 0.72, r = 0.79 respectively) and moderate to very strong correlation(r > 0.4) for Modified Ranawat, Clivus canal angle, C02 Cobb angle and C02 distance in all neck position. The intra-class correlation (ICC) of intra- and inter-observer showed good to excellent reliability, and ICCs were 0.67-0.98. CONCLUSIONS: Multi-positional MRI can be a reliable imaging option for diagnosis of occipitocervical instability or basilar invagination compared to standard dynamic radiographs.
PURPOSE: To evaluate the reliability and validity of the multi-positional magnetic resonance imaging in measuring occipitocervical parameters using the standard cervical dynamic radiographs as a reference. METHODS:Patients were included if they underwent both dynamic radiograph and cervical multi-positional MRI within a 2-week interval from January 2013 to December 2016. Twelve occipitocervical parameters were measured on both image modalities in all positions (neutral, flexion and extension): Posterior Atlanto-Dental Interval, Anterior Atlanto-Dental Interval (AADI), Dens-to-McRae distance, Dens-to-McGregor distance, Occipito-atlantal Cobb angle (C01 angle), Occipito-axis Cobb angle (C02 Cobb angle), Atlas-axis Cobb angle (C12 angle), Redlund-Johnell, Modified Ranawat, Clivus canal angle, Occiput inclination, and Occiput cervical distance. Pearson correlation and linear regression analysis were used to evaluate the correlation of both modalities for each parameter. A p value of < 0.05 was considered statistically significant. RESULTS: Cervical images of 70 patients were measured and analyzed. There was a significant positive correlation between dynamic X-ray and multi-positional MRI for all parameters (p < 0.05) except AADI. Dens-to-McGregor distance and Redlund-Johnell parameter demonstrated a very strong correlation in the neutral position (r = 0.72, r = 0.79 respectively) and moderate to very strong correlation(r > 0.4) for Modified Ranawat, Clivus canal angle, C02 Cobb angle and C02 distance in all neck position. The intra-class correlation (ICC) of intra- and inter-observer showed good to excellent reliability, and ICCs were 0.67-0.98. CONCLUSIONS: Multi-positional MRI can be a reliable imaging option for diagnosis of occipitocervical instability or basilar invagination compared to standard dynamic radiographs.
Authors: J C Sierink; W A M van Lieshout; L F M Beenen; N W L Schep; W P Vandertop; J C Goslings Journal: Eur J Radiol Date: 2013-03-13 Impact factor: 3.528