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Clinical Usefulness of CT-myelogram Comparing With the MRI in Degenerative Cervical Spinal Disorders: Is CTM Still Useful for Primary Diagnostic Tool?

Song, Kyung-Jin MD*; Choi, Byung-Wan MD; Kim, Gyu-Hyung MD*; Kim, Jung-Ryul MD*

Journal of Spinal Disorders & Techniques: July 2009 - Volume 22 - Issue 5 - p 353-357
doi: 10.1097/BSD.0b013e31817df78e
Original Articles
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Study Design A radiographic review of 50 patients (29 radiculopathy and 21 myelopathy) who had undergone the anterior cervical discectomy and fusion was performed by 3 observers retrospectively.

Objective To compare the accuracy between magnetic resonance imaging (MRI) and postmyelographic computed tomography (CTM) in degenerative cervical spine disease by assessing the degree of interobserver and intraobserver agreement.

Summary of Background Data The assessment of degenerative cervical spinal disease is still demanding. Now MRI is accepted as a primary diagnostic tool for degenerative cervical spine disease. Compared with MRI, usage of CTM has diminished, but it is usually reserved for the patients for whom MRI results were ambiguous or technically suboptimal.

Methods We retrospectively reviewed MRIs and CTMs of 50 patients (29 radiculopathy and 21 myelopathy) who had undergone the anterior cervical discectomy and fusion procedure. Using an assessment scale, 3 observers examined 5 parameters: spinal canal narrowing, foraminal stenosis, bony abnormality, intervertebral disk herniation, and nerve root compression. The degree of severity was graded using a 4-point scale for each item. Intraobserver, interobserver agreement, and the accentuation of each image were analyzed.

Results Intraclass correlation coefficiency statistical analysis showed moderate intraobserver agreement (Cronbach's α=0.63) and interobserver agreement (0.52). There was no significant difference in intraobserver, interobserver agreement between MRI (0.58) and CTM (0.57). Compared between MRI and CTM, disc abnormality and nerve root compression on MRI and foraminal stenosis and bony lesion on CTM showed better agreement.

Conclusions CTM was still useful in diagnosis of the foraminal stenosis and bony lesion comparing with MRI but showed limitation in disc abnormality and nerve root compression. So even though CTM may provide valuable additional information in difficult or ambiguous cases, it also requires universal standards and sound experience for constant and objective information.

*Department of Orthopedic Surgery, School of Medicine, Institute for Medical Science, Chonbuk National University Hospital, Chonbuk National University, Jeonju

Department of Orthopaedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea

There were no sources of funding for this manuscript.

Reprints: Byung-Wan Choi, MD, Department of Orthopaedic Surgery, Gwangju Veterans Hospital 880-1, Sanwol-dong, Gwangsan-gu, Gwangju, 506-705, Korea (e-mail: alla1013@naver.com).

Received for publication February 10, 2008; accepted April 23, 2008

© 2009 Lippincott Williams & Wilkins, Inc.