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Chiropractic Research Review

CT Myelography vs. MRI

Discrepancies may arise in the interpretation of computed tomography myelography (CTM) and magnetic resonance imaging (MRI) scans in patients suffering from cervical degenerative disease. These discrepancies are troubling, especially in light of the increasing pressures placed on clinicians by managed health care agencies to rely on a limited number of diagnostic testing procedures.

This study evaluated CTM and MRI in 20 patients (10 men and 10 women, 35-72 years of age) referred for clinically diagnosed cervical spondylotic radiculopathy, myelopathy, or both.

Images were presented independently and blindly to two experienced neuroradiologists who read the scans individually and randomly. They assessed nearly 250 different anatomical sites, including individual cervical disc levels, discovertebral and lateral recess lesions, and facet joints.

Results are presented as follows:

* Agreement for interpretation of the discovertebral junction occurred in 144 of 240 sites (60%), indicating moderate agreement.

* Agreement on the characterization of facet joint disease was also moderately good (143 of 160 sites, or 89.4%).

* Agreement on characterization of lateral recess disease was poor (125 of 160 sites, or 78.1%).

* Agreement on neural foraminal encroachment and cord size was moderately good.

Moderate agreement exists between CTM and MRI, with particular discrepancies noted with respect to the differentiation of disc and bony pathology. Both methods offer "important and sometimes unique information ... neither CTM nor MRI should be solely relied on in the evaluation of cervical degenerative disease."

The authors conclude: "Finally, the current data suggests that reader interpretation-decision algorithms for CTM and MRI in evaluation of degenerative cervical spine disease may not be interchangeable, and that determinations of degree of pathology may be expected to differ between two methods."

Shafaie FF, Wippold II FJ, Gado M, et al. Comparison of computed tomography myelography and magnetic resonance imaging in the evaluation of cervical spondylotic myelopathy and radiculopathy. Spine, Sept. 1, 1999:24(17), pp1781-85.

Chiropractic Research Review

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