ABSTRACT
PURPOSE: To determine the weighted average sensitivity of magnetic resonance (MR) imaging in the prospective detection of acute neck injury and to compare these findings with those of a comprehensive conventional radiographic assessment. MATERIALS AND METHODS: Conventional radiography and MR imaging were performed in 199 patients presenting to a level 1 trauma center with suspected cervical spine injury. Weighted sensitivities and specificities were calculated, and a weighted average across eight vertebral levels from C1 to T1 was formed. Fourteen parameters indicative of acute injury were tabulated. RESULTS: Fifty-eight patients had 172 acute cervical injuries. MR imaging depicted 136 (79%) acute abnormalities and conventional radiography depicted 39 (23%). For assessment of acute fractures, MR images (weighted average sensitivity, 43%; CI: 21%, 66%) were comparable to conventional radiographs (weighted average sensitivity, 48%; CI: 30%, 65%). MR imaging was superior to conventional radiography in the evaluation of pre- or paravertebral hemorrhage or edema, anterior or posterior longitudinal ligament injury, traumatic disk herniation, cord edema, and cord compression. Cord injuries were associated with cervical spine spondylosis (P < .05), acute fracture (P < .001), and canal stenosis (P < .001). CONCLUSION: MR imaging is more accurate than radiography in the detection of a wide spectrum of neck injuries, and further study is warranted of its potential effect on medical decision making, clinical outcome, and cost-effectiveness.
Subject(s)
Cervical Vertebrae/injuries , Magnetic Resonance Imaging , Acute Disease , Adolescent , Adult , Aged , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/pathology , Child , Female , Hemorrhage/diagnosis , Hemorrhage/diagnostic imaging , Humans , Intervertebral Disc Displacement/diagnosis , Intervertebral Disc Displacement/diagnostic imaging , Joint Dislocations/diagnosis , Joint Dislocations/diagnostic imaging , Male , Middle Aged , Prospective Studies , Sensitivity and Specificity , Spinal Fractures/diagnosis , Spinal Fractures/diagnostic imaging , Spinal Injuries/diagnosis , Spinal Injuries/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
The purpose of this study was to develop and evaluate a computerized method of calculating a breast density index (BDI) from digitized mammograms that was designed specifically to model radiologists' perception of breast density. A set of 153 pairs of digitized mammograms (cranio-caudal, CC, and mediolateral oblique, MLO, views) were acquired and preprocessed to reduce detector biases. The sets of mammograms were ordered on an ordinal scale (a scale based only on relative rank-ordering) by two radiologists, and a cardinal (an absolute numerical score) BDI value was calculated from the ordinal ranks. The images were also assigned cardinal BDI values by the radiologists in a subsequent session. Six mathematical features (including fractal dimension and others) were calculated from the digital mammograms, and were used in conjunction with single value decomposition and multiple linear regression to calculate a computerized BDI. The linear correlation coefficient between different ordinal ranking sessions were as follows: intraradiologist intraprojection (CC/CC): r = 0.978; intraradiologist interprojection (CC/MLO): r = 0.960; and interradiologist intraprojection (CC/CC): r = 0.968. A separate breast density index was derived from three separate ordinal rankings by one radiologist (two with CC views, one with the MLO view). The computer derived BDI had a correlation coefficient (r) of 0.907 with the radiologists' ordinal BDI. A comparison between radiologists using a cardinal scoring system (which is closest to how radiologists actually evaluate breast density) showed r = 0.914. A breast density index calculated by a computer but modeled after radiologist perception of breast density may be valuable in objectively measuring breast density. Such a metric may prove valuable in numerous areas, including breast cancer risk assessment and in evaluating screening techniques specifically designed to improve imaging of the dense breast.
