常规MRI在怀疑甲状腺骨折的患者中存在过度诊断的风险
Anne Eva J Bulstra1,2, Marouska F van Boxel1,2, Tom J Crijns3
1Department of Orthopedic and Trauma Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia.
Clinical orthopaedics and related research
|September 14, 2023
概括
磁共振成像 (MRI) 对于怀疑的骨骨折,具有很高的误导性发现率. 只有6%的MRI显示明确或可能的骨折,风险过度诊断和过度治疗.
科学领域:
- 整形外科手术 整形外科手术
- 放射学 放射学是一门学科.
- 诊断成像诊断成像的使用
背景情况:
- 怀疑脊椎骨折的磁共振成像 (MRI) 可能导致过度诊断和过度治疗.
- 这是由于真正骨折的发病率很低,误导性信号变异的频繁发生.
- 了解有用与分散注意力的信号变化的流行程度对于评估过度诊断风险至关重要.
研究的目的:
- 与其他信号变化相比,确定MRI信号变化占确定的或可能的骨骨折的比例.
- 评估可疑骨骨折的患者中潜在误导性发现的流行率.
主要方法:
- 追溯研究256名患者 (16岁或以上) 临床怀疑骨骨折,接受了MRI.
- 分析了MRI图像的信号变化,分类为确定的骨折,可能的骨折或非特定的信号变化.
- 信号变化被归类为0.62.2的卡帕可靠性.
主要成果:
- 只有6%的MRI显示明确的 (2%) 或可能的 (5%) 骨骨折.
- 在29%的病例中发现了非特定的信号变化 (腰部:14%,其他区域:15%).
- 在患有脊椎腰部信号变化的患者中,69%的发现被归类为分散注意力和潜在的误导性.
结论:
- 对于怀疑骨骨折的常规MRI,由于误导性发现,存在过度诊断和过度治疗的重大风险.
- 建议采用替代策略,例如基于临床预测规则的选择性MRI使用.
- 还建议患者参与管理非联合的小风险.
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