PMID- 30783347
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220331
IS  - 0974-8237 (Print)
IS  - 0976-9285 (Electronic)
IS  - 0974-8237 (Linking)
VI  - 9
IP  - 4
DP  - 2018 Oct-Dec
TI  - Ability of magnetic resonance imaging to accurately determine alar ligament 
      integrity in patients with atlanto-occipital injuries.
PG  - 241-245
LID - 10.4103/jcvjs.JCVJS_81_18 [doi]
AB  - OBJECTIVE: The objective of this study is to evaluate the the reliability of 
      magnetic resonance imaging (MRI) in diagnosing alar ligament disruption in 
      patients with potential atlanto-occipital dissociation (AOD). MATERIALS AND 
      METHODS: Three-blinded readers performed retrospective review on 6 patients with 
      intra-operative confirmed atlanto-occipital dissocation in addition to a 
      comparison cohort of patients with other cervical injuries that did not involve 
      the atlanto-occipital articulation. Ligament integrity was graded from 1 to 3 as 
      described by Krakenes et al. The right and left ligaments were assessed 
      separately. Inter-observer agreement by patient, by group (AOD vs. non-AOD), and 
      intra-observer agreement was calculated using weighted Cohen's kappa. RESULTS: 
      Interobserver agreement of alar ligament grade for individual patients ranged 
      from slight to fair (kappa = 0.05-0.30). Interobserver agreement of alar ligament 
      grade for each group (AOD vs. non-AOD) ranged from fair to substantial (kappa = 
      0.37-0.66). No statistically significant difference in categorical analysis of 
      groups (AOD vs. non-AOD) and grade (0-1 vs. 2-3) was observed. Intraobserver 
      agreement of individual patient's alar ligament grade ranged from moderate to 
      substantial (kappa = 0.50-0.62). CONCLUSION: The use of MRI to detect upper cervical 
      ligament injuries in AOD is imperfect. Our results show inconsistent and 
      unsatisfactory interobserver and intraobserver reliability in evaluation of alar 
      ligament injuries. While MRI has immense potential for detection of ligamentous 
      injury at the craniovertebral junction, standardized algorithms for its use and 
      interpretation need to be developed.
FAU - Dyas, Adam R
AU  - Dyas AR
AD  - Department of Orthopedic Surgery, University of Alabama at Birmingham, 
      Birmingham, Alabama, USA.
FAU - Niemeier, Thomas E
AU  - Niemeier TE
AD  - Department of Orthopedic Surgery, University of Alabama at Birmingham, 
      Birmingham, Alabama, USA.
FAU - Mcgwin, Gerald
AU  - Mcgwin G
AD  - Department of Epidemiology, School of Public Health, University of Alabama at 
      Birmingham, Birmingham, Alabama, USA.
FAU - Theiss, Steven M
AU  - Theiss SM
AD  - Department of Orthopedic Surgery, University of Alabama at Birmingham, 
      Birmingham, Alabama, USA.
LA  - eng
PT  - Journal Article
PL  - India
TA  - J Craniovertebr Junction Spine
JT  - Journal of craniovertebral junction & spine
JID - 101536746
PMC - PMC6364359
OTO - NOTNLM
OT  - Atlanta-occipital dissociation
OT  - cervical spine
OT  - cervical trauma
COIS- There are no conflicts of interest.
EDAT- 2019/02/21 06:00
MHDA- 2019/02/21 06:01
PMCR- 2018/10/01
CRDT- 2019/02/21 06:00
PHST- 2019/02/21 06:00 [entrez]
PHST- 2019/02/21 06:00 [pubmed]
PHST- 2019/02/21 06:01 [medline]
PHST- 2018/10/01 00:00 [pmc-release]
AID - JCVJS-9-241 [pii]
AID - 10.4103/jcvjs.JCVJS_81_18 [doi]
PST - ppublish
SO  - J Craniovertebr Junction Spine. 2018 Oct-Dec;9(4):241-245. doi: 
      10.4103/jcvjs.JCVJS_81_18.