• Jun Qiao, Feng Zhu, Zhen Liu, Leilei Xu, Zezhang Zhu, Bangping Qian, Xu Sun, Qing Jiang, and Yong Qiu.
• *Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School †The Center of Diagnosis and Treatment for Joint Disease, the Affiliated Drum Tower Hospital of Nanjing University Medical School.
• J Spinal Disord Tech. 2015 Jun 18.

Study DesignA retrospective radiographic study.ObjectiveTo investigate the reliability of using MRI to measure thoracic outlet parameters and whether supine MRI could supersede upright X-ray in measuring these parameters.Summary Of Background DataIn X-ray, overlapped soft and bony tissues make sternum contour invisible. Thus, measuring thoracic inlet alignment in X-ray may be inaccurate. MRI could clearly show anatomy around thoracic inlet.MethodsOne hundred and twenty-four adolescents with idiopathic thoracolumbar/lumbar scoliosis were recruited. The visibility of T1 upper end plate and the upper end of sternum in the lateral standing X-ray films was rated. For patients with moderate or good clarity forT1 upper end plate and the upper end of sternum on X-ray films, thoracic inlet angle (TIA), T1 slope (T1S) and neck tilt (NT) were measured by 3 observers on standing X-ray films and supine MR images, respectively. Intraclass correlation coefficients were used to determine the intraobserver, interobserver and method reliability. Paired t test was performed to compare the measurements between the two methods. The correlation coefficients between the two methods were analyzed by regression analysis.ResultsThe visibility of thoracic inlet region in X-ray films was unsatisfactory, whereas all the landmarks were clear in MR images. Only 81 patients' X-ray films were graded as moderate or good visibility in the thoracic inlet region. Both the intraobserver ICC and interobserver ICC were better in the MRI set than in the X-ray set in all the observers for three TI parameters. Paired t test demonstrated that no significant difference was noted in terms of TIA, T1S and TN (P=0.572, 0.203 and 0.637, respectively). Regression analysis demonstrated high correlation coefficients for TIA, T1S and NT (R=0.612, 0.629 and 0.722, respectively).ConclusionMRI serves as a good substitute for X-ray scans with regard to the measurement of TI alignment, with superior reliability.

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