Ann Rehabil Med.  2015 Apr;39(2):294-302. 10.5535/arm.2015.39.2.294.

Quantitative Analysis of Magnetic Resonance Imaging of the Neck and Its Usefulness in Management of Congenital Muscular Torticollis

• Kim JW
• Kim SH
• Yim SY

• KMID: 2273052
• DOI: http://doi.org/10.5535/arm.2015.39.2.294

Abstract

OBJECTIVE
To quantify magnetic resonance imaging (MRI) findings of congenital muscular torticollis (CMT) and to demonstrate the usefulness of quantitative MRI findings in the management of CMT.
METHODS
This was a retrospective study of 160 subjects with CMT who had undergone neck MRI at the age of 48 months or younger at a tertiary medical center. Among the 160 subjects, 54 had undergone surgical release of CMT and 106 subjects had not undergone surgery. For the quantitative analysis, the ratios of area and intensity of the MRI findings were measured and compared between the two groups (ratio of area = the largest cross-sectional area of the SCM with CMT - the cross-sectional area of the contralateral SCM without CMT / the cross-sectional area of the contralateral SCM without CMT; ratio of intensity = the mean gray color intensity of the contralateral SCM without CMT - the lowest mean gray color intensity of the SCM with CMT / the mean gray color intensity of the contralateral SCM without CMT). Receiver operating characteristic (ROC) curve analysis was conducted for the ratios of area and intensity in order to find the optimal cutoff value for determining the need for surgery in CMT cases.
RESULTS
The ratios of area and intensity were significantly higher in the surgical group than in the non-surgical group (p< or =0.001), suggesting that the sternocleidomastoid muscle (SCM) was thicker and darker in the surgical group than in the non-surgical group. The optimal cutoff value for the ratio of area was 0.17 and that for the ratio of intensity was 0.05. All subjects with a ratio of intensity less than 0.03 belonged to the non-surgical group, and all subjects with a ratio of intensity greater than 0.16 were categorized in the surgical group.
CONCLUSION
The quantitative MRI findings, i.e., ratios of area and intensity, may provide a guideline for deciding the need for surgical intervention in CMT patients. Further prospective studies are required to verify these findings.

Keyword

Torticollis; Magnetic resonance imaging; Surgery; Muscular diseases; Neck

MeSH Terms

Humans
Magnetic Resonance Imaging*
Muscular Diseases
Neck*
Retrospective Studies
ROC Curve
Torticollis*

Figure

• 

  Fig. 1 Therapeutic protocol for congenital muscular torticollis (CMT). OPD, outpatient department; SCM, sternocleidomastoid muscle; MRI, magnetic resonance imaging.

• 

  Fig. 2 T1-weighted magnetic resonance image of the neck of a patient with congenital muscular torticollis. (A) Methods for measuring the sternocleidomastoid muscle (SCM) area by drawing regions of interest around the SCM. (B) Methods for measuring the SCM gray color intensity (arrow) by drawing regions of interest around the SCM.

• 

  Fig. 3 The algorithm for enrollment of the subjects from January 2012 to December 2013.

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  Fig. 4 Comparison of quantitative magnetic resonance imaging findings of congenital muscular torticollis (CMT) between the 2 groups. (A) The ratio of areaa) was significantly higher in the surgical group (1.44±1.26) than in the non-surgical group (0.66±0.76) (p<0.001). (B) The ratio of intensityb) was significantly higher in the surgical group (0.15±0.10) than in the non-surgical group (0.03±0.06) (p=0.001). '+' denotes the mean value. SCM, sternocleidomastoid muscle. a)Ratio of area = (the largest cross-sectional area of the SCM with CMT - the cross-sectional area of the contralateral SCM without CMT) / the cross-sectional area of the contralateral SCM without CMT. b)Ratio of intensity = (the mean gray color intensity of the contralateral SCM without CMT - the lowest mean gray color intensity of the SCM with CMT) / the mean gray color intensity of the contralateral SCM without CMT.

• 

  Fig. 5 Dot histogram of quantitative magnetic resonance imaging findings of the neck affected by congenital muscular torticollis (CMT) for both the non-surgical and surgical groups. The optimal cutoff values were calculated by the receiver operating characteristic (ROC) curve analysis. (A) The optimal cutoff value for the ratio of area was 0.17 (sensitivity 85.2%, specificity 28.3%) for the need for surgery to treat CMT. (B) For the ratio of area, the area under the ROC curve (AUC) was 0.693. (C) The optimal cutoff value for the ratio of intensity was 0.05 (sensitivity 96.3%, specificity 53.8%) for the need for surgery to treat CMT. While all subjects with a ratio of intensity <0.03 did not undergo surgery, all subjects with a ratio of intensity >0.16 underwent surgery. (D) For the ratio of intensity, the AUC was 0.856.

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