Uchida Kenzo, Nakajima Hideaki, Yayama Takafumi, Kobayashi Shigeru, Shimada Seiichiro, Tsuchida Tatsuro, Okazawa Hidehiko, Mwaka Erisa, Baba Hisatoshi
Department of Orthopaedics and Rehabilitation Medicine, Fukui University Faculty of Medical Sciences, Fukui, Japan.
Spine (Phila Pa 1976). 2009 May 15;34(11):1185-91. doi: 10.1097/BRS.0b013e31819e2919.
Evaluation of cervical spinal cord (CSC) of patients with compressive myelopathy by magnetic resonance imaging (MRI) and high-resolution (18F)fluoro-deoxyglucose (18FDG) positron emission tomography (PET).
To determine changes in morphology, intramedullary signal intensity, and glucose metabolic rate in CSC after decompression, and to assess the utility of 18FDG-PET in evaluation of patients with cervical myelopathy.
The significance of CSC enlargement after decompression and signal intensity changes within the cord remain elusive. No data are available on metabolic activity of the compressed CSC. Only a few studies have examined correlation between high-resolution MRI and 18FDG-PET neuroimaging in cervical myelopathy.
We studied 24 patients who underwent cervical decompressive surgery in terms of postoperative neurologic improvement and changes in MRI and 18FDG-PET. Neurologic status was assessed by the Japanese Orthopedic Association scoring system (17-point scale). Signal intensity change in the cord was qualitatively assessed on both T1- and T2-weighted images. The transverse area of the CSC on MRIs and glucose metabolic rate (standardized uptake value [SUV]) from 18FDG-PET were measured digitally.
Neurologic improvement correlated with preoperative CSC transverse area at maximal compression (P < 0.01) and at follow-up (P < 0.001) and with mean SUV before surgery (P < 0.01) and at follow-up (P < 0.05). Preoperative signal intensity change on MRIs (low intramedullary signal intensity abnormality on T1-weighted image and high intramedullary on T2-weighted image) correlated negatively with neurologic improvement rate (P < 0.05). The transverse area of the CSC was significantly smaller after surgery in patients with preoperative MRI signal intensity changes (P < 0.05). The SUV at follow-up tended to normalize in association with neurologic improvement.
Our results showed that postoperative neurologic improvement in patients with cervical compressive myelopathy correlated with increased transverse area of the spinal cord, signal intensity change on both T1- and T2-weighted image, and the mean SUV.
通过磁共振成像（MRI）和高分辨率（18F）氟脱氧葡萄糖（18FDG）正电子发射断层扫描（PET）对压迫性脊髓病患者的颈脊髓（CSC）进行评估。
确定减压后颈脊髓在形态、髓内信号强度和葡萄糖代谢率方面的变化，并评估18FDG-PET在评估颈脊髓病患者中的效用。
减压后颈脊髓增粗的意义以及脊髓内信号强度变化仍不明确。目前尚无关于受压颈脊髓代谢活性的数据。仅有少数研究探讨了高分辨率MRI与18FDG-PET神经成像在颈脊髓病中的相关性。
我们研究了24例行颈椎减压手术的患者，观察其术后神经功能改善情况以及MRI和18FDG-PET的变化。神经功能状态采用日本骨科协会评分系统（17分制）进行评估。在T1加权和T2加权图像上对脊髓信号强度变化进行定性评估。通过数字测量MRI上颈脊髓的横截面积以及18FDG-PET的葡萄糖代谢率（标准化摄取值[SUV]）。
神经功能改善与最大压迫时术前颈脊髓横截面积（P < 0.01）、随访时（P < 0.001）以及术前平均SUV（P < 0.01）和随访时（P < 0.05）相关。术前MRI信号强度变化（T1加权图像上髓内低信号强度异常，T2加权图像上髓内高信号强度）与神经功能改善率呈负相关（P < 0.05）。术前MRI信号强度有变化的患者术后颈脊髓横截面积明显更小（P < 0.05）。随访时SUV倾向于随着神经功能改善而恢复正常。
我们的结果表明，颈椎压迫性脊髓病患者术后神经功能改善与脊髓横截面积增加、T1加权和T2加权图像上的信号强度变化以及平均SUV相关。
