Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeongi-do, 464-707, South Korea.
Skeletal Radiol. 2011 Aug;40(8):1033-9. doi: 10.1007/s00256-011-1102-x. Epub 2011 Feb 1.
To introduce a new grading system of lumbar central canal stenosis, evaluate its reliabilities, and compare it to the cross-sectional area and anterior-posterior diameter of the dural sac.
Lumbar central canal stenosis is defined as obliteration of the anterior CSF space in front of the cauda equina. Four musculoskeletal radiologists independently graded lumbar central canal stenosis by this new grading system based on separation degree of the cauda equina on T2-weighted axial images (grade 0 = no lumbar stenosis without obliteration of anterior CSF space; grade 1 = mild stenosis with separation of all cauda equina; grade 2 = moderate stenosis with some cauda equina aggregated; and grade 3 = severe stenosis with none of the cauda equina separated) in 81 patients to determine inter- and intra-reader reliability. One radiologist measured cross-sectional areas and anterior-posterior diameters and compared these to lumbar central canal stenosis grades.
Inter-reader reliabilities were substantial to almost perfect (ICC reliability = 0.730-0.953). Intra-reader reliability was almost perfect (kappa value = 0.863-0.900). Cross-sectional areas and anterior-posterior diameters were different according to grades at all levels (p = 0.000-0.049), except between grades 2 and 3 of L2-3. At L5-S1, only anterior-posterior diameter was different between grades 0 and 1 (p = 0.005) and between grades 0 and 2 (p = 0.022).
This new grading system may be helpful to clinicians for simple and practical evaluation of lumbar central canal stenosis and for communicating with each other.
介绍一种新的腰椎中央管狭窄分级系统，评估其可靠性，并与硬脊膜横截面积和前后径进行比较。
腰椎中央管狭窄定义为马尾前方脑脊液空间的闭塞。4 位肌肉骨骼放射科医生根据 T2 加权轴位图像上马尾的分离程度（0 级=无腰椎狭窄，无前 CSF 空间闭塞；1 级=轻度狭窄，所有马尾均分离；2 级=中度狭窄，部分马尾聚集；3 级=严重狭窄，无马尾分离），对 81 例患者的腰椎中央管狭窄进行分级，以确定组内和组间的可靠性。一位放射科医生测量了横截面积和前后径，并将其与腰椎中央管狭窄分级进行比较。
组内读者间的可靠性为中等至几乎完美（ICC 可靠性=0.730-0.953）。组内读者间的可靠性几乎完美（kappa 值=0.863-0.900）。在所有水平上，横截面积和前后径均根据分级而有所不同（p=0.000-0.049），除了 L2-3 的 2 级和 3 级之间。在 L5-S1 水平，仅 0 级和 1 级（p=0.005）以及 0 级和 2 级（p=0.022）之间的前后径存在差异。
这种新的分级系统可能有助于临床医生对腰椎中央管狭窄进行简单实用的评估，并有助于相互沟通。
