Department of Radiology, Cohen Children's Medical Center, New Hyde Park, NY, USA.
Pediatr Radiol. 2012 Jun;42(6):685-91. doi: 10.1007/s00247-011-2308-8. Epub 2011 Dec 6.
Tethered cord syndrome (TCS) is defined by abnormal traction on the spinal cord that confines its movement. Surgical cord release usually stops neurological deterioration; therefore, early and accurate neuroradiological diagnosis is important. Supine MRI is the imaging modality of choice, but prone MRI and cine MRI can demonstrate cord movement.
We compared the diagnostic accuracies of standard MRI, prone MRI and cine MRI in patients with clinical suspicion of TCS and evaluated inter-reader reliability for MR imaging.
Children who underwent MRI for suspicion of TCS were retrospectively identified. Supine, prone and cine MRI studies were re-read by two pediatric neuroradiologists. Conus level, filum appearance and cord movement were documented.
Thirteen of 49 children had tethered cord documented at surgery. Conus level had the highest diagnostic accuracy (sensitivity 69-77%, specificity 94%, positive predictive value 82-83%, negative predictive value 89-92%, correct diagnosis 88-90%) and highest between-reader concordance (98%). Prone and cine MRI did not add to the accuracy of the supine imaging.
Conus level provides the highest diagnostic accuracy and inter-reader reliability in TCS. Until a larger series is evaluated, it remains questionable whether prone or cine MRI provides enough additional diagnostic information to warrant routine use.
脊髓栓系综合征（TCS）定义为脊髓受到异常牵拉，限制了其运动。脊髓松解术通常可以阻止神经功能恶化；因此，早期、准确的神经影像学诊断很重要。仰卧位 MRI 是首选的影像学检查方法，但俯卧位 MRI 和电影 MRI 可显示脊髓运动。
我们比较了标准 MRI、俯卧位 MRI 和电影 MRI 在临床怀疑 TCS 患者中的诊断准确性，并评估了 MRI 检查的读者间可靠性。
回顾性确定了因怀疑 TCS 而行 MRI 检查的儿童。由两名儿科神经放射科医生重新阅读仰卧位、俯卧位和电影 MRI 研究。记录圆锥水平、终丝外观和脊髓运动情况。
手术证实 49 例儿童中有 13 例存在脊髓栓系。圆锥水平的诊断准确性最高（敏感度 69-77%，特异性 94%，阳性预测值 82-83%，阴性预测值 89-92%，正确诊断率 88-90%），读者间一致性也最高（98%）。俯卧位和电影 MRI 并未提高仰卧位成像的准确性。
圆锥水平在 TCS 中提供了最高的诊断准确性和读者间可靠性。在评估更大的系列之前，还不能确定俯卧位或电影 MRI 是否提供了足够的额外诊断信息，值得常规使用。
