Radiological Associates of Sacramento, Sacramento, CA, USA.
J Am Coll Radiol. 2012 May;9(5):315-24. doi: 10.1016/j.jacr.2012.01.010.
Myelopathy is a problem that requires imaging to distinguish among numerous specifically treatable causes. The first priority is to determine mechanical stability after trauma. Next, it is crucial to distinguish intrinsic disease from extrinsic compression-for example, by epidural abscess. Osteophytes or disc extrusions and metastatic compression are the most common causes of extrinsic lesions. Imaging approaches rely on clinical features such as pain, fever, trauma, and pattern of progression. CT is preferred initially in acute trauma and MRI in all other circumstances. Contrast-enhanced MRI is added when tumor or infection is suspected or with slow or stepwise progression, especially when pain is not prominent. Vascular imaging is used when arteriovenous malformation, fistula, or occlusive disease is suspected. Because the treatment of myelopathy is often complex, treatment planning may require more than one imaging study or sequential examination to assess interval change. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
脊髓病是一种需要影像学检查来区分众多特定可治疗病因的疾病。首先要确定创伤后的机械稳定性。其次，区分内在疾病与外在压迫至关重要，例如硬膜外脓肿。骨赘或椎间盘突出以及转移性压迫是外在病变的最常见原因。成像方法依赖于临床特征，如疼痛、发热、创伤和进展模式。急性创伤时首选 CT，其他情况下首选 MRI。怀疑肿瘤或感染，或进展缓慢或呈阶梯式时，尤其是疼痛不明显时，加用增强 MRI。怀疑动静脉畸形、瘘或闭塞性疾病时，进行血管成像。由于脊髓病的治疗往往很复杂，治疗计划可能需要不止一次的影像学检查或连续检查来评估间隔变化。ACR 适宜性标准（®）是针对特定临床情况的循证指南，由多学科专家小组每两年审查一次。指南的制定和审查包括对同行评议期刊上的现有医学文献进行广泛分析，并应用成熟的共识方法（改良 Delphi）来对小组评估成像和治疗程序的适宜性进行评级。在证据不足或不明确的情况下，可能会使用专家意见来推荐成像或治疗。
