Cadotte David W, Wilson Jefferson R, Mikulis David, Stroman Patrick W, Brady Sinead, Fehlings Michael G
University of Toronto, Toronto Western Hospital, Division of Neurosurgery, McLaughlin Pavilion, 12th floor Rm 407, 399 Bathurst St, Toronto, Ontario, Canada M5T 2S8 +416 603 5627 ; +416 603 5298 ;
Expert Opin Med Diagn. 2011 Mar;5(2):121-33. doi: 10.1517/17530059.2011.556111. Epub 2011 Feb 8.
The diagnosis and prognosis of traumatic spinal cord injury has historically relied on clinical examination whereby those presenting with severe injuries were deemed unlikely to recover and those presenting with mild injuries were deemed more likely to recover. With the widespread use of MRI to visualize traumatic injury to the spinal cord, a spectrum of previously unseen characteristics ranging from mild T2-weighted signal intensity to complete spinal cord transection is now available to aid in both the diagnosis and prognosis.
In this systematic review, the authors outline how clinical examination (using the American Spinal Injury Association standards) and MRI characteristics can be used to classify and characterize acute traumatic cervical spinal cord injury. The reader will gain an appreciation for the different magnetic resonance signal characteristics that can be used to predict a favorable or unfavorable prognosis following traumatic spinal cord injury. The accuracy of this information, in terms of sensitivity and specificity, is presented. Using likelihood ratios, the authors work through specific examples.
The use of MRI in the evaluation of the human spinal cord has aided our understanding of the condition significantly. However, there are still several challenges that need to be met, in particular the use of MRI to detect functional abnormalities as well as structural ones. In the coming years, our ability to define damaged circuits in the spinal cord will mean that it will be possible to link structure to function in an objective non-invasive way, which will have implications for the understanding and potential treatment of spinal cord injury.
创伤性脊髓损伤的诊断和预后历来依赖于临床检查，据此，严重损伤患者被认为不太可能恢复，而轻度损伤患者被认为更有可能恢复。随着磁共振成像（MRI）广泛用于观察脊髓创伤性损伤，现在有一系列从前未被发现的特征，从轻度T2加权信号强度到完全性脊髓横断，可用于辅助诊断和判断预后。
在本系统评价中，作者概述了如何利用临床检查（采用美国脊髓损伤协会标准）和MRI特征对急性创伤性颈脊髓损伤进行分类和特征描述。读者将了解到可用于预测创伤性脊髓损伤后预后良好或不良的不同磁共振信号特征。文中给出了该信息在敏感性和特异性方面的准确性。作者通过具体实例计算似然比。
MRI在评估人类脊髓方面的应用极大地帮助了我们对这种疾病的理解。然而，仍有几个挑战需要应对，特别是利用MRI检测功能异常以及结构异常。在未来几年，我们界定脊髓中受损神经回路的能力意味着将有可能以客观的非侵入性方式将结构与功能联系起来，这将对脊髓损伤的理解和潜在治疗产生影响。
