神经根沉降征对腰椎管狭窄症的诊断：可靠性、敏感性和特异性。
Nerve root sedimentation sign for the diagnosis of lumbar spinal stenosis: reliability, sensitivity, and specificity.
作者信息
Tomkins-Lane Christy C, Quint Douglas J, Gabriel Shaun, Melloh Markus, Haig Andrew J
机构信息
*Department of Physical Education and Recreation Studies, Mount Royal University, Calgary, Canada †Department of Radiology, University of Michigan, Ann Arbor, MI ‡Department of Anesthesiology, University of Michigan, Ann Arbor, MI §Western Australian Institute for Medical Research, University of Western Australia, Perth, Australia; and ¶Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
出版信息
Spine (Phila Pa 1976). 2013 Nov 15;38(24):E1554-60. doi: 10.1097/BRS.0b013e3182a8c2da.
STUDY DESIGN
Retrospective review of magnetic resonance images.
OBJECTIVE
Examine the diagnostic accuracy, discriminative ability, and reliability of the sedimentation sign in a sample of patients with clinically diagnosed lumbar spinal stenosis (LSS), low back pain (LBP), and vascular claudication, and in asymptomatic controls.
SUMMARY OF BACKGROUND DATA
The nerve root sedimentation sign (SedSign) was recently described as a new diagnostic test for LSS; however, the degree to which this sign is sensitive and specific in diagnosis of LSS is unknown.
METHODS
All LSS images were obtained from subjects who had clinically diagnosed LSS confirmed on imaging by a spine specialist. The other images were obtained from people with LBP but no LSS, people with severe vascular claudication, and asymptomatic participants. Three blinded raters independently assessed the images. A positive sign was defined as the absence of nerve root sedimentation at the level above or below the level of maximum stenosis.
RESULTS
Images from 148 subjects were reviewed (67 LSS, 31 LBP, 4 vascular, and 46 asymptomatic). Intrarater reliability for the sign ranged from κ= 0.87 to 0.97 and inter-rater reliability from 0.62 to 0.69. Sensitivity ranged from 42% to 66%, and specificity ranged from 49% to 78%. Sensitivity improved to a range of 60% to 96% when images with only a smallest cross-sectional area of the dural sac less than 80 mm were included. The sign was able to differentiate (P = 0.004) between LSS and asymptomatic controls but not between LSS and LBP or between LSS and vascular claudication.
CONCLUSION
The SedSign was shown to have high intrarater reliability and acceptable inter-rater reliability. The Sign appears most sensitive in defining severe LSS cases, yet may not aid in the differential diagnosis of LSS from LBP or vascular claudication, or add any specific diagnostic information beyond the traditional history, physical examination, and imaging studies that are standard in LSS diagnosis.
LEVEL OF EVIDENCE
研究设计
磁共振图像的回顾性研究。
目的
在临床诊断为腰椎管狭窄症（LSS）、腰痛（LBP）和血管性间歇性跛行的患者样本以及无症状对照中，检验沉降征的诊断准确性、鉴别能力和可靠性。
背景数据总结
神经根沉降征（SedSign）最近被描述为一种用于LSS的新诊断测试；然而，该征象在LSS诊断中的敏感程度和特异性尚不清楚。
方法
所有LSS图像均来自经脊柱专科医生影像学确诊为临床LSS的受试者。其他图像来自患有LBP但无LSS的患者、患有严重血管性间歇性跛行的患者以及无症状参与者。三名盲法评估者独立评估图像。阳性征象定义为在最大狭窄水平上方或下方的神经根沉降缺失。
结果
回顾了148名受试者的图像（67例LSS、31例LBP、4例血管性疾病和46例无症状者）。该征象的评估者内可靠性范围为κ=0.87至0.97，评估者间可靠性范围为0.62至0.69。敏感性范围为42%至66%，特异性范围为49%至78%。当纳入硬脊膜囊最小横截面积小于80平方毫米的图像时，敏感性提高到60%至96%。该征象能够区分LSS与无症状对照（P = 0.004），但不能区分LSS与LBP或LSS与血管性间歇性跛行。
结论
沉降征显示出较高的评估者内可靠性和可接受的评估者间可靠性。该征象在定义严重LSS病例时似乎最敏感，但可能无助于LSS与LBP或血管性间歇性跛行的鉴别诊断，也无法提供超出LSS诊断标准的传统病史、体格检查和影像学检查之外的任何特定诊断信息。
证据水平
4级。
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