Wilmink J T
Department of Neuroradiology, University Hospital, Groningen, the Netherlands.
AJNR Am J Neuroradiol. 1989 Mar-Apr;10(2):233-48.
Spinal CT scans and radiculograms of 100 patients who had undergone both examinations were studied with the aim of identifying morphologic CT features associated with compression of the intrathecal segment of the nerve root as demonstrated by radiculography. The interest for such a study lies in the fact that, in contradistinction to the distal, extrathecal root segment outlined by fat in the foramen, the proximal segment within the dural sac cannot be distinguished from the surrounding CSF by CT. CT features assessed consisted of deformation of the dural sac and displacement of the surrounding epidural fat. These features were compared with radiculographic signs of root involvement in the same location: kinking of the nerve root, local swelling of the root within the dural sac or the root sheath, and cutoff of root-sheath filling. In addition, a separate "expert opinion" verdict was given in each location as to the likelihood of compression of the intrathecal root segment on the basis of CT findings as confirmed or rejected by radiculography. A degree of correlation existed between CT and radiculographic features in clearly normal or abnormal locations, but there were some marked discrepancies. In borderline cases there were many discrepancies. The lack of agreement was confirmed by generally disappointing kappa values. The expert opinion, combining separate radiologic features into verdicts for CT and radiculography, did not lead to significantly better agreement as expressed by kappa, but less extreme discrepancies were seen. It proved to be possible, however, to distinguish locations with CT features likely to correlate well the radiculographic picture from those less likely to show good correlation. Such a distinction can guide the decision whether or not to perform confirmatory radiculography. False-positive locations were identified by questionnaire; CT and radiculographic features proved to differ only a matter of degree from the same features is presumably symptomatic locations. CT and radiculographic findings in compression of the intrathecal segment of the nerve root are complementary. Correlating the two studies is of limited value because they provide different anatomic information.
对100例同时接受了脊髓CT扫描和神经根造影检查的患者进行了研究，目的是确定与神经根造影所示鞘内神经根段受压相关的形态学CT特征。进行这项研究的意义在于，与椎间孔内由脂肪勾勒出的远端鞘外神经根段不同，硬膜囊内的近端神经根段在CT上无法与周围的脑脊液区分开来。评估的CT特征包括硬膜囊变形和周围硬膜外脂肪移位。将这些特征与同一部位神经根受累的神经根造影征象进行比较：神经根扭结、硬膜囊或神经根鞘内神经根局部肿胀以及神经根鞘充盈中断。此外，根据CT表现并经神经根造影证实或否定，在每个部位给出关于鞘内神经根段受压可能性的单独“专家意见”判定。在明显正常或异常的部位，CT和神经根造影特征之间存在一定程度的相关性，但也存在一些明显差异。在临界病例中，差异很多。kappa值普遍令人失望，证实了两者之间缺乏一致性。将单独的放射学特征综合为CT和神经根造影判定的专家意见，并没有使kappa表示的一致性显著提高，但差异没那么极端。然而，确实有可能将CT特征与神经根造影图像可能有良好相关性的部位与那些不太可能显示良好相关性的部位区分开来。这种区分可以指导是否进行确认性神经根造影的决策。通过问卷调查确定了假阳性部位；CT和神经根造影特征与推测为有症状部位的相同特征仅在程度上有所不同。神经根鞘内段受压的CT和神经根造影结果是互补的。将这两项研究进行关联的价值有限，因为它们提供的解剖学信息不同。
