Chang Han Soo, Nejo Takahide, Yoshida Shinsuke, Oya Soichi, Matsui Toru
From the Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Spine (Phila Pa 1976). 2014 Dec 15;39(26):2136-42. doi: 10.1097/BRS.0000000000000607.
STUDY DESIGN: Prospective controlled trial. OBJECTIVE: To describe a newly found increased flow signal in phase-contrast magnetic resonance imaging observed in compressed segments of the spinal cord in patients with cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: Derangement of cerebrospinal fluid movement in the spine is a well-known cause of syringomyelia. However, its possible role in CSM has not been studied well, despite the fact that similar derangement takes place in CSM. METHODS: In a consecutive series of 57 patients with CSM, cardiac-gated phase-contrast magnetic resonance imaging was analyzed. The amplitude of the flow signal obtained in the compressed segment of the spinal cord was compared with that obtained in the lesion-free C2 segment. It was also compared with controls obtained from 10 healthy volunteers. We also studied whether the amplitude was correlated with the severity of cervical canal stenosis, neurological symptoms, indication of surgery, and the presence of intramedullary high-intensity signal on T2-weighted images. In 33 patients who underwent decompression surgical procedures, we compared the amplitude of the flow signal between the preoperative and the postoperative study. RESULTS: Increased flow signal on phase-contrast study was seen in compressed segments of the spinal cord in 36 (63%) patients. The mean amplitude of the signal in the compressed segment was 0.64 ± 0.06 cm/s, whereas that in the C2 segment was 0.27 ± 0.01 and that in the controls was 0.28 ± 0.01. The flow signal linearly increased as the severity of canal stenosis increased. It significantly correlated with the symptom of upper-extremity dysesthesia, and the indication of surgery in these patients. The mean amplitude of the signal tended to be higher in those with intramedullary high-intensity signal than in those without. After decompression surgery, the increased flow signal was markedly diminished, and returned to a level comparable with the controls. CONCLUSION: Phase-contrast imaging demonstrated increased flow signal in compressed segments of the spinal cord in a majority of patients with CSM. This suggests a possible role played by derangement of cerebrospinal fluid movement in CSM. It also suggests potential usefulness of phase-contrast study in the management of patients with CSM. LEVEL OF EVIDENCE: 2.
研究设计：前瞻性对照试验。 目的：描述在脊髓型颈椎病（CSM）患者脊髓受压节段的相位对比磁共振成像中新发现的血流信号增加情况。 背景资料总结：脊柱中脑脊液流动紊乱是脊髓空洞症的一个众所周知的病因。然而，尽管在CSM中也发生了类似的紊乱，但其在CSM中的可能作用尚未得到充分研究。 方法：对连续的57例CSM患者进行心脏门控相位对比磁共振成像分析。将脊髓受压节段获得的血流信号幅度与无病变的C2节段获得的信号幅度进行比较。还与10名健康志愿者的对照数据进行了比较。我们还研究了该幅度是否与颈椎管狭窄的严重程度、神经症状、手术指征以及T2加权图像上髓内高强度信号的存在相关。在33例接受减压手术的患者中，我们比较了术前和术后研究中血流信号的幅度。 结果：36例（63%）患者的脊髓受压节段在相位对比研究中出现血流信号增加。受压节段信号的平均幅度为0.64±0.06cm/s，而C2节段为0.27±0.01cm/s，对照组为0.28±0.01cm/s。随着椎管狭窄严重程度的增加，血流信号呈线性增加。它与上肢感觉异常症状以及这些患者的手术指征显著相关。有髓内高强度信号的患者信号平均幅度往往高于无信号的患者。减压手术后，增加的血流信号明显减弱，并恢复到与对照组相当的水平。 结论：相位对比成像显示大多数CSM患者脊髓受压节段血流信号增加。这表明脑脊液流动紊乱在CSM中可能起作用。这也表明相位对比研究在CSM患者管理中的潜在用途。 证据级别：2级。
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