1 Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, 55 Fruit St, Gray 2, Rm 273A, Boston, MA 02114.
AJR Am J Roentgenol. 2015 May;204(5):1082-5. doi: 10.2214/AJR.14.13310.
The workup of a syrinx often includes contrast-enhanced MRI to exclude the presence of an underlying mass. The diagnostic yield of performing these additional contrast-enhanced sequences is not well defined in the literature. We hypothesized that T2-weighted imaging alone could reliably exclude the presence of a syrinx-associated mass without the need for contrast-enhanced imaging sequences in all cases.
Two independent readers retrospectively analyzed contrast-enhanced MRI studies of 87 consecutive patients with syringes. The presence or absence of an associated spinal cord mass was determined using only T2-weighted imaging. The imaging features considered positive for a possible syrinx-associated lesion on T2-weighted imaging were syrinx nodularity, syrinx septations, and a spinal cord signal intensity abnormality or a mass separate from the syrinx. The size of the syrinx was also recorded. Using contrast-enhanced sequences as the reference standard, statistical analysis was performed to determine the accuracy of T2-weighted imaging in detecting a syrinx-associated mass.
Of the 87 cases of syrinx, there were 23 mass lesions, 11 Chiari malformations, three spinal cord contusions, and 50 idiopathic syringes. Using T2-weighted imaging alone, readers detected no findings suspicious for a syrinx-associated mass in 55 cases and detected findings suspicious for a mass in 32 of 87 cases. Reader sensitivity for an underlying mass lesion was 100%; specificity, 86%; positive predictive value, 72%; and negative predictive value, 100%. Interreader agreement was excellent (κ = 0.88). Syrinx size showed a positive correlation with the presence of a mass lesion (p < 0.0001).
T2-weighted imaging alone appears to have a high sensitivity and high negative predictive value in evaluating for a syrinx-associated mass, and contrast-enhanced imaging may not be required for the workup of a syrinx.
脊髓空洞症的检查通常包括增强 MRI，以排除潜在的肿块。在文献中，这些额外的增强序列检查的诊断收益尚未明确。我们假设，仅 T2 加权成像就可以可靠地排除存在与脊髓空洞相关的肿块，而无需在所有情况下进行对比增强成像序列。
两位独立的读者回顾性分析了 87 例连续脊髓空洞症患者的增强 MRI 研究。仅使用 T2 加权成像确定是否存在相关的脊髓肿块。T2 加权成像上存在脊髓空洞结节、空洞分隔、脊髓信号强度异常或与脊髓空洞分离的肿块等表现被认为与脊髓空洞相关病变可能有关。还记录了脊髓空洞的大小。使用增强序列作为参考标准，进行统计学分析以确定 T2 加权成像检测与脊髓空洞相关的肿块的准确性。
在 87 例脊髓空洞症中，有 23 例肿块病变、11 例 Chiari 畸形、3 例脊髓挫伤和 50 例特发性脊髓空洞症。仅使用 T2 加权成像，两位读者在 55 例中未发现可疑与脊髓空洞相关的肿块，在 87 例中有 32 例发现可疑肿块。读者对潜在肿块病变的敏感性为 100%；特异性为 86%；阳性预测值为 72%；阴性预测值为 100%。两位读者之间的一致性极好（κ=0.88）。脊髓空洞的大小与肿块病变的存在呈正相关（p<0.0001）。
仅 T2 加权成像在评估与脊髓空洞相关的肿块时具有较高的敏感性和较高的阴性预测值，并且可能不需要对脊髓空洞进行对比增强成像。
