无放射学异常的颈脊髓损伤患者的延迟磁共振成像
Delayed Magnetic Resonance Imaging in Patients With Cervical Spinal Cord Injury Without Radiographic Abnormality.
作者信息
Ouchida Jun, Yukawa Yasutsugu, Ito Keigo, Katayama Yoshito, Matsumoto Tomohiro, Machino Masaaki, Inoue Taro, Tomita Keisuke, Kato Fumihiko
机构信息
Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan.
出版信息
Spine (Phila Pa 1976). 2016 Aug 15;41(16):E981-E986. doi: 10.1097/BRS.0000000000001505.
STUDY DESIGN
A prospective imaging study to develop diagnostic criteria.
OBJECTIVE
The aim of this study was to investigate image findings on delayed magnetic resonance imaging (MRI) after the acute phase of spinal cord injury without radiographic abnormality (SCIWORA) and their relationship with symptom severity.
SUMMARY OF BACKGROUND DATA
MRI is used to diagnose acute neurological injury, with increased signal intensity (ISI) and prevertebral hyperintensity (PVH) often seen in patients with SCIWORA; however, changes after the acute phase are unclear.
METHODS
We included 68 patients diagnosed with SCIWORA within 48 hours of injury. We then compared their acute (within 2 days) and delayed (after 2 weeks) MRI images. ISI grade (0-3) and ISI and PVH ranges (relative to the C3 vertebral height) were measured. Neurological status at admission and 2 weeks after injury was assessed by the Japanese Orthopaedic Association scoring system for cervical myelopathy (JOA score) and the American Spinal Injury Association impairment scale.
RESULTS
For acute MRI, the rates of grade 0, 1, and 2 ISI were 4, 54, and 10 patients, respectively. For delayed MRI, the rates of grade 0, 1, and 2 ISI changed to 3, 31, and 34 patients, respectively. ISI ranges reduced in delayed MRI, but there was no significance. PVH ranges were 3.0 ± 1.7 in acute MRI, and reduced to 1.3 ± 0.9 with significant difference (P < 0.001). There were significant negative correlations with the JOA score for ISI grades on delayed MRI only (r = -0.49). However, there were significant negative correlations with the JOA score for the PVH range on both the acute (r = -0.55) and delayed (r = -0.46) MRI.
CONCLUSION
When comparing acute and delayed MRI, there were significant differences in ISI and PVH findings. Delayed MRI also reflected the clinical symptom severity, giving useful information about the state of the spinal cord.
LEVEL OF EVIDENCE
研究设计
一项用于制定诊断标准的前瞻性影像学研究。
目的
本研究旨在调查无放射学异常的脊髓损伤（SCIWORA）急性期后延迟磁共振成像（MRI）的影像表现及其与症状严重程度的关系。
背景数据总结
MRI用于诊断急性神经损伤，SCIWORA患者常可见信号强度增加（ISI）和椎体前高信号（PVH）；然而，急性期后的变化尚不清楚。
方法
我们纳入了68例在受伤后48小时内被诊断为SCIWORA的患者。然后比较他们的急性期（2天内）和延迟期（2周后）MRI图像。测量ISI分级（0 - 3级）以及ISI和PVH范围（相对于C3椎体高度）。入院时和受伤后2周的神经功能状态通过日本骨科协会颈椎病评分系统（JOA评分）和美国脊髓损伤协会损伤量表进行评估。
结果
对于急性期MRI，ISI 0级、1级和2级的患者分别为4例、54例和10例。对于延迟期MRI，ISI 0级、1级和2级的患者分别变为3例、31例和34例。延迟期MRI的ISI范围减小，但无统计学意义。急性期MRI的PVH范围为3.0±1.7，延迟期降至1.3±0.9，差异有统计学意义（P < 0.001）。仅延迟期MRI的ISI分级与JOA评分有显著负相关（r = -0.49）。然而，急性期（r = -0.55）和延迟期（r = -0.46）MRI的PVH范围与JOA评分均有显著负相关。
结论
比较急性期和延迟期MRI时，ISI和PVH表现存在显著差异。延迟期MRI也反映了临床症状严重程度，为脊髓状态提供了有用信息。
证据级别
3级。
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