Lee Kyu H, Park Hee J, Lee So Y, Chung Eun C, Rho Myung H, Shin Hyunchul, Kwon Young J
1 Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
2 Department of Neurosurgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
Br J Radiol. 2016 Jun;89(1062):20150971. doi: 10.1259/bjr.20150971. Epub 2016 Mar 23.
To compare the reliability of two recently reported MR grading systems of cervical neural foraminal stenosis (CNFS) and their correlation with clinical manifestations.
We evaluated 188 patients (male : female = 80 : 108; mean age of 41 years) who visited our institution and underwent oblique sagittal MRI of the cervical spine. Two radiologists evaluated the MRI findings for the presence and grade of CNFS at the narrowest point, with the grading systems (Park, Kim and mKim systems) suggested by Park et al and Kim et al. More than one positive neurologic sign and more than one neurologic clinical symptom was considered a positive neurologic manifestation of each foraminal stenosis. Interobserver agreement between the two readers was analyzed using kappa statistics. Non-parametric correlation analysis (Spearman's correlation) was used to evaluate the correlation coefficients (R) to assess the relationship between CNFS grade and clinical manifestations.
Both the Park and mKim systems demonstrated a relatively high correlation (R = 0.714-0.764) between the CNFS grade and clinical manifestation, while the Kim system yielded a moderate correlation (by Reader 2). The Park and mKim systems demonstrated higher correlation values at the level of C6-7 than C4-5, while the Kim system showed no difference in correlation at the cervical spine level.
Both the Park and mKim systems provide a reliable, reproducible CNFS diagnosis, while the Kim system has a slightly inferior reliability. The Park and mKim systems had a similar, relatively high clinical correlation.
Grades 2 and 3 of the Park system and Grade 2 in the Kim and mKim systems exhibited a similar clinical significance. Patients with a grade of 0 (using each system) consistently exhibit negative neurologic manifestation.
比较最近报道的两种颈椎神经孔狭窄（CNFS）的磁共振成像（MRI）分级系统的可靠性及其与临床表现的相关性。
我们评估了188例到我院就诊并接受颈椎斜矢状位MRI检查的患者（男∶女 = 80∶108；平均年龄41岁）。两名放射科医生采用Park等人和Kim等人提出的分级系统（Park、Kim和mKim系统）评估MRI检查结果，以确定在最狭窄点处CNFS的存在情况及分级。超过一种阳性神经体征和超过一种神经临床症状被视为每个椎间孔狭窄的阳性神经表现。使用kappa统计分析两名阅片者之间的观察者间一致性。采用非参数相关分析（Spearman相关性分析）评估相关系数（R），以评估CNFS分级与临床表现之间的关系。
Park系统和mKim系统在CNFS分级与临床表现之间均显示出较高的相关性（R = 0.714 - 0.764），而Kim系统显示出中等相关性（由阅片者2评估）。Park系统和mKim系统在C6 - 7水平的相关性值高于C4 - 5水平，而Kim系统在颈椎各节段水平的相关性无差异。
Park系统和mKim系统均可提供可靠、可重复的CNFS诊断，而Kim系统的可靠性略低。Park系统和mKim系统具有相似的、相对较高的临床相关性。
Park系统的2级和3级以及Kim系统和mKim系统的2级具有相似的临床意义。（使用每个系统）分级为0的患者始终表现为阴性神经表现。
