使用腰枕的传统仰卧位磁共振成像：诊断腰椎管狭窄症时负重磁共振成像的替代方法？一项横断面研究。
Conventional Supine MRI With a Lumbar Pillow-An Alternative to Weight-bearing MRI for Diagnosing Spinal Stenosis?: A Cross-sectional Study.
作者信息
Hansen Bjarke Brandt, Hansen Philip, Grindsted Jacob, Rasti Zoreh, Bliddal Henning, Riis Robert G C, Boesen Mikael
机构信息
Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.
Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.
出版信息
Spine (Phila Pa 1976). 2017 May 1;42(9):662-669. doi: 10.1097/BRS.0000000000001889.
STUDY DESIGN
Cross-sectional study.
OBJECTIVE
To investigate if adding a lumbar pillow in supine position during magnetic resonance imaging (MRI) is superior to standing positional MRI for diagnosing lumbar spinal stenosis (LSS).
SUMMARY OF BACKGROUND DATA
The upright standing position and especially extension of the lumbar spine seem to worsening symptoms of LSS. However, it is unclear whether a forced lumbar extension by a pillow in the lower back during conventional supine MRI may improve the diagnostics of LSS compared with standing MRI.
METHODS
Patients suspected for LSS and referred to conventional MRI were included to an additional positional MRI scan (0.25T G-Scan) performed in: (1) conventional supine, (2) standing, (3) supine with a lumbar pillow in the lower back. LSS was evaluated for each position in consensus on a 0 to 3 semi-quantitative grading scale. Independently, L2-S1 lordosis angle, spinal cross-sectional diameter (SCSD), dural cross-sectional diameter (DCSD), and dural cross-sectional diameter (DCSA) were measured. The smallest dural diameter was defined as stenosis level and the largest control level for comparison.
RESULTS
Twenty-seven patients (60.6 years; ±9.4) were included. The lordosis angle increased significantly from supine to standing (3.2° CI: 1.2-5.2) and with the lumbar pillow (12.8° CI: 10.3-15.3). One-way analysis of variance (ANOVA) showed significant differences between positions (P < 0.001). When compared with the supine position, pairwise comparisons showed decreased SCSD, DCSD, DCSA, and increasing semi-quantitative grading, during both standing and supine with the lumbar pillow. A difference in the semi-quantitative grades was only found between standing and supine with a lumbar pillow, and the scan with a lumbar pillow was significantly more painful.
CONCLUSION
Standing MRI and supine MRI with a lumbar pillow resulted in equal changes in the lumbar spine, although standing MRI may be more sensitive in the assessment of patients suspected for LSS.
LEVEL OF EVIDENCE
研究设计
横断面研究。
目的
探讨在磁共振成像（MRI）仰卧位时添加腰枕是否优于站立位MRI用于诊断腰椎管狭窄症（LSS）。
背景数据总结
直立站立位，尤其是腰椎伸展似乎会加重LSS症状。然而，与站立位MRI相比，在传统仰卧位MRI期间通过腰背部的枕头强制腰椎伸展是否能改善LSS的诊断尚不清楚。
方法
疑似LSS并接受传统MRI检查的患者被纳入额外的体位MRI扫描（0.25T G-Scan），扫描体位包括：（1）传统仰卧位；（2）站立位；（3）仰卧位且在腰背部放置腰枕。根据0至3的半定量分级量表对每个体位的LSS进行一致评估。独立测量L2-S1前凸角、脊柱横截面积（SCSD）、硬脊膜横截面积（DCSD）和硬脊膜横截面积（DCSA）。最小的硬脊膜直径被定义为狭窄水平，最大的作为对照水平用于比较。
结果
纳入27例患者（60.6岁；±9.4）。从仰卧位到站立位以及使用腰枕时，前凸角显著增加（3.2°，可信区间：1.2 - 5.2）和（12.8°，可信区间：10.3 - 15.3）。单因素方差分析（ANOVA）显示不同体位之间存在显著差异（P < 0.001）。与仰卧位相比，两两比较显示在站立位和使用腰枕的仰卧位时，SCSD、DCSD、DCSA均减小，半定量分级增加。仅在站立位和使用腰枕的仰卧位之间发现半定量分级存在差异，并且使用腰枕的扫描疼痛明显更严重。
结论
站立位MRI和使用腰枕的仰卧位MRI在腰椎产生的变化相同，尽管站立位MRI在评估疑似LSS患者时可能更敏感。
证据级别
2级。
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