Petrasic J R, Chhabra A, Scott K M
From the Departments of Physical Medicine and Rehabilitation (J.R.P., K.M.S.).
Radiology (A.C.), University of Texas Southwestern Medical Center, Dallas, Texas
AJNR Am J Neuroradiol. 2017 Feb;38(2):418-422. doi: 10.3174/ajnr.A4994. Epub 2016 Nov 10.
Chronic cauda equina syndrome, defined as persistent damage of the cauda equina nerve roots within the spinal canal can be a challenging diagnosis with varied presentations. MR neurography imaging is more commonly being used to evaluate the lumbosacral spine of patients suspected of having subacute or chronic cauda equina syndrome. Our aim was to evaluate the impact of lumbosacral plexus MR neurography in the diagnostic thinking and therapeutic management of patients presenting with chronic pelvic pain and dysfunction and suspected chronic cauda equina syndrome.
Consecutive MR neurography lumbosacral plexus examinations at our institution were reviewed retrospectively. Relevant data collected included the following: patient demographics, clinical history, pertinent physical examination findings, preimaging diagnostic impression, prior MR imaging lumbar spine findings, MR neurography findings, postimaging diagnosis, and postimaging treatment plan. The impact of imaging on the preimaging clinical diagnosis and therapeutic management was evaluated.
Of 185 studies of patients who presented with chronic pelvic pain and/or dysfunction, 23 with clinically suspected chronic cauda equina syndrome and imaging findings were included in the study (2 subjects were lost to follow-up). The mean ages were 53 ± 12 years and 53 ± 16 years for men and women, respectively. The common etiologies included arachnoiditis ( = 8), tethered cord ( = 2), and simple/Tarlov cysts ( = 3). Eighteen of 23 (78%) subjects had a change in diagnosis resulting from MR neurography findings, and 5/23 (22%) had no change. Seventeen of 21 (81%) subjects had a change in management, and 4/21 (19%) had no change.
MR neurography impacts the diagnosis and therapeutic management of patients with suspected chronic cauda equina syndrome.
慢性马尾综合征被定义为椎管内马尾神经根的持续性损伤，其临床表现多样，诊断具有挑战性。磁共振神经成像越来越多地用于评估疑似患有亚急性或慢性马尾综合征患者的腰骶部脊柱。我们的目的是评估腰骶丛磁共振神经成像对表现为慢性盆腔疼痛和功能障碍且疑似慢性马尾综合征患者的诊断思路及治疗管理的影响。
回顾性分析了在我院连续进行的腰骶丛磁共振神经成像检查。收集的相关数据包括：患者人口统计学资料、临床病史、相关体格检查结果、成像前诊断印象、既往腰椎磁共振成像结果、磁共振神经成像结果、成像后诊断及成像后治疗计划。评估了成像对成像前临床诊断及治疗管理的影响。
在185例表现为慢性盆腔疼痛和/或功能障碍的患者研究中，23例临床疑似慢性马尾综合征且有成像结果的患者纳入研究（2例失访）。男性和女性的平均年龄分别为53±12岁和53±16岁。常见病因包括蛛网膜炎（n = 8）、脊髓栓系（n = 2）和单纯/Tarlov囊肿（n = 3）。23例患者中有18例（78%）因磁共振神经成像结果导致诊断改变，5/23例（22%）无变化。21例患者中有17例（81%）治疗管理发生改变，4/21例（19%）无变化。
磁共振神经成像对疑似慢性马尾综合征患者的诊断及治疗管理有影响。
