Xu Nanfang, Wang Shaobo, Yuan Huishu, Liu Xiaoguang, Liu Zhongjun
Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China.
Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China.
World Neurosurg. 2017 Apr;100:474-479. doi: 10.1016/j.wneu.2017.01.047. Epub 2017 Jan 24.
We aimed to critically analyze the current evidence regarding the role of dynamic supine magnetic resonance imaging (dsMRI) in the evaluation of cervical spondylotic myelopathy.
Thirteen studies were identified through a comprehensive literature search performed in the PubMed, EMBASE, and ISI databases as fulfilling the inclusion criteria and were reviewed for subject characteristics, radiographic parameters, and salient findings.
Studies herein reviewed suggested that dsMRI was able to detect new appearance or increased grade of medullary compression in ≥20% of patients and to demonstrate an average narrowing of the cervical canal by 20% (in comparison with the neutral position). Several additional parameters were investigated, but their clinical significance remained unconfirmed. Two studies examined how surgical decision-making could be affected by the additional findings of dsMRI.
dsMRI represents an available modification of conventional static magnetic resonance imaging and is potentially able to demonstrate pathologies that might be previously missed. Evidence suggests that dsMRI can elucidate spinal cord compression with higher sensitivity, resulting in improved diagnostic accuracy of cervical spondylotic myelopathy, which may impact surgical planning for these patients. However, more high-quality studies are required to further establish its indications to avoid overdiagnosis with this powerful imaging technique and to justify its cost-effectiveness.
我们旨在严格分析当前关于动态仰卧位磁共振成像（dsMRI）在评估脊髓型颈椎病中作用的证据。
通过在PubMed、EMBASE和ISI数据库中进行全面文献检索，确定了13项符合纳入标准的研究，并对其受试者特征、影像学参数和显著发现进行了综述。
本文综述的研究表明，dsMRI能够在≥20%的患者中检测到新出现的或髓质压迫等级增加的情况，并显示颈椎管平均狭窄20%（与中立位相比）。还研究了其他几个参数，但其临床意义尚未得到证实。两项研究探讨了dsMRI的额外发现如何影响手术决策。
dsMRI是传统静态磁共振成像的一种可用改进，有可能显示出之前可能遗漏的病变。有证据表明，dsMRI能够以更高的灵敏度阐明脊髓压迫情况，从而提高脊髓型颈椎病的诊断准确性，这可能会影响这些患者的手术规划。然而，需要更多高质量的研究来进一步确定其适应证，以避免使用这种强大的成像技术导致过度诊断，并证明其成本效益。
