Department of Neurosurgery, Yale University School of Medicine, Toronto, Ontario, Canada.
Department of Neurosurgery, Kerman University of Medical Sciences, Kerman, Iran.
Spine (Phila Pa 1976). 2017 Dec 15;42(24):1851-1858. doi: 10.1097/BRS.0000000000002234.
Retrospective analysis of prospective data.
To assess the relationship between MRI signal intensity changes, clinical presentation, and surgical outcome in degenerative cervical myelopathy (DCM).
Several studies have sought to assess the extent of spinal cord dysfunction and the potential for postoperative neurological recovery through the evaluation of spinal cord signal change on T2-weighted (T2WI) and T1-weighted images (T1WI). There remains ambiguity if T2WI and T1WI signal changes (1) relate to baseline severity, and (2) predict neurological recovery after surgical treatment.
Four hundred nineteen MRIs from two prospective multicenter studies were examined. Images were assessed for the presence, levels, and location of spinal cord signal intensity changes and compared with clinical data. Signal changes were also evaluated for the prediction of 2-year postoperative outcome using mJOA parameters.
MRIs were categorized by T1WI and T2WI signal change: no signal change (28.9%), T2WI hyperintensity-only (T2WI-only, 51.8%), and T2WI-hyperintensity and T1WI-hypointensity (T1WI+T2WI, 19.3%). T2WI-hyperintensity was present at multiple levels in 27% of patients overall. Baseline severity increased from no signal change to T2WI-only to T2WI+T1WI (P < 0.0001), and there was an incremental increase in the frequency of signs/symptoms. There were no differences in outcomes between no signal change and T2WI-only groups. The presence of T1WI-hypointensity correlated with reduced recovery ratio (P = 0.03) and likelihood of an optimal surgical outcome (P = 0.005), adjusting for baseline mJOA. A greater number of T2WI-hyperintensity levels was also associated with worse baseline severity (P < 0.0001) and recovery ratio (P = 0.001).
This analysis of a global cohort of DCM patients shows a stepwise trend toward increasing impairment from no signal change to T2WI-hypertensity to T1WI-hypointensity. T1WI signal change indicates more permanent injury, portending decreased functional recovery. T2WI-hyperintensity alone does not predict outcomes. Multiple levels of T2WI-hyperintensity suggest additional tissue injury, correlating with worse clinical impairment and recovery potential.
前瞻性数据的回顾性分析。
评估退行性颈椎脊髓病（DCM）中 MRI 信号强度变化、临床表现与手术结果之间的关系。
几项研究试图通过评估 T2 加权（T2WI）和 T1 加权图像（T1WI）上脊髓信号变化来评估脊髓功能障碍的程度和术后神经恢复的潜力。对于 T2WI 和 T1WI 信号变化（1）是否与基线严重程度相关，以及（2）是否能预测手术治疗后的神经恢复，目前仍存在争议。
对来自两个前瞻性多中心研究的 419 例 MRI 进行了检查。评估了脊髓信号强度变化的存在、水平和位置，并与临床数据进行了比较。还使用 mJOA 参数评估了信号变化对术后 2 年结果的预测。
根据 T1WI 和 T2WI 信号变化对 MRI 进行分类：无信号变化（28.9%）、T2WI 高信号（T2WI-only，51.8%）和 T2WI 高信号伴 T1WI 低信号（T1WI+T2WI，19.3%）。总体而言，27%的患者 T2WI 高信号存在于多个节段。基线严重程度从无信号变化到 T2WI-only 再到 T2WI+T1WI 逐渐增加（P<0.0001），且体征/症状的发生频率也逐渐增加。无信号变化组与 T2WI-only 组之间的结果无差异。T1WI 低信号的存在与恢复比例降低（P=0.03）和获得最佳手术结果的可能性（P=0.005）相关，这是在调整基线 mJOA 后得到的结果。T2WI 高信号的数量增加也与基线严重程度（P<0.0001）和恢复比例（P=0.001）更差相关。
本分析对退行性颈椎脊髓病患者的全球队列进行了研究，结果显示，从无信号变化到 T2WI 高信号再到 T1WI 低信号，损伤程度呈逐步加重趋势。T1WI 信号变化表明更持久的损伤，预示着功能恢复减少。单纯的 T2WI 高信号并不能预测结果。多个节段的 T2WI 高信号提示有额外的组织损伤，与更严重的临床损伤和恢复潜力相关。
2 级。
