Jeong Tae Seok, Ahn Yong, Lee Sang Gu, Kim Woo Kyung, Son Seong, Kwon Jung Hwa
Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea.
Department of Radiology, Nanoori Hospital, Seoul, Korea.
J Korean Neurosurg Soc. 2017 Jul;60(4):465-470. doi: 10.3340/jkns.2016.1010.004. Epub 2017 Jul 31.
Magnetic resonance imaging (MRI) grading systems using sagittal images are useful for evaluation of lumbar foraminal stenosis. We evaluated whether such a grading system is useful as a diagnostic tool for surgery.
Between July 2014 and June 2015, 99 consecutive patients underwent unilateral lumbar foraminotomy for lumbar foraminal stenosis. Surgically confirmed foraminal stenosis and the contralateral, asymptomatic neuroforamen were assessed based on a 4-point MRI grading system. Two experienced researchers independently evaluated the MR sagittal images. Interobserver agreement and intraobserver agreement were analyzed using κ statistics.
The mean age of patients (54 women, 45 men) was 62.5 years. A total of 101 levels (202 neuroforamens) were evaluated. MRI grades for operated neuroforamens were as follows: Grade 0 in 0.99%, Grade 1 in 5.28%, Grade 2 in 14.85%, and Grade 3 in 78.88%. Interobserver agreement was moderate for operated neuroforamens (κ=0.511) and good for asymptomatic neuroforamens (κ=0.696). Intraobserver agreement by reader 1 for operated neuroforamens was good (κ=0.776) and that for asymptomatic neuroforamens was very good (κ=0.831). In terms of lumbar level, interobserver agreement for L5-S1 (κ=0.313, fair) was relatively lower than the other level (κ=0.804, very good).
MRI grading system for lumbar foraminal stenosis is thought to be useful as a diagnostic tool for surgery in the lumbar spine; however, it is less reliable for symptomatic L5-S1 foraminal stenosis than for other levels. Thus, various clinical factors as well as the MRI grading system are required for surgical decision-making.
使用矢状位图像的磁共振成像（MRI）分级系统对评估腰椎椎间孔狭窄很有用。我们评估了这样一个分级系统作为手术诊断工具是否有用。
在2014年7月至2015年6月期间，99例连续患者因腰椎椎间孔狭窄接受了单侧腰椎椎间孔切开术。基于4分MRI分级系统评估手术证实的椎间孔狭窄以及对侧无症状的神经孔。两名经验丰富的研究人员独立评估MR矢状位图像。使用κ统计分析观察者间一致性和观察者内一致性。
患者平均年龄（54名女性，45名男性）为62.5岁。共评估了101个节段（202个神经孔）。手术神经孔的MRI分级如下：0级占0.99%，1级占5.28%，2级占14.85%，3级占78.88%。手术神经孔的观察者间一致性为中等（κ=0.511），无症状神经孔的观察者间一致性良好（κ=0.696）。读者1对手术神经孔的观察者内一致性良好（κ=0.776），对无症状神经孔的观察者内一致性非常好（κ=0.831）。就腰椎节段而言，L5-S1节段的观察者间一致性（κ=0.313，一般）相对低于其他节段（κ=0.804，非常好）。
腰椎椎间孔狭窄的MRI分级系统被认为是腰椎手术有用的诊断工具；然而，对于有症状的L5-S1椎间孔狭窄，其可靠性低于其他节段。因此，手术决策需要综合考虑各种临床因素以及MRI分级系统。
