Gadde Judith A, Shah Vinil, Liebo Greta B, Ringstad Geir A, Pomeraniec I Jonathan, Bakke Soren J, Fric Radek, Ksendzovsky Alexander, Jane John A, Schwartz Erin S, Haughton Victor
1 Department of Radiology, The Children's Hospital of Philadelphia, USA.
2 Department of Radiology, University of California San Francisco, USA.
Neuroradiol J. 2017 Oct;30(5):405-409. doi: 10.1177/1971400917718842. Epub 2017 Jul 10.
Purpose The relationship between syringomyelia and presyrinx, characterized by edema in the spinal cord, has not been firmly established. Patients with syringomyelia have abnormal spinal canal tapering that alters cerebrospinal fluid flow dynamics, but taper ratios in presyrinx have never been reported. We tested the hypothesis that presyrinx patients have abnormal spinal canal tapering. Materials and methods At six medical institutions, investigators searched the PACS system for patients with Chiari I and spinal cord edema unassociated with tumor, trauma, or other evident cause. In each case taper ratios were calculated for C1 to C4 and C4 to C7. In two age- and gender-matched control groups, Chiari I patients with no syringomyelia and patients with normal MR scans, the same measurements were made. Differences between groups were tested for statistical significance with t tests. Results The study enrolled 21 presyrinx patients and equal numbers of matched Chiari I and normal controls. C4 to C7 taper ratios were positive and steeper in presyrinx patients than in the normal controls ( p = 0.04). The upper cervical spine, C1 to C4, tapered negatively in cases and controls without significant differences between the groups. The difference in degree of tonsillar herniation was statistically significant between presyrinx patients and Chiari I controls ( p = 0.01). Conclusions Presyrinx patients have greater than normal positive tapering in the lower cervical spine and greater degree of tonsillar herniation than the controls.
目的 脊髓空洞症与空洞前状态（以脊髓水肿为特征）之间的关系尚未完全明确。脊髓空洞症患者存在椎管异常变窄，这会改变脑脊液流动动力学，但空洞前状态下的变窄比率此前从未有过报道。我们检验了空洞前状态患者存在椎管异常变窄这一假设。材料与方法 在六家医疗机构，研究人员在 Picture Archiving and Communication System（PACS）系统中搜索患有 Chiari I 型畸形且脊髓水肿与肿瘤、创伤或其他明显病因无关的患者。对每个病例计算 C1 至 C4 和 C4 至 C7 的变窄比率。在两个年龄和性别匹配的对照组中，即没有脊髓空洞症的 Chiari I 型畸形患者和磁共振成像（MR）扫描正常的患者，进行相同的测量。使用 t 检验对组间差异进行统计学显著性检验。结果 该研究纳入了 21 例空洞前状态患者以及数量相等的匹配的 Chiari I 型畸形患者和正常对照组。空洞前状态患者 C4 至 C7 的变窄比率为正值且比正常对照组更陡（p = 0.04）。在病例组和对照组中，上颈椎（C1 至 C4）呈负向变窄，两组之间无显著差异。空洞前状态患者与 Chiari I 型畸形对照组之间扁桃体疝程度的差异具有统计学显著性（p = 0.01）。结论 空洞前状态患者下颈椎的正向变窄大于正常情况，且扁桃体疝程度比对照组更严重。
