Department of Medical Imaging, Heraklion University Hospital, Voutes, 71110, Crete, Greece.
Department of Orthopaedics, University Hospital of Heraklion, Voutes, 71110, Crete, Greece.
Eur Radiol. 2018 Feb;28(2):447-458. doi: 10.1007/s00330-017-4982-x. Epub 2017 Aug 7.
To increase the clinical awareness of piriformis muscle syndrome (PMs) by reporting cross-sectional imaging findings, the clinical impact of imaging studies and treatment outcome.
Within a 10-year-period, 116 patients referred for radiological evaluation of clinically suspected PMs, with excluded lumbar pathology related to symptomatology, were prospectively studied with MRI and/or computed tomography (CT). Piriformis muscle (PM), sciatic nerve (SN), piriformis region and sacroiliac joints were evaluated. PMs was categorised into primary/secondary, according to a reported classification system. Treatment decisions were recorded. Outcome was categorised using a 3-point-scale.
Seventy-four patients (63.8%) exhibited pathologies related to PMs. Primary causes were detected in 12 and secondary in 62 patients. PM enlargement was found in 45.9% of patients, abnormal PM signal intensity/density in 40.5% and sciatic neuritis in 25.7%. Space-occupying lesions represented the most common related pathology. Treatment proved effective in 5/8 patients with primary and 34/51 patients with secondary PMs. In 34 patients, imaging revealed an unknown underlying medical condition and altered treatment planning.
Secondary PMs aetiologies appear to prevail. In suspected PMs, PM enlargement represented the most common imaging finding and space-occupying lesions the leading cause. Imaging had the potential to alter treatment decisions.
• In clinically suspected PMs cross-sectional imaging may reveal variable pathology. • Secondary PMs aetiologies appeared to be more common than primary. • PM enlargement represented the most common imaging finding in clinically suspected PMs. • Space-occupying lesions in the piriformis region represented the leading cause of PMs. • In clinically suspected PMs cross-sectional imaging may alter treatment planning.
通过报告影像学表现、影像学研究的临床影响和治疗结果，提高对梨状肌综合征（PMs）的临床认识。
在 10 年期间，对 116 例因临床疑似 PMs 而接受影像学评估的患者进行前瞻性研究，这些患者排除了与症状相关的腰椎病变。采用 MRI 和/或计算机断层扫描（CT）进行评估。评估梨状肌（PM）、坐骨神经（SN）、梨状肌区域和骶髂关节。根据报告的分类系统，将 PMs 分为原发性/继发性。记录治疗决策。使用 3 分制对结果进行分类。
74 例患者（63.8%）存在与 PMs 相关的病变。原发性病因在 12 例患者中发现，继发性病因在 62 例患者中发现。45.9%的患者存在 PM 增大，40.5%的患者存在 PM 信号强度/密度异常，25.7%的患者存在坐骨神经炎。占位性病变是最常见的相关病变。原发性 PMs 中 5/8 例患者和继发性 PMs 中 34/51 例患者的治疗有效。在 34 例患者中，影像学显示存在未知的潜在医学疾病，并改变了治疗计划。
继发性 PMs 病因似乎更为常见。在疑似 PMs 中，PM 增大是最常见的影像学表现，占位性病变是主要病因。影像学有改变治疗决策的潜力。
在临床疑似 PMs 中，横断面成像可能会发现不同的病变。
继发性 PMs 病因似乎比原发性更为常见。
在临床疑似 PMs 中，PM 增大是最常见的影像学表现。
梨状肌区域的占位性病变是 PMs 的主要病因。
在临床疑似 PMs 中，横断面成像可能会改变治疗计划。
