术后磁共振成像信号强度变化的消退及其对退行性颈椎脊髓病患者预后的影响：全球患者队列分析。
Postoperative Resolution of Magnetic Resonance Imaging Signal Intensity Changes and the Associated Impact on Outcomes in Degenerative Cervical Myelopathy: Analysis of a Global Cohort of Patients.
机构信息
Divisions of Neurosurgery, Orthopedic Surgery and Spinal Program, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada.
Department of Neurosurgery, University of Cincinnati, Cincinnati, OH.
出版信息
Spine (Phila Pa 1976). 2018 Jun 15;43(12):824-831. doi: 10.1097/BRS.0000000000002426.
STUDY DESIGN
Subanalysis of the prospective AOSpine CSM North America and International studies.
OBJECTIVE
To describe the postoperative changes in magnetic resonance imaging (MRI) spinal cord signal intensity in degenerative cervical myelopathy (DCM) patients and to investigate the impact of its postoperative resolution on clinical outcomes.
SUMMARY OF BACKGROUND DATA
When examining the spinal cord, hyperintensity found in MRI T2-weighted images and hypointensity in T1-weighted images are known to correlate with preoperative severity of DCM and to predict postoperative neurological recovery. However, the clinical importance of these signal intensity changes in postoperative images has not been established.
METHODS
Among 757 surgical DCM patients enrolled in two prospective multicenter studies, postoperative MRI images obtained between 6 and 24 months after the operation were examined with a focus on T2 hyper- and T1 hypointensity in the spinal cord. The 2-year postoperative Nurick grade, modified Japanese Orthopaedic Association score and modified Japanese Orthopaedic Association recovery rate (RR) were analyzed between patients with or without resolution of signal intensity changes.
RESULTS
A total of 167 patients with preoperative T2 hyperintensity were included with complete postoperative MRI images. Of these patients, 11% showed resolution of signal intensity changes, 70% retained T2 hyperintensity only, and 19% showed both T2 hyper- and T1 hypointensity postoperatively. There was a stepwise trend toward worse postoperative outcomes, with the no signal intensity change group showing the best outcome and the T1 hypointensity group showing the worst (mean RR: 72% vs. 51% vs. 36%, P = 0.02). Patients who exhibited resolution of T2 hyperintensity showed better outcomes than those who retained it (RR: 72% vs. 47%, P = 0.04), but the resolution of T1 hypointensity was not associated with improved outcomes (RR: 38% vs. 26%, P = 0.36).
CONCLUSION
Postoperative resolution of T2 hyperintensity in patients with DCM was associated with the best clinical outcomes, whereas those with T1 hypointensity showed the worst.
LEVEL OF EVIDENCE
研究设计
前瞻性 AOSpine CSM 北美和国际研究的亚分析。
目的
描述退行性颈椎病（DCM）患者术后磁共振成像（MRI）脊髓信号强度的变化，并探讨其术后缓解对临床结果的影响。
背景资料概要
在检查脊髓时，MRI T2 加权图像中的高信号和 T1 加权图像中的低信号与术前 DCM 的严重程度相关，并可预测术后神经恢复。然而，术后图像中这些信号强度变化的临床重要性尚未确定。
方法
在两项前瞻性多中心研究中，共纳入 757 例手术治疗的 DCM 患者，对术后 6 至 24 个月的 MRI 图像进行检查，重点关注脊髓 T2 高信号和 T1 低信号。分析术后 2 年的 Nurick 分级、改良日本矫形协会评分和改良日本矫形协会恢复率（RR）在信号强度变化缓解和不缓解的患者之间的差异。
结果
共纳入 167 例术前 T2 高信号的患者，且均有完整的术后 MRI 图像。这些患者中，11%的患者信号强度变化得到缓解，70%的患者仅保留 T2 高信号，19%的患者术后同时出现 T2 高信号和 T1 低信号。术后结果呈逐步恶化趋势，无信号强度变化组的结果最好，T1 低信号组的结果最差（平均 RR：72%比 51%比 36%，P=0.02）。与保留 T2 高信号的患者相比，T2 高信号缓解的患者术后结局更好（RR：72%比 47%，P=0.04），但 T1 低信号的缓解与改善结局无关（RR：38%比 26%，P=0.36）。
结论
DCM 患者术后 T2 高信号缓解与最佳临床结局相关，而 T1 低信号则提示最差结局。
证据等级
3 级
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