Hansen Bjarke Brandt
Dan Med J. 2017 Oct;64(10).
This PhD thesis is based on three scientific papers. In 2011 the Parker Institute the department of rheumatology introduced standing weight-bearing MRI (G-Scan, ESAOTE, Genova, Italy) in the diagnostic of low back pain patients. Unfortunately, we experienced a substantial risk of fainting (orthostatic syncope) during standing pMRI. In paper 1 we present in an observational study that the risk of fainting (19%) during standing pMRI could almost be eliminated by the use of an external pneumatic compression device (2%). The lumbar lordosis in the standing position is a significant contributor to positional changes in the morphology in the lumbar spine. In paper 2, we present in an observational study that changes in lumbar lordosis angle (ΔLA) between the conventional supine and standing position were independent of pain and the degenerative disc score. Before a full introduction of standing pMRI in clinical practice, it is important to know if the interpretation of positional changes in common degenerative findings has a sufficient reproducibility. In paper 3, we present in a reliability study that the pMRI evaluation has a fair to substantial reliability, although positional changes in the lumbar spine's morphology from the supine to the standing seems a less reliable outcome. There are currently no international evidence-based recommendations for the use of standing pMRI, and we have limited knowledge about how to interpret these positional changes in the lumbar spine into a clinical context. Therefore, further research is warranted to test the precision (sensitivity and specificity) in prospective longitudinal studies or RCTs. However, from a clinical perspective it seems logical to scan patients with low back pain in the position worsening their symptoms - typically the upright position. Therefore, standing pMRI may provide a higher diagnostic specificity and additional benefit to low back pain patients in the future.
本博士论文基于三篇科学论文。2011年，帕克研究所的风湿病学系在腰痛患者的诊断中引入了站立负重磁共振成像（G-Scan，意大利热那亚的ESAOTE公司）。不幸的是，我们在站立式磁共振成像过程中经历了相当大的昏厥风险（体位性晕厥）。在论文1中，我们在一项观察性研究中指出，使用外部气动压缩装置（昏厥风险为2%）几乎可以消除站立式磁共振成像期间的昏厥风险（19%）。站立位时的腰椎前凸是腰椎形态位置变化的一个重要因素。在论文2中，我们在一项观察性研究中指出，传统仰卧位和站立位之间的腰椎前凸角度变化（ΔLA）与疼痛和椎间盘退变评分无关。在临床实践中全面引入站立式磁共振成像之前，了解常见退变表现的位置变化解读是否具有足够的可重复性非常重要。在论文3中，我们在一项可靠性研究中指出，尽管从仰卧位到站立位腰椎形态的位置变化似乎是一个不太可靠的结果，但磁共振成像评估具有中等至较高的可靠性。目前尚无关于使用站立式磁共振成像的国际循证推荐，而且我们对于如何将腰椎的这些位置变化解读到临床背景中的了解有限。因此，有必要在前瞻性纵向研究或随机对照试验中进一步研究以测试其准确性（敏感性和特异性）。然而，从临床角度来看，对症状加重体位（通常是直立位）的腰痛患者进行扫描似乎是合乎逻辑的。因此，站立式磁共振成像未来可能会为腰痛患者提供更高的诊断特异性和额外益处。
