定量磁化传递 MRI 测量颈椎脊髓病前脊髓区域与临床结果相关。
Quantitative Magnetization Transfer MRI Measurements of the Anterior Spinal Cord Region are Associated With Clinical Outcomes in Cervical Spondylotic Myelopathy.
机构信息
Department of Neurological Surgery, Northwestern Feinberg School of Medicine, Chicago, IL.
Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Stanford, CA.
出版信息
Spine (Phila Pa 1976). 2018 May 15;43(10):675-680. doi: 10.1097/BRS.0000000000002470.
STUDY DESIGN
A case-control study.
OBJECTIVE
The aim of this study was to understand the role of magnetization transfer ratio (MTR) in identifying patients with clinically significant myelopathy and disability.
SUMMARY OF BACKGROUND DATA
MTR is a quantitative measure that correlates with myelin loss and neural tissue destruction in a variety of neurological diseases. However, the usefulness of MTR in patients with cervical spondylotic myelopathy (CSM) has not been examined.
METHODS
We prospectively enrolled seven CSM patients and seven age-matched controls to undergo magnetic resonance imaging (MRI) of the cervical spine. Nurick, Neck Disability Index (NDI), and modified Japanese Orthopedic Association (mJOA) scores were collected for all patients. Clinical hyperreflexia was tested at the MCP joint, using a six-axis load cell. Reflex was simulated by quickly moving the joint from maximum flexion to maximum extension (300°/second). Anterior, lateral, and posterior cord MTR measurements were compared with clinical outcomes.
RESULTS
Compared with controls, CSM patients had lower anterior cord MTR (38.29 vs. 29.97, Δ = -8.314, P = 0.0022), and equivalent posterior cord (P = 0.2896) and lateral cord (P = 0.3062) MTR. Higher Nurick scores were associated with lower anterior cord MTR (P = 0.0205), but not lateral cord (P = 0.5446) or posterior cord MTR (P = 0.1222). Lower mJOA was associated with lower anterior cord MTR (P = 0.0090), but not lateral cord (P = 0.4864) or posterior cord MTR (P = 0.4819). There was no association between NDI and MTR of the anterior (P = 0.4351), lateral (P = 0.7557), or posterior cord (P = 0.9171). There was a linear relationship between hyperreflexia and anterior cord MTR (slope = -117.3, R = 0.6598, P = 0.0379), but not lateral cord (P = 0.1906, R = 0.4511) or posterior cord (P = 0.2577, R = 0.3957) MTR.
CONCLUSION
Anterior cord MTR correlates with clinical outcomes as measured by mJOA index, Nurick score, and quantitative hyperreflexia, and could play a role in the preoperative assessment of CSM.
LEVEL OF EVIDENCE
研究设计
病例对照研究。
目的
本研究旨在了解磁化传递率（MTR）在识别有临床意义的脊髓病和残疾患者中的作用。
背景资料总结
MTR 是一种定量测量指标，与多种神经疾病中的髓鞘丢失和神经组织破坏相关。然而，MTR 在颈椎脊髓病（CSM）患者中的应用尚未得到研究。
方法
我们前瞻性地招募了 7 名 CSM 患者和 7 名年龄匹配的对照组进行颈椎磁共振成像（MRI）检查。对所有患者进行 Nurick 评分、颈部残疾指数（NDI）和改良日本骨科协会（mJOA）评分。使用六轴负载单元在 MCP 关节处测试临床反射亢进。通过快速将关节从最大屈曲移动到最大伸展（300°/秒）来模拟反射。比较前、侧和后索 MTR 测量值与临床结果。
结果
与对照组相比，CSM 患者的前索 MTR 较低（38.29 与 29.97，Δ=-8.314，P=0.0022），后索（P=0.2896）和侧索（P=0.3062）MTR 无差异。较高的 Nurick 评分与较低的前索 MTR 相关（P=0.0205），但与侧索（P=0.5446）或后索（P=0.1222）MTR 无关。较低的 mJOA 与较低的前索 MTR 相关（P=0.0090），但与侧索（P=0.4864）或后索（P=0.4819）MTR 无关。NDI 与前索（P=0.4351）、侧索（P=0.7557）或后索（P=0.9171）的 MTR 无相关性。反射亢进与前索 MTR 之间存在线性关系（斜率=-117.3，R=0.6598，P=0.0379），但与侧索（P=0.1906，R=0.4511）或后索（P=0.2577，R=0.3957）MTR 无关。
结论
前索 MTR 与 mJOA 指数、Nurick 评分和定量反射亢进等临床结果相关，在 CSM 的术前评估中可能发挥作用。
证据水平
2 级。
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