Espeland Ansgar, Dalen Nina
1 Department of Radiology, Haukeland University Hospital , Bergen , Norway.
2 Department of Clinical Medicine, University of Bergen , Bergen , Norway.
Br J Radiol. 2019 Apr;92(1096):20180851. doi: 10.1259/bjr.20180851. Epub 2019 Jan 17.
: To compare disc and nerve root findings, image quality, and pain between supine lumbar MRI positions with straightened v s flexed hips and knees.
: In this prospective pilot study, 14 adults with sciatica or suspected lumbar radiculopathy underwent MRI supine with their hips and knees flexed and then straightened. For each position, two experienced radiologists assessed disc contour, location/size of disc herniation, nerve root affection, image quality, image evaluation difficulty, and sagittal angles between the vertebral bodies at each disc level L3-S1. Patients scored pain (0-10) after MRI in each position. We compared MRI assessments and mean pain scores (t-test, log-transformation) between the two positions.
: We found no clear difference in disc bulges, disc herniation, nerve root affection, image quality, or image evaluation difficulty between MRI with straightened v s flexed knees/hips. Herniation size differed ≤ 0.6 mm between the two positions. Sagittal angles between neighboring vertebral bodies differed ≤3.8°. Mean pain score after MRI with straightened v s flexed knees/hips was 4.64 v s 3.29 (p = 0.005).
: In this pilot study, supine lumbar MRI with straightened vs flexed hips/knees showed similar disc and nerve root findings. The straightened position appeared more painful.
: In previous studies, spondylolisthesis increased on supine MRI with straightened v s flexed lower limbs, but corresponding data on disc findings were lacking. In this pilot study, supine lumbar MRI with straightened rather than flexed hips and knees was more painful and did not improve the diagnosis of disc or nerve root findings.
比较仰卧位腰椎MRI检查时，髋关节和膝关节伸直与屈曲状态下椎间盘及神经根的表现、图像质量和疼痛情况。
在这项前瞻性初步研究中，14例患有坐骨神经痛或疑似腰椎神经根病的成年人先在髋关节和膝关节屈曲状态下进行仰卧位MRI检查，然后再将髋关节和膝关节伸直进行检查。对于每个体位，两名经验丰富的放射科医生评估椎间盘轮廓、椎间盘突出的位置/大小、神经根受累情况、图像质量、图像评估难度以及L3-S1各椎间盘水平椎体之间的矢状角。患者在每个体位的MRI检查后对疼痛进行评分（0-10分）。我们比较了两个体位之间的MRI评估结果和平均疼痛评分（t检验，对数转换）。
我们发现，髋关节和膝关节伸直与屈曲状态下的MRI检查在椎间盘膨出、椎间盘突出、神经根受累、图像质量或图像评估难度方面没有明显差异。两个体位之间的突出大小差异≤0.6mm。相邻椎体之间矢状角差异≤3.8°。髋关节和膝关节伸直与屈曲状态下MRI检查后的平均疼痛评分分别为4.64和3.29（p=0.005）。
在这项初步研究中，髋关节和膝关节伸直与屈曲状态下的仰卧位腰椎MRI检查显示出相似的椎间盘和神经根表现。伸直体位似乎更疼痛。
在以往研究中，仰卧位MRI检查时下肢伸直比屈曲会使椎体滑脱增加，但缺乏关于椎间盘表现的相应数据。在这项初步研究中，髋关节和膝关节伸直而非屈曲的仰卧位腰椎MRI检查更疼痛，且未改善椎间盘或神经根表现的诊断。
