Royal Berkshire Hospital, Reading, UK.
Stoke Mandeville Hospital, Aylesbury, UK.
Bone Joint J. 2020 Apr;102-B(4):501-505. doi: 10.1302/0301-620X.102B4.BJJ-2019-0645.R2.
Early cases of cauda equina syndrome (CES) often present with nonspecific symptoms and signs, and it is recommended that patients undergo emergency MRI regardless of the time since presentation. This creates substantial pressure on resources, with many scans performed to rule out cauda equina rather than confirm it. We propose that compression of the cauda equina should be apparent with a limited sequence (LS) scan that takes significantly less time to perform.
In all, 188 patients with suspected CES underwent a LS lumbosacral MRI between the beginning of September 2017 and the end of July 2018. These images were read by a consultant musculoskeletal radiologist. All images took place on a 3T or 1.5T MRI scanner at Stoke Mandeville Hospital, Aylesbury, UK, and Royal Berkshire Hospital, Reading, UK.
The 188 patients, all under the age of 55 years, underwent 196 LS lumbosacral MRI scans for suspected CES. Of these patients, 14 had cauda equina compression and underwent emergency decompression. No cases of CES were missed. Patients spent a mean 9.9 minutes (8 to 10) in the MRI scanner.
Our results suggest that a LS lumbosacral MRI could be used to diagnose CES safely in patients under the age of 55 years, but that further research is needed to assess safety and efficacy of this technique before changes to existing protocols can be recommended. In addition, work is needed to assess if LS MRIs can be used throughout the spine and if alternative pathology is being considered. Cite this article: 2020;102-B(4):501-505.
马尾综合征（CES）的早期病例常表现出非特异性症状和体征，建议患者无论就诊时间长短，均行急诊 MRI 检查。这给资源带来了巨大压力，许多扫描用于排除马尾综合征，而不是确认其存在。我们建议，通过时间明显缩短的有限序列（LS）扫描，可明显看出马尾受压。
2017 年 9 月初至 2018 年 7 月底，共有 188 例疑似 CES 的患者接受了 LS 腰骶部 MRI 检查。这些图像由一名顾问肌肉骨骼放射科医师进行阅读。所有图像均在英国阿克斯布里奇的斯托克曼德维尔医院和英国雷丁的皇家伯克郡医院的 3T 或 1.5T MRI 扫描仪上进行。
这 188 例年龄均小于 55 岁的患者共进行了 196 次 LS 腰骶部 MRI 检查，以排查 CES。其中 14 例患者存在马尾受压，行紧急减压术。无一例 CES 漏诊。患者在 MRI 扫描仪中平均花费 9.9 分钟（8 至 10 分钟）。
我们的研究结果表明，LS 腰骶部 MRI 可安全用于 55 岁以下 CES 患者的诊断，但需要进一步研究，以评估该技术的安全性和有效性，然后才能推荐对现有方案进行更改。此外，还需要评估 LS MRI 是否可用于整个脊柱，以及是否考虑了其他病变。
2020；102-B（4）：501-505.
