Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK.
Division of Medical Education, University of Brighton, Brighton, UK.
Eur Spine J. 2021 Apr;30(4):865-869. doi: 10.1007/s00586-020-06656-5. Epub 2020 Nov 11.
No clinical CT-based classification system is currently in use for lumbar foraminal stenosis. MRI scanners are not easily available, are expensive and may be contraindicated in an increasing number of patients. This study aimed to propose and evaluate the reproducibility of a novel CT-based classification for lumbar foraminal stenosis.
The grading was developed as four grades: normal foramen-Grade 0, anteroposterior (AP)/superoinferior (SI) (single plane) fat compression-Grade 1, both AP/SI compression (two planes) without distortion of nerve root-Grade 2 and Grade 2 with distortion of nerve root-Grade 3. A total of 800 lumbar foramen of a cohort of 100 random patients over the age of 60 who had undergone both CT and MRI scans were reviewed by two radiologists independently to assess agreement of the novel CT classification against the MRI-based grading system of Lee et al. Interobserver(n = 400) and intraobserver agreement(n = 160) was also evaluated. Agreement analysis was performed using the weighted kappa statistic.
A total of 100 patients (M:F = 45:55) with a mean age of 68.5 years (range 60-83 years were included in the study. The duration between CT and MRI scans was 98 days (range 0-540, SD-108). There was good correlation between CT and MRI with kappa scores (k = 0.81) and intraobserver kappa of 0.89 and 0.98 for the two readers.
The novel CT-based classification correlates well with the MRI grading system and can safely and accurately replace it where required.
目前尚无用于腰椎侧隐窝狭窄症的基于临床 CT 的分类系统。MRI 扫描仪不易获得，价格昂贵，并且在越来越多的患者中可能存在禁忌。本研究旨在提出并评估一种新的基于 CT 的腰椎侧隐窝狭窄症分类的可重复性。
该分级法分为四级：正常椎间孔-Grade 0，前后（AP）/上下（SI）（单平面）脂肪压迫-Grade 1，AP/SI 均受压（双平面）且神经根无变形-Grade 2，神经根变形-Grade 2。共有 100 名年龄超过 60 岁的随机患者的 800 个腰椎侧隐窝，这些患者同时接受了 CT 和 MRI 扫描，由两位放射科医生独立对新型 CT 分类与 Lee 等人的基于 MRI 的分级系统进行评估，以评估与新型 CT 分类的一致性。还评估了观察者间（n=400）和观察者内（n=160）的一致性。使用加权 Kappa 统计量进行一致性分析。
共纳入 100 名患者（男/女=45/55），平均年龄为 68.5 岁（范围为 60-83 岁）。CT 和 MRI 之间的时间间隔为 98 天（范围为 0-540，SD-108）。CT 与 MRI 之间具有良好的相关性，Kappa 评分（k=0.81）和两位读者的观察者内 Kappa 评分分别为 0.89 和 0.98。
新型基于 CT 的分类与 MRI 分级系统相关性良好，在需要时可以安全、准确地替代 MRI 分级系统。
