Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Magn Reson Imaging. 2021 Sep;54(3):904-909. doi: 10.1002/jmri.27583. Epub 2021 Feb 28.
Prior imaging studies characterizing lumbar arachnoiditis have been based on small sample numbers and have reported inconsistent results.
To review the different imaging patterns of lumbosacral arachnoiditis, their significance, and clinical implications.
Retrospective.
A total of 96 patients (43 women; average age 61.3 years) with imaging findings of arachnoiditis (postsurgical: N = 49; degenerative: N = 29; vertebral fracture: N = 6; epidural and subdural hemorrhage: N = 3, infectious: N= 1; other: N = 8) from January 2009 to April 2018.
FIELD STRENGTH/SEQUENCE: Sagittal and axial T2-weighted Turbo Spin Echo at 1.5 T and 3 T.
Chart review was performed to assess the cause of arachnoiditis, and imaging was reviewed by two musculoskeletal and three neurology radiologists, blinded to the clinical data and to each other's imaging interpretation. Previous classification included a three-group system based on the appearance of the nerve roots on T2-weighted images. A fourth group was added in our review as "nonspecified" and was proposed for indeterminate imaging findings that did not fall into the classical groups. The presence/absence of synechiae/fibrous bands that distort the nerve roots and of spinal canal stenosis was also assessed.
The kappa score was used to assess agreement between readers for both classification type and presence/absence of synechiae.
Postsurgical (51%) and degenerative changes (30%) were the most common etiologies. About 7%-55% of arachnoiditis were classified as group 4. There was very poor classification agreement between readers (kappa score 0.051). There was also poor interreader agreement for determining the presence of synechiae (kappa 0.18) with, however, strong interreader agreement for the presence of synechia obtained between the most experienced readers (kappa 0.89).
This study demonstrated the lack of consensus and clarity in the classification system of lumbar arachnoiditis. The presence of synechia has high interreader agreement only among most experienced readers and promises to be a useful tool in assessing arachnoiditis.
3 TECHNICAL EFFICACY: Stage 2.
先前描述腰椎蛛网膜炎的影像学研究基于小样本数量，且报告结果不一致。
回顾腰骶部蛛网膜炎的不同影像学表现、其意义及临床意义。
回顾性。
共纳入 96 例患者（43 例女性；平均年龄 61.3 岁），均存在蛛网膜炎影像学表现（手术：49 例；退行性变：29 例；椎体骨折：6 例；硬膜外和硬脊膜下出血：3 例，感染：1 例；其他：8 例），这些患者的影像学表现来自 2009 年 1 月至 2018 年 4 月。
磁场强度/序列：矢状位和轴位 1.5T 和 3T 磁共振 T2 加权快速自旋回波。
通过图表回顾评估蛛网膜炎的病因，并由 2 名肌肉骨骼放射科医生和 3 名神经放射科医生进行影像学评估，每位医生均对临床数据和彼此的影像学解释不知情。先前的分类包括基于 T2 加权图像神经根外观的三组系统。在我们的评估中，还增加了第四组“未指定”，用于诊断不确定的影像学表现，这些表现未归入经典组。还评估了神经根受压的黏连/纤维带和椎管狭窄的存在/不存在。
使用 Kappa 评分评估两位读者对分类类型和黏连/纤维带存在/不存在的一致性。
手术（51%）和退行性改变（30%）是最常见的病因。约 7%-55%的蛛网膜炎被归类为第 4 组。读者之间的分类一致性非常差（Kappa 评分 0.051）。读者之间对于黏连/纤维带存在的判断也存在较差的一致性（Kappa 0.18），然而，最有经验的读者之间对于黏连/纤维带存在的判断具有很强的一致性（Kappa 0.89）。
本研究表明，在腰椎蛛网膜炎的分类系统中缺乏共识和清晰度。黏连/纤维带的存在仅在最有经验的读者之间具有较高的读者间一致性，有望成为评估蛛网膜炎的有用工具。
3 级 技术功效：2 级。
