Mustafa Rafid, Passe Theodore J, Lopez-Chiriboga Alfonso S, Weinshenker Brian G, Krecke Karl N, Zalewski Nicholas L, Diehn Felix E, Sechi Elia, Mandrekar Jay, Kaufmann Timothy J, Morris Padraig P, Pittock Sean J, Toledano Michel, Lanzino Giuseppe, Aksamit Allen J, Kumar Neeraj, Lucchinetti Claudia F, Flanagan Eoin P
Department of Neurology (RM, BGW, NLZ, ES, SJP, MT, AJA, NK, CFL, EPF), Department of Radiology (TJP, KNK, FED, TJK, PPM), Department of Biostatistics (JM), Department of Laboratory Medicine and Pathology (SJP, EPF), and Department of Neurologic Surgery (GL), Mayo Clinic College of Medicine & Science, Rochester, MN; and Department of Neurology, Mayo Clinic College of Medicine & Science (ASL-C), Jacksonville, FL.
Neurol Clin Pract. 2021 Oct;11(5):e601-e611. doi: 10.1212/CPJ.0000000000001036.
To determine whether MRI gadolinium enhancement patterns in myelopathies with longitudinally extensive T2 lesions can be reliably distinguished and assist in diagnosis.
We retrospectively identified 74 Mayo Clinic patients (January 1, 1996-December 31, 2019) fulfilling the following criteria: (1) clinical myelopathy; (2) MRI spine available; (3) longitudinally extensive T2 hyperintensity (≥3 vertebral segments); and (4) characteristic gadolinium enhancement pattern associated with a specific myelopathy etiology. Thirty-nine cases with alternative myelopathy etiologies, without previously described enhancement patterns, were included as controls. Two independent readers, educated on enhancement patterns, reviewed T2-weighted and postgadolinium T1-weighted images and selected the diagnosis based on this knowledge. These were compared with the true diagnoses, and agreement was measured with Kappa coefficient.
Among all cases and controls (n = 113), there was excellent agreement for diagnosis using postgadolinium images (kappa, 0.76) but poor agreement with T2-weighted characteristics alone (kappa, 0.25). A correct diagnosis was more likely when assessing postgadolinium image characteristics than with T2-weighted images alone (rater 1: 100/113 [88%] vs 61/113 [54%] correct, < 0.0001; rater 2: 95/113 [84%] vs 68/113 [60%] correct, < 0.0001). Of the 74 with characteristic enhancement patterns, 55 (74%) were assigned an alternative incorrect or nonspecific diagnosis when originally evaluated in clinical practice, 12 (16%) received immunotherapy for noninflammatory myelopathies, and 2 (3%) underwent unnecessary spinal cord biopsy.
Misdiagnosis of myelopathies is common. The gadolinium enhancement patterns characteristic of specific diagnoses can be identified with excellent agreement between raters educated on this topic. This study highlights the potential diagnostic utility of enhancement patterns in myelopathies with longitudinally extensive T2 lesions.
确定在具有纵向广泛T2病变的脊髓病中，MRI钆增强模式是否能够可靠区分并有助于诊断。
我们回顾性纳入了梅奥诊所74例患者（1996年1月1日至2019年12月31日），其符合以下标准：（1）临床脊髓病；（2）有脊柱MRI检查；（3）纵向广泛T2高信号（≥3个椎体节段）；（4）与特定脊髓病病因相关的特征性钆增强模式。39例具有其他脊髓病病因且无先前描述的增强模式的病例作为对照。两名了解增强模式的独立阅片者，回顾了T2加权像和钆增强后T1加权像，并基于此知识选择诊断。将这些诊断与真实诊断进行比较，并用Kappa系数测量一致性。
在所有病例和对照（n = 113）中，使用钆增强后图像进行诊断的一致性良好（kappa值为0.76），但仅根据T2加权特征的一致性较差（kappa值为0.25）。评估钆增强后图像特征时比仅评估T2加权图像更有可能做出正确诊断（阅片者1：100/113 [88%]正确 vs 61/113 [54%]正确，<0.0001；阅片者2：95/113 [84%]正确 vs 68/113 [60%]正确，<0.0001）。在74例具有特征性增强模式的患者中，55例（74%）在临床实践中最初评估时被误诊为其他错误或非特异性诊断，12例（16%）因非炎性脊髓病接受了免疫治疗，2例（3%）接受了不必要的脊髓活检。
脊髓病的误诊很常见。特定诊断的钆增强模式特征在了解该主题的阅片者之间具有良好的一致性。本研究强调了增强模式在具有纵向广泛T2病变的脊髓病中的潜在诊断效用。
