Wahezi Sayed E, Hillery Terence, Przkora Rene, Lubenow Tim, Deer Tim, Kim Chong, Sayed Dawood, Krystal Jonathan, Kinon Merritt, Sitapara Kishan, Nguyen Kim, Wong Daniel, Sperling Karen
Montefiore Multidisciplinary Pain Program, Montefiore Medical Center, Bronx, NY, USA.
The MetroHealth System, Cleveland, OH, USA.
J Pain Res. 2022 May 24;15:1515-1526. doi: 10.2147/JPR.S360847. eCollection 2022.
Neuroforaminal stenosis (NFS), a narrowing of the intervertebral foramen, is a cause of disability in the aging population. Formal magnetic resonance imaging (MRI) classification of NSF has been developed recently and contradictory findings have been reported. This study aims to assess whether in-plane, anatomically conformed two-dimensional (2D) views of the neuroforamen characterize NFS more accurately than traditional axial, coronal, and sagittal views in healthy individuals with and without simulated scoliosis.
This observational study was approved by the designated institutional review board at our academic tertiary care center. Four volunteers underwent lumbar spine MRI twice, once in the supine position and once with intentionally introduced hip tilt. The latter resulted in lumbar curvature mimicking positioning errors approximating degenerative lumbar scoliosis. Anatomically oriented cuts such as axial with endplate correction and coronally obliqued parasagittals, also called coronal obliques, were performed. Standard sagittal and axial views were also performed in both the supine and rotated groups.
Coronal oblique and anatomically oriented axial views demonstrated the highest correlation with true neuroforaminal caliber. Deviation from anatomical congruence resulted in false measurements of neuroforaminal size. The hip-tilt studies produced MR that were less favorable to characterization of the caliber of neuroforamina. Coronal sections demonstrated reliability only when performed at the mid-pedicular lines. Standard axial views were reliable only when taken at the upper one-third of the neuroforamen. Coronal oblique views demonstrated superiority when evaluating consecutive neuroforamen on one image compared to non-obliqued parasagittal slices.
To minimize error in neuroforaminal analysis, imaging specialists should perform anatomically oriented cuts to conform to individual patient anatomy. When this cannot be performed due to a patient's spine rotation or position, the MRI reader should view oblique, axial, and coronal images simultaneously and dynamically for proper foraminal characterization.
神经孔狭窄（NFS）是椎间孔变窄，是老年人群致残的一个原因。最近已开发出NFS的正式磁共振成像（MRI）分类法，且有相互矛盾的研究结果报道。本研究旨在评估在有和没有模拟脊柱侧弯的健康个体中，神经孔的平面内、解剖学匹配的二维（2D）视图是否比传统的轴向、冠状和矢状视图更准确地表征NFS。
本观察性研究获得了我们学术三级医疗中心指定的机构审查委员会的批准。四名志愿者接受了两次腰椎MRI检查，一次是仰卧位，一次是故意引入髋关节倾斜。后者导致腰椎弯曲，模拟接近退行性腰椎侧弯的定位误差。进行了解剖学定向切片，如带有终板校正的轴向切片和冠状斜矢状切片（也称为冠状斜切片）。仰卧位组和旋转组均进行了标准矢状和轴向视图检查。
冠状斜切片和解剖学定向轴向视图与真正的神经孔口径相关性最高。偏离解剖一致性会导致神经孔大小的错误测量。髋关节倾斜研究产生的MR图像对神经孔口径的表征不太有利。冠状切片仅在椎弓根中线处进行时才显示出可靠性。标准轴向视图仅在神经孔上三分之一处拍摄时才可靠。与非斜矢状切片相比，冠状斜视图在评估一幅图像上连续的神经孔时表现出优越性。
为了尽量减少神经孔分析中的误差，影像专家应进行符合个体患者解剖结构的解剖学定向切片。当由于患者脊柱旋转或位置原因无法进行此操作时，MRI阅片者应同时动态查看斜位、轴位和冠状位图像，以正确表征椎间孔。
