Hagenau C, Grosh W, Currie M, Wiley R G
Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37212.
J Clin Oncol. 1987 Oct;5(10):1663-9. doi: 10.1200/JCO.1987.5.10.1663.
Spinal involvement by systemic malignancy is common, and often leads to extradural compression of the spinal cord and/or nerve roots by metastases. Rapid, anatomically accurate diagnosis is essential to the successful management of these patients. We compared spinal magnetic resonance imaging (MRI) with conventional myelography in a series of 31 cancer patients being evaluated for myelopathy (N = 10), or back/radicular pain (N = 21). All patients were evaluated between April 1985 and July 1986, and underwent both studies within ten days of each other (median, two days). MRI was performed on a 0.5 Tesla Technicare unit with a body surface coil, and results compared with standard contrast myelography. All studies were reviewed separately and in a "blinded" fashion. MRI and myelography were comparable in detecting large lesions that produced complete subarachnoid block (five of ten patients with myelopathy, three of twenty-one patients with back/radicular pain). In 19 of 31 patients, smaller but clinically significant extradural lesions were found. In nine of 19 cases, these lesions were demonstrated equally well by both modalities; in nine of 19 cases, these lesions were demonstrated by myelography alone; in one of 19, a lesion was demonstrated by MRI alone. Given our current technology, myelography appeared superior to MRI as a single imaging modality. However, MRI may be an alternative in patients where total myelography is technically impossible or unusually hazardous.
系统性恶性肿瘤累及脊柱很常见，常导致转移瘤对脊髓和/或神经根的硬膜外压迫。快速、解剖学上准确的诊断对于这些患者的成功治疗至关重要。我们在一系列31例因脊髓病（n = 10）或背部/神经根性疼痛（n = 21）接受评估的癌症患者中，比较了脊柱磁共振成像（MRI）和传统脊髓造影。所有患者在1985年4月至1986年7月期间接受评估，并在彼此10天内（中位数为2天）接受了这两项检查。MRI在一台配备体表线圈的0.5特斯拉Technicare设备上进行，结果与标准对比脊髓造影进行比较。所有研究均分别以“盲法”进行回顾。在检测导致完全蛛网膜下腔阻塞的大病变方面，MRI和脊髓造影具有可比性（10例脊髓病患者中有5例，21例背部/神经根性疼痛患者中有3例）。在31例患者中的19例中，发现了较小但具有临床意义的硬膜外病变。在19例中的9例中，两种检查方式对这些病变的显示效果相同；在19例中的9例中，仅脊髓造影显示了这些病变；在19例中的1例中，仅MRI显示了一个病变。鉴于我们目前的技术，作为单一成像方式，脊髓造影似乎优于MRI。然而，在完全脊髓造影在技术上不可能或异常危险的患者中，MRI可能是一种替代方法。
