在诊断第五腰神经根的腰椎椎间孔狭窄方面，T1加权三维磁共振图像是否不如T2加权图像？一项针对同一组患者的前瞻性比较研究。
Are T1-Weighted Three-Dimensional Magnetic Resonance Images Inferior to T2-Weighted Images for Diagnosing Lumbar Foraminal Stenosis in the Fifth Lumbar Nerve Root? A Prospective, Comparative Study in Identical Patients.
作者信息
Hashimoto Ko, Tanaka Yasuhisa, Tsubakino Takumi, Hoshikawa Takeshi, Kawahara Chikashi, Nakagawa Tomowaki, Tateda Satoshi, Takahashi Kohei, Suzuki Manabu, Onoki Takahiro, Kanno Haruo, Morozumi Naoki, Koizumi Yutaka, Honda Masahito, Kusakabe Takashi, Suda Masaru, Kokubun Shoichi, Aizawa Toshimi
机构信息
Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Orthopaedic Surgery, Tohoku Central Hospital, Yamagata, Japan.
出版信息
Spine Surg Relat Res. 2023 Apr 21;7(5):436-442. doi: 10.22603/ssrr.2023-0026. eCollection 2023 Sep 27.
INTRODUCTION
Imaging analysis of foraminal stenosis in the fifth lumbar (L5) nerve root remains to be a challenge because of the anatomical complexity of the lumbosacral transition. T2-weighted three-dimensional (3D) magnetic resonance images (MRI) have been dominantly used for diagnosis of lumbar foraminal stenosis, while the reliability of T1-weighted images (WI) has also been proven. In this study, we aim to compare the reliability and reproducibility of T1- and T2-weighted 3D MRI in diagnosing lumbar foraminal stenosis (LFS) of the L5 nerve root.
METHODS
In this study, 39 patients with unilateral L5 radiculopathy (20 had L4-L5 intracanal stenosis; 19 had L5-S foraminal stenosis) were enrolled, prospectively. T1- and T2-weighted 3D lumbar MRI were obtained from each patient. T1WI and T2WI were blinded and then separately reviewed twice by four examiners randomly. The examiners were instructed to answer the side of LFS or absence of LFS. The correct answer rate, sensitivity, specificity, and area under the curve were analyzed and compared between T1WI and T2WI. Also, intra- and interobserver agreements were calculated using kappa (κ)-statistics and compared in the same manner.
RESULTS
The average correct answer rate, sensitivity, specificity, and area under the curve of the T1WI/T2WI were 84.6%/80.1%, 82.9%/80.3%, 86.3%/81.3%, and 0.846/0.801, respectively. The intraobserver κ-values of the four examiners ranged from 0.692 to 0.916 (average: 0.762) and from 0.669 to 0.801 (average: 0.720) for T1WI and T2WI, respectively. The interobserver κ-values calculated in a round-robin manner (24 combinations in total) ranged from 0.544 to 0.790 (average: 0.657) and from 0.524 to 0.828 (average: 0.652), respectively.
CONCLUSIONS
As per our findings, T1- and T2-weighted 3D MRI were determined to have nearly equivalent reliability and reproducibility in terms of diagnosing LFS of the L5 nerve root.
引言
由于腰骶部移行区的解剖结构复杂，对第五腰椎（L5）神经根孔狭窄进行影像学分析仍然是一项挑战。T2加权三维（3D）磁共振成像（MRI）一直主要用于诊断腰椎孔狭窄，而T1加权成像（WI）的可靠性也已得到证实。在本研究中，我们旨在比较T1加权和T2加权3D MRI在诊断L5神经根腰椎孔狭窄（LFS）方面的可靠性和可重复性。
方法
在本研究中，前瞻性纳入了39例单侧L5神经根病患者（20例有L4-L5椎管内狭窄；19例有L5-S椎间孔狭窄）。从每位患者获取T1加权和T2加权3D腰椎MRI。T1WI和T2WI不显示信息，然后由四名检查者随机分别复查两次。指导检查者回答LFS的侧别或是否存在LFS。分析并比较T1WI和T2WI之间的正确回答率、敏感性、特异性和曲线下面积。此外，使用kappa（κ）统计量计算观察者内和观察者间的一致性，并以相同方式进行比较。
结果
T1WI/T2WI的平均正确回答率、敏感性、特异性和曲线下面积分别为84.6%/80.1%、82.9%/80.3%、86.3%/81.3%和0.846/0.801。对于T1WI和T2WI，四名检查者的观察者内κ值分别为0.692至0.916（平均：0.762）和0.669至0.801（平均：0.720）。以循环方式计算的观察者间κ值（共24种组合）分别为0.544至0.790（平均：0.657）和0.524至0.828（平均：0.652）。
结论
根据我们的研究结果，在诊断L5神经根LFS方面，T1加权和T2加权3D MRI的可靠性和可重复性几乎相当。
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