From the Department of Radiology (P.J.D., D.T.R., G.L., J.W.P., A.H.Y., P.J.M.), Mater Misericordiae University Hospital, Dublin, Ireland
From the Department of Radiology (P.J.D., D.T.R., G.L., J.W.P., A.H.Y., P.J.M.), Mater Misericordiae University Hospital, Dublin, Ireland.
AJNR Am J Neuroradiol. 2024 Sep 9;45(9):1370-1377. doi: 10.3174/ajnr.A8315.
Lumbar disc herniation, potentially leading to nerve root compression and cauda equina syndrome, is typically evaluated using MR imaging. However, the limited availability of MR imaging outside regular hours in certain health care systems poses considerable challenges. This purpose of this study was to prospectively evaluate the diagnostic accuracy of an optimized CT lumbar spine protocol as a potential alternative to MR imaging in assessing suspected neural compression.
Patients presenting to the emergency department with suspected cauda equina syndrome or acute radicular symptoms secondary to lumbar disc herniation referred for MR imaging were prospectively enrolled for an additional CT optimized to assess spinal stenosis. An expert radiologist, blinded to clinical data, graded canal stenosis at each lumbar level on CT. The same grading process was applied to MR imaging after a 4-week interval to maintain blinding.
Fifty-nine individuals were included in the final analysis. In 22 (39%) cases, no significant stenosis was identified. In a further 22 (37%) cases, disc pathology was identified that was managed conservatively. Thirteen (22%) individuals proceeded to urgent surgical decompression. In 1 (2%) instance, an alternative diagnosis was identified. Compared with MR imaging, the sensitivity, specificity, and positive and negative predictive values for CT in detecting disc pathology in patients presenting with symptoms suggestive of acute neural compression were 97% (95% CI, 82%-99%), 97% (95% CI, 83%-99%), 97% (95% CI, 92%-99%), and 97% (95% CI, 83%-99%), respectively. CT accurately identified all cases requiring urgent decompression.
CT accurately predicted MR imaging findings in patients with suspected cauda equina and nerve root compression, demonstrating its utility as an adjunct tool for patient triage in emergency settings with limited MR imaging access. This protocol could enhance the allocation of emergency resources by appropriately selecting patients for emergent MR imaging.
腰椎间盘突出症可能导致神经根受压和马尾综合征，通常采用磁共振成像（MR 成像）进行评估。然而，在某些医疗保健系统中，MR 成像在非工作时间的可用性有限，这带来了相当大的挑战。本研究的目的是前瞻性评估优化后的 CT 腰椎成像方案作为替代 MR 成像评估疑似神经受压的诊断准确性。
前瞻性纳入因疑似马尾综合征或腰椎间盘突出症所致急性神经根症状而转诊至 MR 成像的急诊科患者，进行额外的优化 CT 成像以评估椎管狭窄。一位经验丰富的放射科医生在 CT 上对每个腰椎水平的椎管狭窄程度进行分级，不了解临床数据。4 周后，对 MR 成像应用相同的分级过程以保持盲法。
最终分析纳入 59 例患者。22 例（39%）患者未见明显狭窄，22 例（37%）患者发现椎间盘病变，采用保守治疗。13 例（22%）患者接受紧急手术减压。1 例（2%）患者发现其他诊断。与 MR 成像相比，在出现急性神经压迫症状的患者中，CT 检测椎间盘病变的敏感性、特异性、阳性预测值和阴性预测值分别为 97%（95%CI，82%-99%）、97%（95%CI，83%-99%）、97%（95%CI，92%-99%）和 97%（95%CI，83%-99%）。CT 准确识别了所有需要紧急减压的病例。
在疑似马尾和神经根受压的患者中，CT 准确预测了 MR 成像结果，表明其作为有限 MR 成像资源的紧急情况下患者分诊的辅助工具具有实用性。该方案可通过适当选择需要紧急 MR 成像的患者来增强紧急资源的分配。
