Szum Adrian, Granberg Tobias, Fagerlund Michael, Lange Carolin, Junglander Pontuz, Sadus Thomas, Lundberg Johan, Skorpil Mikael
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
J Comput Assist Tomogr. 2025 Sep 3. doi: 10.1097/RCT.0000000000001801.
Early diagnosis of cauda equina syndrome is essential to prevent irreversible neurological damage, but MRI can be unavailable or contraindicated. This study aimed to evaluate whether photon-counting CT (PCCT) can be a reliable alternative to reference standard MRI for diagnosing cauda equina syndrome.
In this prospective study, participants with different conditions, including degenerative spinal canal stenosis, disk herniation, vertebral compression fracture, and intraspinal extradural tumor underwent PCCT and MRI between November 2022 and March 2024 at a university hospital. Three radiologists independently evaluated images for compression of cauda equina and/or spinal cord, level and cause of compression, and spinal cord visibility. Intrarater sensitivity and specificity in diagnosing compression of cauda equina and/or spinal cord on PCCT versus MRI were calculated. Pearson correlation between PCCT and MRI was assessed for dural sac areas at all lumbar disk levels. Point-biserial correlation was calculated for body mass index (BMI) versus spinal cord visibility.
A total of 14 participants [mean age 76±6 y (SD); 8 women] were examined. PCCT demonstrated 100% sensitivity and 60% to 83% specificity for diagnosing compression of cauda equina and/or spinal cord across 3 raters, compared with MRI. Axial area measurements showed an almost perfect correlation between modalities (r >0.9), with PCCT slightly underestimating areas in 70% of measurements. PCCT visualized the spinal cord in all participants, but in 19% of the assessments it was barely visible. No correlation was found between BMI and spinal cord visibility (P >.05).
Photon-counting CT demonstrated its usefulness as a rapid alternative in selected patients with suspected cauda equina syndrome (excluding spinal hematomas and spondylodiscitis), when MRI is unavailable or contraindicated. There were strong correlations in spinal canal stenosis measurements with MRI, showing its potential as an alternative to MRI in nonacute conditions of the lumbar spine, such as degenerative disk disease.
早期诊断马尾综合征对于预防不可逆的神经损伤至关重要，但磁共振成像（MRI）可能无法进行或存在禁忌。本研究旨在评估光子计数计算机断层扫描（PCCT）能否作为诊断马尾综合征的可靠替代方法，以取代参考标准MRI。
在这项前瞻性研究中，2022年11月至2024年3月期间，在一所大学医院，患有不同病症的参与者，包括退行性椎管狭窄、椎间盘突出、椎体压缩骨折和椎管内硬膜外肿瘤，接受了PCCT和MRI检查。三名放射科医生独立评估图像，以确定马尾和/或脊髓受压情况、受压水平和原因以及脊髓的可视性。计算了PCCT与MRI在诊断马尾和/或脊髓受压方面的观察者内敏感性和特异性。评估了所有腰椎间盘水平硬膜囊区域在PCCT和MRI之间的Pearson相关性。计算了体重指数（BMI）与脊髓可视性之间的点二列相关性。
共检查了14名参与者[平均年龄76±6岁（标准差）；8名女性]。与MRI相比，PCCT在3名评估者中诊断马尾和/或脊髓受压的敏感性为100%，特异性为60%至83%。轴向面积测量显示两种检查方式之间几乎具有完美的相关性（r>0.9），在70%的测量中，PCCT略微低估了面积。PCCT在所有参与者中均能显示脊髓，但在19%的评估中脊髓几乎不可见。未发现BMI与脊髓可视性之间存在相关性（P>.05）。
当MRI无法进行或存在禁忌时，光子计数计算机断层扫描在疑似马尾综合征的特定患者（不包括脊髓血肿和脊椎椎间盘炎）中显示出作为快速替代检查方法的有用性。在椎管狭窄测量方面，与MRI有很强的相关性，表明其在腰椎非急性病症（如退行性椎间盘疾病）中作为MRI替代方法的潜力。
