Tyrrell P N, Cassar-Pullicino V N, McCall I W
Department of Diagnostic Imaging, The Institute of Orthopaedics, The Robert Jones & Agnes Hunt Orthopaedic & District Hospital NHS Trust, Oswestry, Shropshire SY10 7AG, UK.
Eur Radiol. 1998;8(1):116-22. doi: 10.1007/s003300050350.
Disc prolapse presenting with sciatica may be associated with enhancement of the symptomatic nerve root following magnetic resonance imaging (MRI) with intravenous gadolinium (Gd)-DTPA. Previous studies have shown, however, that this does not occur in all cases. The aim of this study was to assess the incidence of nerve root enhancement in patients with sciatica and disc prolapse and to try to identify any specific features that might be associated with the phenomenon. A total of 227 patients presenting with low back pain and/or sciatica underwent a MRI study of the lumbar spine with intravenous contrast enhancement. Nineteen of 81 (23.5 %) patients with disc prolapse demonstrated nerve root enhancement. Nerve root enhancement had a highly significant association with sequestrated disc lesions (13/19, 68 %; P < 0.0005), and was primarily seen in the symptomatic ipsilateral nerve root (16/19, 84 %). The sensitivity of nerve root enhancement associated with disc prolapse was 23.5 % with a specificity of 95.9 %, a positive predictive value of 76 % and a negative predictive value of 69.3 %. Nerve root enhancement may be indicative of the symptomatic level but its poor sensitivity negates the routine use of Gd-DTPA in MRI for sciatica.
伴有坐骨神经痛的椎间盘突出在静脉注射钆（Gd）-二乙三胺五乙酸（DTPA）后进行磁共振成像（MRI）时，可能与有症状的神经根强化有关。然而，先前的研究表明，并非所有病例都会出现这种情况。本研究的目的是评估坐骨神经痛和椎间盘突出患者神经根强化的发生率，并试图确定可能与该现象相关的任何特定特征。共有227例伴有腰痛和/或坐骨神经痛的患者接受了腰椎MRI静脉造影增强检查。81例椎间盘突出患者中有19例（23.5%）出现神经根强化。神经根强化与游离型椎间盘病变高度相关（13/19，68%；P<0.0005），且主要见于有症状的同侧神经根（16/19，84%）。与椎间盘突出相关的神经根强化的敏感性为23.5%，特异性为95.9%，阳性预测值为76%，阴性预测值为69.3%。神经根强化可能提示有症状的节段，但其敏感性较差，这使得在MRI检查坐骨神经痛时常规使用Gd-DTPA失去了意义。
