Rankine J J, Gill K P, Hutchinson C E, Ross E R, Williamson J B
Department of Diagnostic Radiology, University of Manchester, UK.
Clin Radiol. 1998 Sep;53(9):688-93. doi: 10.1016/s0009-9260(98)80296-1.
The influence of lumbar spine magnetic resonance imaging (MRI) on the management of patients with low back and leg pain, with a clinical diagnosis of neural compression, has been investigated by a controlled prospective observational study. The clinical features of the patients at the time of request for MRI have been compared with the subsequent management in order to define the clinical indications for lumbar spine MRI.
Clinical history, physical examination findings and tests of functional and psychological disability were all recorded at the time of request for MRI. Following MRI, patients were assessed without knowledge of the MRI findings and a diagnosis and management plan recorded. Immediate access to the MRI report and hard copy films was then provided and a revised diagnosis and management plan made. The clinical features and MRI findings were compared with the subsequent management.
Seventy-two patients were examined, 65 (90.3%) had leg pain as a predominant feature and abnormalities in neurological examination were found in 31 (43%). Twenty-three of 48 (47.9%) of patients with a pre MRI management plan of surgery were changed to conservative management following the MRI. The diagnosis altered in 50 % of cases with the largest change in diagnosis occurring in 13 patients where MRI did not confirm the clinical impression of nerve root compression. Seventeen patients with no abnormality of neurological testing were subsequently treated by surgery which included all 12 patients treated by spinal fusion.
The major impact of MRI was to move patients towards conservative treatment. A variety of features in the history and physical examination as well as MRI findings are predictors for surgical treatment. The variety of diagnoses and surgical options available make it difficult to define clear clinical guidelines for the use of MRI.
通过一项对照前瞻性观察研究，调查了腰椎磁共振成像（MRI）对临床诊断为神经受压的腰腿痛患者治疗的影响。将患者进行MRI检查时的临床特征与后续治疗情况进行比较，以确定腰椎MRI的临床适应证。
在申请MRI检查时，记录患者的临床病史、体格检查结果以及功能和心理残疾测试情况。MRI检查后，在不知道MRI检查结果的情况下对患者进行评估，并记录诊断和治疗计划。然后提供MRI报告和硬拷贝胶片，并制定修订后的诊断和治疗计划。将临床特征和MRI检查结果与后续治疗情况进行比较。
共检查了72例患者，其中65例（90.3%）以腿痛为主要特征，31例（43%）神经检查有异常。48例术前计划手术的患者中，23例（47.9%）在MRI检查后改为保守治疗。50%的病例诊断发生改变，其中诊断变化最大的是13例MRI未证实神经根受压临床印象的患者。17例神经检查无异常的患者随后接受了手术治疗，其中包括所有12例行脊柱融合术的患者。
MRI的主要影响是使患者转向保守治疗。病史、体格检查中的各种特征以及MRI检查结果都是手术治疗的预测指标。可用的诊断和手术选择多种多样，因此难以制定明确的MRI临床应用指南。
