MRI脊髓/硬膜囊面积比值测量对脊髓型颈椎病严重程度的评估价值
|
摘要
目的通过MRI测量脊髓与硬膜囊面积比值,探讨该比值对脊髓型颈椎病的严重程度的评估价值。方法收集不同脊髓受压程度的脊髓型颈椎病患者340例及92例健康志愿者,在3.0T MR轴位T2WI图像上分别测量对照组(A组)C3/4～C6/7椎间盘节段及患者组(B～D组)受压最严重节段脊髓/硬膜囊面积比值,分析其组间差异。在每次扫描的之前,使用日本骨科协会(JOA)量表测量神经损害的程度,分析脊髓/硬膜囊面积比值与JOA评分之间相关性。结果对照组不同节段及同一节段不同年龄、性别C3/4、C4/5、C5/6、C6/7节段脊髓/硬膜囊面积比值差异无统计学意义(P>0.05),B、C、D组脊髓/硬膜囊面积比值明显高于对照组(P<0.05),且随着脊髓受压严重/硬膜囊面积逐渐升高,而JOA评分逐渐降低,差异均有统计学意义(P<0.05)。脊髓/硬膜囊面积比值与JOA评分呈负相关(r=-0.859,P=0.000)。对照组与B组获得最佳检验效能的脊髓/硬膜囊面积比值为0.392,对应的诊断敏感度、特异度、曲线下面积为72.6%、88.6%、0.833。C、D组最佳检验效能临界值为0.580,对应的诊断敏感度、特异度、曲线下面积分别为:75.7%、51.7%、0.664。结论 MRI脊髓/硬膜囊面积比值可作为脊髓型颈椎病患者脊髓损伤程度的可靠定量指标。
Objective To investigate the significance of measuring the ratio of spinal cord to dural sac area by magnetic resonance imaging(MRI) in evaluating the severity of cervical spondylotic myelopathy by magnetic resonance imaging.Methods A total of 340 patients with cervical spondylotic myelopathy at different degrees of spinal cord compression were enrollled as group B,group C and group D(C3/4～C6/7),and 92 healthy volunteers were enrolled as group A(control group).The area ratios of the C3/4～C6/7 intervertebral disc segments in group A and the most severely compressed segments in group group B,C,D were measured on 3.0 T MR axial T2 WI images,and the differences among the groups were analyzed.Before each scanning,the Japanese Orthopedics department Association(JOA) scale was used to measure the degree of nerve damage and to analyze the correlation between the ratio of spinal cord/dural sac area and JOA scores.Results There was no significant difference in the area ratio of spinal cord to dural sac at C3/4,C4/5,C5/6,C6/7 segments in different segments,and in the same segment,in different age and gender in group A(P>0.05).However the area ratio of spinal cord to dural sac in group B,C,D was significantly higher than that in group A(P<0.05),which was gradually increased with the severity of the spinal compression,however,the JOA scores were gradually decreased,and the differences were statistically significant(P<0.05).The ratio of medulla spinalis/dural sac area was negatively correlated with JOA score(r=-0.859,P<0.01).The ratio of medulla spinalis/dural sac area to get the best power of test was 0.392,and the corresponding diagnosis sensitiveness,specificity and the area under the curve(AUC) were 72.6%,88.6%,0.833,respectively.However the critical value for the best power of test was 0.580 in group C and group D,the corresponding diagnosis sensitiveness,specificity and the AUC were 75.7%,51.7%,0.664,respectively.Conclusion The ratio of spinal cord to dural sac area measured by MRI can be regarded as a reliable quantitative index in evaluating the severity of spinal cord injury in patients with cervical spondylotic myelopathy.
Objective To investigate the significance of measuring the ratio of spinal cord to dural sac area by magnetic resonance imaging(MRI) in evaluating the severity of cervical spondylotic myelopathy by magnetic resonance imaging.Methods A total of 340 patients with cervical spondylotic myelopathy at different degrees of spinal cord compression were enrollled as group B,group C and group D(C3/4～C6/7),and 92 healthy volunteers were enrolled as group A(control group).The area ratios of the C3/4～C6/7 intervertebral disc segments in group A and the most severely compressed segments in group group B,C,D were measured on 3.0 T MR axial T2 WI images,and the differences among the groups were analyzed.Before each scanning,the Japanese Orthopedics department Association(JOA) scale was used to measure the degree of nerve damage and to analyze the correlation between the ratio of spinal cord/dural sac area and JOA scores.Results There was no significant difference in the area ratio of spinal cord to dural sac at C3/4,C4/5,C5/6,C6/7 segments in different segments,and in the same segment,in different age and gender in group A(P>0.05).However the area ratio of spinal cord to dural sac in group B,C,D was significantly higher than that in group A(P<0.05),which was gradually increased with the severity of the spinal compression,however,the JOA scores were gradually decreased,and the differences were statistically significant(P<0.05).The ratio of medulla spinalis/dural sac area was negatively correlated with JOA score(r=-0.859,P<0.01).The ratio of medulla spinalis/dural sac area to get the best power of test was 0.392,and the corresponding diagnosis sensitiveness,specificity and the area under the curve(AUC) were 72.6%,88.6%,0.833,respectively.However the critical value for the best power of test was 0.580 in group C and group D,the corresponding diagnosis sensitiveness,specificity and the AUC were 75.7%,51.7%,0.664,respectively.Conclusion The ratio of spinal cord to dural sac area measured by MRI can be regarded as a reliable quantitative index in evaluating the severity of spinal cord injury in patients with cervical spondylotic myelopathy.
引文
1 Nouri A,Tetreault L,Singh A,et al.Degenerative Cervical Myelopathy:Epidemiology,Genetics and Pathogenesis.Spine,2015,40:675-693.
2 胡有谷,陈晓亮,刘勇,等.关于颈椎病命名及分类的讨论—脊髓型颈椎病及颈椎管狭窄之间的关系及命名探讨.中国脊柱脊髓杂志,2003,13:203-204.
3 Fukui M,Chiba K,Kawakami M,et al.Japanese orthopaedic association cervical myelopathy evaluation questionnaire(JOACMEQ):part 4.Establishment of equations for severity scores.J Orthop Sci,2008,13:1890-1895.
4 Mattei TA,Goulart CR,Milano JB,et al.Cervical spondylotic myelopathy:pathophysiology,diagnosis and surgical techniques.ISRN Neurol,2011,2011:463729.
5 Xu N,Wang S,Yuan H,Liu X,et al.Does dynamic supine magnetic resonance imaging improve the diagnostic accuracy of cervical spondylotic myelopathy?A review of the current evidence.World Neurosurgery,2017,100:474-479.
6 Tykocki T,Du PJ,Wynne-Jones G.Correlation between the severity of myelopathy and cervical morphometric parameters on dynamic magnetic resonance imaging.Acta Neurochirurgica,2018,160:1251-1258.
7 Nakashima H,Yukawa Y,Suda K,et al.Narrow cervical canal in 1211 asymptomatic healthy subjects:the relationship with spinal cord compression on MRI.European Spine Journal,2016,25:2149-2154.
8 Nagata K,Yoshimura N,Hashizume H,et al.The prevalence of cervical myelopathy among subjects with narrow cervical spinal canal in a population-based magnetic resonance imaging study:the Wakayama Spine Study.The Spine Journal,2014,14:2811-2817.
9 唐彦超,于森,刘晓光,等.术前MRI测量脊髓受压程度与脊髓型颈椎病手术疗效的相关性.中国脊柱脊髓杂志,2014,24:742-746.
10 Kadanka Z,Kerkovsky M,Bednarik J,et al.Cross-sectional transverse area and hyperintensities on magnetic resonance imaging in relation to the clinical picture in cervical spondylotic myelopathy.Spine,2007,32:2573-2577.
11 Kato F,Yukawa Y,Suda K,et al.Normal morphology,age-related changes and abnormal findings of the cervical spine.Part Ⅱ:Magnetic resonance imaging of over 1,200 asymptomatic subjects.Eur Spine J,2012,21:1499-1507.
12 夏景君,张伟,关国发,等.颈髓与有效椎管面积的比值及与脊髓型颈椎病关系的研究.中国临床解剖学杂志,2007,25:708-710.
13 Yanase M,Matsuyama Y,Hirose K,et al.Measurement of the cervical spinal cord volume on MRI.J Spinal Disord Tech,2006,19:125-129.
14 常德勇,王沛,伊慧明,等.颈脊髓体积及颈椎管容积比值的MRI测量及其价值.天津医科大学学报,2008,14:519-521.
15 Nagashima H,Dokai T,Hashiguchi H,et al.Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients aged 80 years or older:a multi-center retrospective study.Eur Spine J,2011,20:240-246.
16 Al-Ryalat NT,Saleh SA,Mahafza WS,et al.Myelopathy associated with age-related cervical disc herniation:a retrospective review of magnetic resonance images.Annals of Saudi Medicine,2017,37:130-137.
17 Okazaki T,Kanchiku T,Nishida N,et al.Age-related changes of the spinal cord:A biomechanical study.Experimental & Therapeutic Medicine,2018,15:2824-2829.
18 Zhiyou C,Chuanling W,Fuming T,et al.The incidence of cervical spondylosis decreases with aging in the elderly,and increases with aging in the young and adult population:a hospital-based clinical analysis.Clinical Interventions in Aging,2016,11:47-53.
2 胡有谷,陈晓亮,刘勇,等.关于颈椎病命名及分类的讨论—脊髓型颈椎病及颈椎管狭窄之间的关系及命名探讨.中国脊柱脊髓杂志,2003,13:203-204.
3 Fukui M,Chiba K,Kawakami M,et al.Japanese orthopaedic association cervical myelopathy evaluation questionnaire(JOACMEQ):part 4.Establishment of equations for severity scores.J Orthop Sci,2008,13:1890-1895.
4 Mattei TA,Goulart CR,Milano JB,et al.Cervical spondylotic myelopathy:pathophysiology,diagnosis and surgical techniques.ISRN Neurol,2011,2011:463729.
5 Xu N,Wang S,Yuan H,Liu X,et al.Does dynamic supine magnetic resonance imaging improve the diagnostic accuracy of cervical spondylotic myelopathy?A review of the current evidence.World Neurosurgery,2017,100:474-479.
6 Tykocki T,Du PJ,Wynne-Jones G.Correlation between the severity of myelopathy and cervical morphometric parameters on dynamic magnetic resonance imaging.Acta Neurochirurgica,2018,160:1251-1258.
7 Nakashima H,Yukawa Y,Suda K,et al.Narrow cervical canal in 1211 asymptomatic healthy subjects:the relationship with spinal cord compression on MRI.European Spine Journal,2016,25:2149-2154.
8 Nagata K,Yoshimura N,Hashizume H,et al.The prevalence of cervical myelopathy among subjects with narrow cervical spinal canal in a population-based magnetic resonance imaging study:the Wakayama Spine Study.The Spine Journal,2014,14:2811-2817.
9 唐彦超,于森,刘晓光,等.术前MRI测量脊髓受压程度与脊髓型颈椎病手术疗效的相关性.中国脊柱脊髓杂志,2014,24:742-746.
10 Kadanka Z,Kerkovsky M,Bednarik J,et al.Cross-sectional transverse area and hyperintensities on magnetic resonance imaging in relation to the clinical picture in cervical spondylotic myelopathy.Spine,2007,32:2573-2577.
11 Kato F,Yukawa Y,Suda K,et al.Normal morphology,age-related changes and abnormal findings of the cervical spine.Part Ⅱ:Magnetic resonance imaging of over 1,200 asymptomatic subjects.Eur Spine J,2012,21:1499-1507.
12 夏景君,张伟,关国发,等.颈髓与有效椎管面积的比值及与脊髓型颈椎病关系的研究.中国临床解剖学杂志,2007,25:708-710.
13 Yanase M,Matsuyama Y,Hirose K,et al.Measurement of the cervical spinal cord volume on MRI.J Spinal Disord Tech,2006,19:125-129.
14 常德勇,王沛,伊慧明,等.颈脊髓体积及颈椎管容积比值的MRI测量及其价值.天津医科大学学报,2008,14:519-521.
15 Nagashima H,Dokai T,Hashiguchi H,et al.Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients aged 80 years or older:a multi-center retrospective study.Eur Spine J,2011,20:240-246.
16 Al-Ryalat NT,Saleh SA,Mahafza WS,et al.Myelopathy associated with age-related cervical disc herniation:a retrospective review of magnetic resonance images.Annals of Saudi Medicine,2017,37:130-137.
17 Okazaki T,Kanchiku T,Nishida N,et al.Age-related changes of the spinal cord:A biomechanical study.Experimental & Therapeutic Medicine,2018,15:2824-2829.
18 Zhiyou C,Chuanling W,Fuming T,et al.The incidence of cervical spondylosis decreases with aging in the elderly,and increases with aging in the young and adult population:a hospital-based clinical analysis.Clinical Interventions in Aging,2016,11:47-53.