脊髓型颈椎病脊髓受压征象的MRI分级及其临床意义

The magnetic resonance imaging grading of spinal cord compression in cervical spondylotic myeopathy and its clinical significance

中文关键词:  脊髓型颈椎病  脊髓压迫症  硬膜囊  MRI分级

英文关键词:Cervical spondylotic myeopathy  Spinal cord compression  Dural sac  Magnetic resonance imaging grading

中文摘要:

  【摘要】 目的：建立脊髓型颈椎病（cervical spondylotic myelopathy，CSM）脊髓受压征象的MRI分级系统，探讨其可靠性及其与年龄、病程和JOA评分的相关性。方法：收集2010年1月～2011年9月就诊的78例多节段CSM患者的颈椎MRI资料，男51例，女27例；年龄42～77岁，平均55.1岁；病程0.25～276个月，平均48.8个月。以颈椎MRI中脊髓形态、脊髓信号、脊髓与硬膜囊关系作为分级依据征象，将每个征象按照其严重程度分为3个等级，相应赋予0～2分，按3个征象总分划分为四级： 0级，0分；Ⅰ级，1～2分；Ⅱ级，3～4分；Ⅲ级，5～6分。由3位初、中、高级职称医师对78例患者的颈椎MRI从C2/3～C6/7进行2次独立分级和1次共同分级，Kappa分析评价每位医师前后2次之间及3位医师之间分级结果的一致性。将3位医师对三个征象共同分级的结果进行Spearman相关分析，同时将患者年龄、病程、术前JOA评分与分级结果进行Spearman相关分析。结果：3位医师分别2次对78例患者的390个节段进行分级，0级82～94个（21.03%～24.10%），Ⅰ级112～126个（28.72%～32.31%），Ⅱ级111～137个(28.46%～35.13%)，Ⅲ级47～70个(12.05%～17.95%)。同一医师前后2次分级一致的节段占74.6%～78.5%，Kappa值为0.657～0.706；不同级别医师分级一致的节段占71.5%～76.7%，Kappa值为0.614～0.683。三个征象分级的结果之间相关系数分别为0.552、0.603、0.577，呈显著性正相关（P<0.05）。患者年龄、病程与3位医师共同分级结果的相关系数分别为0.372～0.511、0.388～0.498，呈显著性正相关（P<0.05）；术前JOA评分与3位医师共同分级结果的相关系数为-0.409～-0.546，呈显著性负相关（P<0.05）。结论：依据脊髓形态、脊髓信号、脊髓与硬膜囊关系建立的脊髓型颈椎病脊髓受压征象的MRI分级系统具有良好的一致性，其与患者年龄、病程呈正性相关，而与术前JOA评分呈负性相关，对脊髓受压后病变的严重程度评估和研究有指导意义。

英文摘要:

  【Abstract】 Objectives: To establish a magnetic resonance imaging(MRI) grading system of spinal cord compression in cervical spondylotic myelopathy（CSM）, and to investigate its clinical significance and the correlation with age, duration of disease and JOA scores. Methods: From January 2010 to September 2011, a retrospective study of 78 consecutive patients with multi-level CSM, who were referred to our hospital and underwent MRI examination of the cervical spine, was carried out. There were 51 males and 27 females with an average age of 55.1 years(range, 42-77 years) and an average duration of disease of 48.8 months(range, 0.25-276 months). The spinal cord morphology, spinal cord signal and relationship between spinal cord and dural sac in the MRI were regarded as grading signs. Each sign was divided into three types on the basis of severity degrees, and corresponding scores were 0 to 2. The grades of spinal cord compression on MRI were scored on the same four-point scale according to total scores： grade 0, 0 score; grade 1, 1-2 scores; grade 2, 3-4 scores; grade 3, 5-6 scores. Three independent spine surgeons(ranking as senior, middle, and primary) evaluated twice respectively and together for the third time, the MRI of CSM from the C2/3 through C6/7 levels of 78 consecutive patients. Kappa analysis was used to evaluate the consistency of the first and second results of grading. The Spearman correlation among three grading signs and the correlation of age, duration of disease and the JOA scores were investigated according to the third results of grading. Results: A total of 390 levels from 78 consecutive patients was evaluated by three independent spine surgeons twice respectively, 82-94 levels (21.03%-24.10%) were considered to be grade 0, 112-126 (28.72%-32.31%) grade 1, 111-137 (28.46%-35.13%) grade 2, 47-70(12.05%-17.95%) grade 3. The Kappa values of intraobserver were ranged from 0.657 to 0.706, representing substantial or excellent agreement in 74.6%-78.5% of 390 levels. The Kappa values of interobserver were ranged from 0.614 to 0.683, representing substantial or excellent agreement in 71.5%-76.7% of 390 levels. There were positive correlations among three grading signs(r=0.552, 0.603, 0.577, P<0.05). Age and duration of disease had positive correlations with the MRI grading of spinal cord compression in CSM(r=0.372-0.511, 0.388-0.498, P<0.05). The preoperative JOA scores had negative correlations with the MRI grading of spinal cord compression in CSM(r=-0.409--0.546, P<0.05). Conclusions: MRI grading system of spinal cord compression in CSM according to spinal cord morphology, spinal cord signal and relationship between spinal cord and dural sac is presented with good reliability, which can be useful for assessment and research of spinal cord compression. The magnetic resonance imaging grading of spinal cord compression in CSM exists a positive correlation with age and duration of disease, but has a negative correlation with preoperative JOA scores.