The Relationship Between MRI Signal Intensity Changes, Clinical Presentation, and Surgical Outcome in Degenerative Cervical Myelopathy Analysis of a Global Cohort
The Relationship Between MRI Signal Intensity Changes, Clinical Presentation, and Surgical Outcome in Degenerative Cervical Myelopathy Analysis of a Global Cohort
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DOI：
10.1097/brs.0000000000002234
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发表时间：
2017-12-15
期刊：
影响因子：
3
通讯作者：
Fehlings, Michael G.
中科院分区：
文献类型：
--
作者：
Nouri, Aria;Martin, Allan R.;Fehlings, Michael G.
研究设计。前瞻性数据的回溯性分析。目的：评估退行性脊髓型颈椎病(DCM)患者MRI信号强度变化、临床表现和手术结果之间的关系。一些研究试图通过评估脊髓T2加权像(T2WI)和T1加权像(T1WI)上脊髓信号的变化来评估脊髓功能障碍的程度和术后神经恢复的潜力。T2WI和T1WI信号变化(1)与基线严重程度有关，(2)预测手术治疗后神经功能恢复情况仍不明确。来自两个前瞻性多中心研究的419个磁共振成像被检查。图像评估脊髓信号强度变化的存在、水平和位置，并与临床数据进行比较。使用mJOA参数对信号变化进行评估以预测术后2年的结果。MRI分为T1WI和T2WI信号改变：无信号改变(28.9%)，仅T2WI高信号(51.8%)，T2WI高信号和T1WI低信号(T1WIthornT2WI，19.3%)。27%的患者存在不同程度的T2WI高信号。基线严重程度从无信号改变到只有T2WI，再到T2WI+T1WI(P<；0.0001)，体征/症状的频率逐渐增加。在无信号改变组和仅T2WI组之间，结果没有差异。T1WI低信号的存在与恢复率降低(P=0.03)和最佳手术结果的可能性(P=0.005)相关，并调整了基线的MJOA值。T2WI高信号的数目越多，基线严重程度(P<；0.0001)和恢复率(P=0.001)越差。这项对全球扩张型心肌病患者队列的分析显示，从无信号改变到T2WI高信号再到T1WI低信号，损害有逐渐增加的趋势。T1WI信号改变提示更多的永久性损伤，预示功能恢复减退。单靠T2WI高信号并不能预测结果。多个水平的T2WI高信号提示额外的组织损伤，与更严重的临床损害和恢复潜力相关。
Study Design. Retrospective analysis of prospective data.Objective. To assess the relationship between MRI signal intensity changes, clinical presentation, and surgical outcome in degenerative cervical myelopathy (DCM).Summary of Background Data. Several studies have sought to assess the extent of spinal cord dysfunction and the potential for postoperative neurological recovery through the evaluation of spinal cord signal change on T2-weighted (T2WI) and T1-weighted images (T1WI). There remains ambiguity if T2WI and T1WI signal changes (1) relate to baseline severity, and (2) predict neurological recovery after surgical treatment.Methods. Four hundred nineteen MRIs from two prospective multicenter studies were examined. Images were assessed for the presence, levels, and location of spinal cord signal intensity changes and compared with clinical data. Signal changes were also evaluated for the prediction of 2-year postoperative outcome using mJOA parameters.Results. MRIs were categorized by T1WI and T2WI signal change: no signal change (28.9%), T2WI hyperintensity-only (T2WI-only, 51.8%), and T2WI-hyperintensity and T1WI-hypointensity (T1WIthornT2WI, 19.3%). T2WI-hyperintensity was present at multiple levels in 27% of patients overall. Baseline severity increased from no signal change to T2WI-only to T2WI+T1WI (P < 0.0001), and there was an incremental increase in the frequency of signs/symptoms. There were no differences in outcomes between no signal change and T2WI-only groups. The presence of T1WI-hypointensity correlated with reduced recovery ratio (P = 0.03) and likelihood of an optimal surgical outcome (P = 0.005), adjusting for baseline mJOA. A greater number of T2WI-hyperintensity levels was also associated with worse baseline severity (P < 0.0001) and recovery ratio (P = 0.001).Conclusion. This analysis of a global cohort of DCM patients shows a stepwise trend toward increasing impairment from no signal change to T2WI-hypertensity to T1WI-hypointensity. T1WI signal change indicates more permanent injury, portending decreased functional recovery. T2WI-hyperintensity alone does not predict outcomes. Multiple levels of T2WI-hyperintensity suggest additional tissue injury, correlating with worse clinical impairment and recovery potential.