A comparison of radiological descriptions of spinal cord compression with quantitative measures, and their role in non-specialist clinical management

被引：28

作者：

Tempest-Mitchell, Jennifer ^{[1
]}

Hilton, Bryn ^{[1
]}

Davies, Benjamin M. ^{[2
]}

Nouri, Aria ^{[3
]}

Hutchinson, Peter J. ^{[2
]}

Scoffings, Daniel J. ^{[4
]}

Mannion, Richard J. ^{[2
]}

Trivedi, Rikin ^{[2
]}

Timofeev, Ivan ^{[2
]}

Crawford, John R. ^{[2
]}

Hay, Douglas ^{[2
]}

Laing, Rodney J. ^{[2
]}

Kotter, Mark R. N. ^{[2
,5
]}

机构：

[1] Univ Cambridge, Sch Clin Med, Cambridge, England

[2] Univ Cambridge, Dept Clin Neurosci, Div Neurosurg, Cambridge, England

[3] Univ Hlth Network, Toronto Western Hosp, Div Neurosurg, Toronto, ON, Canada

[4] Cambridge Univ Hosp NHS Fdn Trust, Dept Radiol, Cambridge, England

[5] Univ Cambridge, Welcome Trust MRC Cambridge Stem Cell Inst, Anne McLaren Lab Regenerat Med, Cambridge, England

来源：

PLOS ONE | 2019年 / 14卷 / 07期

基金：

英国惠康基金;

关键词：

CERVICAL SPONDYLOTIC MYELOPATHY; OF-THE-ART; SIGNAL INTENSITY; PREDICTION; DIAGNOSIS; ACCURACY; RECOVERY; IMPROVE; IMAGES; TERM;

D O I：

10.1371/journal.pone.0219380

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Introduction Magnetic resonance imaging (MRI) is gold-standard for investigating Degenerative Cervical Myelopathy (DCM), a disabling disease triggered by compression of the spinal cord following degenerative changes of adjacent structures. Quantifiable compression correlates poorly with disease and language describing compression in radiological reports is unstandardised. Study design Retrospective chart review. Objectives 1) Identify terminology in radiological reporting of cord compression and elucidate relationships between language and quantitative measures 2) Evaluate language's ability to distinguish myelopathic from asymptomatic compression 3) Explore correlations between quantitative or qualitative features and symptom severity 4) Investigate the influence of quantitative and qualitative measures on surgical referrals. Methods From all cervical spine MRIs conducted during one year at a tertiary centre (N = 1123), 166 patients had reported cord compression. For each spinal level deemed compressed by radiologists (N = 218), four quantitative measurements were calculated: 'Maximum Canal Compromise (MCC); 'Maximum Spinal Cord Compression' (MSCC); 'Spinal Canal Occupation Ratio' (SCOR) and 'Compression Ratio' (CR). These were compared to associated radiological reporting terminology. Results 1) Terminology in radiological reports was varied. Objective measures of compromise correlated poorly with language. "Compressed" was used for more severe cord compromise as measured by MCC (p<0.001), MSCC (p<0.001), and CR (p = 0.002). 2) Greater compromise was seen in cords with a myelopathy diagnosis across MCC (p<0.001); MSCC (p = 0.002) and CR (p<0.001). "Compress" (p<0.001) and "Flatten" (p<0.001) were used more commonly for myelopathy-diagnosis levels. 3) Measurements of cord compromise (MCC: p = 0.304; MSCC: p = 0.217; SCOR: p = 0.503; CR: p = 0.256) and descriptive terms (p = 0.591) did not correlate with i-mJOA score. 4) The only variables affecting spinal surgery referral were increased MSCC (p = 0.001) and use of 'Compressed' (p = 0.045). Conclusions Radiological reporting in DCM is variable and language is not fully predictive of the degree of quantitative cord compression. Additionally, terminology may influence surgical referrals.

引用

页数：16

共 46 条

[1] Measurement of long-term outcome in patients with cervical spondylotic myelopathy treated surgically [J].