脊髓型颈椎病MRI-T_2WI高信号与临床预后分析

Correlation between increased spinal cord signal intensity on T_2-weighted MRI and clinical prognosis of compressive cervical myelopathy

目的探讨脊髓型颈椎病(CSM)患者MRI-T2加权像高信号与临床效果的联系。方法将66例行颈椎前路椎间盘摘除减压、植骨和内固定手术的脊髓型颈椎病患者分为A组30例,MRIT1/T2表现为等/等,B组36例MRIT1/T2表现为等/高,所有病例于术前1周采用MRI检查和JOA评分。分别比较手术前、手术后6个月、手术后1年两组病人的JOA评分、改善率是否有差异。结果所有患者均随访12～38月,平均21月。A、B两组在手术前和手术后的JOA评分和改善率无显著性差异(P>0.05)。结论MRI-T2加权像高信号与患者的预后无明显相关性,有高信号患者同样可有良好的临床预后。不能仅通过MRI-T2加权像异常的高信号表现来判断患者的预后。

Objective To analyze the correlations between increased spinal cord signal intensity on magnetic resonance images （MRI） and the clinical prognosis of compressive cervical myelopathy. Methods Sixty-six patients with cervical spondylotic myelopathy underwent surgeries through the anterior approach. In all the patients, the diagnoses were established on the basis of both neurological examination and MRI findings that showed spinal cord compression. The patients were divided into two groups according to preoperative MRI, namely isointense MRI T1/T2 signal group and iso/hyperintense MRI T1/T2 group. The JOA scores of the patients were evaluated before and at 6 and 12 months after the operation. Results The patients were followed up for 12 to 38 months after the operation （mean 21 months）, and no statistically significant difference were found in the pre- and postoperative JOA scores between the two groups （P〉0.05）. Conclusion The peoperative hyperintense signals on T2 weighted MRI does not correlate to the prognosis of patients with compressive cervical myelopathy, who may also have favorable clinical outcomes after the operation.