关键字:
儿科急诊

    字体: | |

我应该核磁检查病人哪个部位?
原作者: Brian Corwell, 肖锋译 文章来源: 《中华急诊医学杂志》编辑部 发布日期:2013-05-28

Title: What should I MRI
题目:我应该核磁检查病人哪个部位?
Author 作者: Brian Corwell

You have a patient with a spinal cord syndrome and you order the MRI. Have you ever had that conversation with radiology where you have to "choose" what part of the spine you want imaged?
你有一个有脊髓受损表现的病人,并准备要进行MRI检查。你是否与放射科有过交流,应该检查脊柱的哪个部位?
The entire spine needs to be imaged!
应该照整个脊柱!
The reason: False localizing sensory levels.
理由:不能准确判断感觉异常水平。
For example: The patient has a thoracic sensory level that is caused by a cervical lesion.
 列如:病人胸椎感觉异常可能会是由颈椎病变引起。
A study of 324 episodes of malignant spinal cord compression (MSCC) found that clinical signs were very unreliable indicators of the level of compression. Only 53 patients (16%) had a sensory level that was within 3 vertebral levels of the level of compression demonstrated on MRI.
一个324例恶性脊髓压迫报告显示在判断压迫水平时,临床体征是极为不可靠的。只有53个病人(16%)的异常感觉水平在MRI判断的压迫水平的3个锥体范围内。
Further, pain (both midline back pain and radicular pain) was also a poor predictor of the level of compression.
另外,疼痛(不管是后背正中痛或放射痛)也是一个非常差的判断压迫水平的 指标。
Finally, of the 187 patients who had plain radiographs at the level of compression at referral, 60 showed vertebral collapse suggesting cord compression, but only 39 of these predicted the correct level of compression (i.e. only 20% of all radiographs correctly identified the level of compression).
最后,在187个就诊时平片显示脊椎压缩水平的病人中,有60例的脊椎塌陷造成脊髓压迫,但只有39例与脊髓压迫水平相符(也就是说,只有20%的平片异常可以准确判断压迫的位置)。
The authors note that frequently only the lumbar spine was XR at the time of clinical presentation, presumably due to false localizing signs and a low awareness on the part of clinicians that most MSCC occurs in the thoracic spine (68% in this series).
作者指出,病人初诊时经常只照腰椎,可能是由于判断体征有误或临床医生对多数的恶性脊髓压迫发生在胸椎(此文献中占68%)的概念认识不足。
References 参考文献:
Summers D, et al. Assessment of MSCC using MRI Br J Radiol 2001;74:977-8.

文章来源:《中华急诊医学杂志》编辑部