Imaging Appearance of Magnetic Resonance Myelography in Normal Population: Employing Three-dimensional Sampling Perfection with Application Optimized Contrasts Using Different Flip-angle Evolutions (3D-SPACE) Sequence

正常人的磁振脊隨攝影影像表現：採用3D-SPACE序列

陳泉翰(Chuan-Han Chen) ； 陳虹潔(Hung-Chieh Chen) ； 蔡志文(Jyh-Wen Chai) ； 陳啟昌(Clayton Chi-Cheng Chen)

《Journal of Radiological Science》 39卷1期 (2014/03) Pp. 1-6+37

https://doi.org/10.6698/JRS.201403_3901.01

摘要

磁振脊髓攝影因為能清楚呈現腦脊髓液的分布，近年來按廣泛使用於脊椎磁振造影。認識磁振脊髓攝影在正常人的表現對於疾病的診斷非常重要。本研究將由3D-SPACE序列來研究正常磁振脊髓攝影可以出現的影像變化。21位正常受試者接受3D-SPACE全脊椎的磁振脊髓攝影，將得到的影像重組成軸向平面重建影像（axial MPR）以及最大密度投影影像（MIP），由兩位放射科醫師判讀並且給于分級，使用kappa檢驗來檢測兩位醫師間的一致性。在軸向平面重建影像，其中1位醫師判斷由A型至G型在頸椎的個數分別為46、67、4、0、0、7以及2，另1位醫師判斷結果為53、57、6、0、0、5以及5；其中1位醫師判斷在胸椎的個數分別為185、41、8、0、0、16以及2，另1位醫師判斷為186、44、5、0、0、11以及6；其中1位醫師判斷在腰椎的個數分別為46、25、9、0、0、19以及6，另1位醫師判斷為58、23、5、0、0、13以及6。兩者間的一致性在頸椎、胸椎、腰椎、及整個脊椎分別為很好（kappa值為0.74）、很好（kappa值為0.69）、中等（kappa值為0.50），及很好（kappa值為0.69）。在最大密度投影影像，其中1位醫師判斷由0級到3級在頸椎的個數分別為0、13、8以及0；另1位醫師判斷結果為0、13、8以及0；其中1位醫師判斷在胸椎的個數分別為10、8、3以及0。另1位醫師判斷結果為14、5、2以及0；其中1位醫師判斷在腰椎的個數分別為5、10、6以及0，另1位醫師判斷結果為2、8、11以及0。兩者間的一致性在頸椎、胸椎、腰椎、及整個脊椎分別為很好（kappa值為0.80）、很好（kappa值為0.67）、尚可（kappa值為0.26），及很好（kappa值為0.61）。3D-SPACE用於磁振脊髓攝影，可同時提供品質佳的軸向平面重建影像以及最大密度投影影像。熟悉磁振脊髓攝影在正常人的表現，對於判斷脊髓疾病能提供準確的資訊，尤其對於診斷腦脊髓液滲漏患者更是重要。

並列摘要

Characterizing the normal distribution of cerebrospinal fluid (CSF) in the spine is crucial for an accurate assessment of CSF leakage and other abnormalities. Magnetic resonance myelography (MRM) is a noninvasive diagnostic method that is commonly used to evaluate the spinal distribution of CSF. Our aim was to evaluate the anatomical distribution of CSF in the spine of healthy individuals, by MRM using the three-dimensional sampling perfection with amplification-optimized contrasts using flip-angle evolutions (3D-SPACE) sequence. Twenty-one healthy volunteers underwent whole-spine MRM imaging using the 3D-SPACE sequence. MRM images were reconstructed with 5-mm axial multiplanar reconstruction (MPR) and maximum intensity projection (MIP) at each spine level. Two radiologists evaluated CSF distribution from the spinal canal in the MPR and MIP images, using 7-point (types A-G) and 3-point (grades 0-3) classification systems, respectively. Inter-reader agreement was calculated with the kappa coefficient (K). Reader 1/reader 2 evaluated 46/53, 67/57, 4/6, 0/0, 0/0, 7/5, and 2/5 cervical spine (C-spine)-level MPR images corresponding to types A-G, respectively (K = 0.74). Numbers at the thoracic spine (T-spine) level were 1851186, 41144, 8/5, 0/0, 0/0, 16/11, and 2/6, respectively (K = 0.69), and at the lumbar spine (L-spine) level were 46/58, 25/23, 9/5, 0/0, 0/0, 19/13, and 6/6, respectively (K = 0.50). Inter-reader agreement for MPR images at the whole-spine level was considered good (K = 0.69). Reader 1/reader 2 evaluated 0/0, 13/13, 8/8, and % MIP images at the C-spine level corresponding to grades 0-3, respectively (K = 0.80). Numbers at the T-spine level were 10/14, 8/5, 3/2, and 0/0, respectively (K = 0.67), and at the L-spine level were 5/2, 10/8, 6/11, and 0/0, respectively (K = 0.26). Inter-reader agreement for MIP images at the whole-spine level was considered good (K = 0.61). In conclusion, T2-weighted MRM with 3D-SPACE sequence imaging can be a useful technique to detect the normal distribution of CSF in the spinal canal. Understanding the normal distribution of CSF in the spinal canal is necessary to achieve an accurate diagnosis of CSF leakage.