NEJM：磁共振随访检查对坐骨神经痛患者无益
2013-03-21 shumufeng 丁香园
存在已知腰椎间盘突出症和持续存在坐骨神经痛症状的患者在随访期间经常进行磁共振成像（MRI）检查。目前对MRI的表现与临床转归之间的相关性尚存争议。荷兰莱顿大学医学中心神经外科的Abdelilah Barzouhi博士等人进入了深入研究，他们发现，已治疗坐骨神经痛和腰椎间盘突出症的患者随访1年时进行的MRI检查在转归良好的患者与转归欠佳的患者之间无差异。研究结果发表于国际权威杂志NEJM 2013年
存在已知腰椎间盘突出症和持续存在坐骨神经痛症状的患者在随访期间经常进行磁共振成像（MRI）检查。目前对MRI的表现与临床转归之间的相关性尚存争议。荷兰莱顿大学医学中心神经外科的Abdelilah Barzouhi博士等人进入了深入研究，他们发现，已治疗坐骨神经痛和腰椎间盘突出症的患者随访1年时进行的MRI检查在转归良好的患者与转归欠佳的患者之间无差异。研究结果发表于国际权威杂志NEJM 2013年最新一期在线版上。
研究人员在一项比较坐骨神经痛和腰椎间盘突出症手术治疗与长期保守治疗的随机试验中对283例患者进行了研究。患者在基线和1年后进行了MRI检查。我们采用了一个4分的量表（范围从“确定有”的1分到“确定没有”的4分）来评估MRI上的椎间盘突出症（表现）。良好的临床转归定义为1年时症状完全或几乎完全消失。我们比较了确定没有椎间盘突出症的患者和确定、很可能、可能有椎间盘突出症的患者在1年时转归良好的患者比例。我们采用了接受者操作特征（ROC）曲线下的面积来评估该4分量表预测转归良好或欠佳的准确性，1（ROC曲线下的面积）提示有鉴别价值，≤0.5提示无鉴别价值。
试验1年时，84%的患者报告转归良好。椎间盘突出症见于35%转归良好的患者和33%转归欠佳的患者（P＝0.70）。85%的椎间盘突出症患者和83%的无椎间盘突出症患者报告转归良好（P＝0.70）。转归良好的患者和转归欠佳的患者椎间盘突出症的MRI评估无差异（ROC曲线下的面积0.48）。
研究者由此得出结论，已治疗坐骨神经痛和腰椎间盘突出症的患者随访1年时进行的MRI检查在转归良好的患者与转归欠佳的患者之间无差异。
BACKGROUND
Magnetic resonance imaging (MRI) is frequently performed during follow-up in patients with known lumbar-disk herniation and persistent symptoms of sciatica. The association between findings on MRI and clinical outcome is controversial.
METHODS
We studied 283 patients in a randomized trial comparing surgery and prolonged conservative care for sciatica and lumbar-disk herniation. Patients underwent MRI at baseline and after 1 year. We used a 4-point scale to assess disk herniation on MRI, ranging from 1 for “definitely present” to 4 for “definitely absent.” A favorable clinical outcome was defined as complete or nearly complete disappearance of symptoms at 1 year. We compared proportions of patients with a favorable outcome among those with a definite absence of disk herniation and those with a definite, probable, or possible presence of disk herniation at 1 year. The area under the receiver-operating-characteristic (ROC) curve was used to assess the prognostic accuracy of the 4-point scores regarding a favorable or unfavorable outcome, with 1 indicating perfect discriminatory value and 0.5 or less indicating no discriminatory value.
RESULTS
At 1 year, 84% of the patients reported having a favorable outcome. Disk herniation was visible in 35% with a favorable outcome and in 33% with an unfavorable outcome (P=0.70). A favorable outcome was reported in 85% of patients with disk herniation and 83% without disk herniation (P=0.70). MRI assessment of disk herniation did not distinguish between patients with a favorable outcome and those with an unfavorable outcome (area under ROC curve, 0.48).
CONCLUSIONS
MRI performed at 1-year follow-up in patients who had been treated for sciatica and lumbar-disk herniation did not distinguish between those with a favorable outcome and those with an unfavorable outcome.
作者：shumufeng
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#磁共振#
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#坐骨神经痛#
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