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Correlation between epidural space depth measured with ultrasound and MRI compared to clinical loss of resistance when performing lumbar epidural steroid injection

超聲和MRI測量的硬膜外間隙深度與腰椎硬膜外類固醇注射時臨床阻力消失的相關性

前  言

Background This prospective study assessed the accuracy of MRI and ultrasound (US) measurements as a preprocedural assessment tool for predicting clinical loss of resistance depth (CLORD) during fluoroscopy-guided lumbar epidural steroid injections (ESIs).

本前瞻性研究評估了MRI和超聲（US）測量作為預測透視引導下腰椎硬膜外類固醇注射（ESIs）過程中臨床穿刺阻力消失深度（CLORD）的術前評估工具的準確性。

Materials and methods Sixty patients enrolled received lumbar ESIs at an academic chronic pain clinic.

60例患者在慢性疼痛門診接受腰椎穿刺治療。

The MRI measurement calculated the distance between the skin and the posterior epidural space, while US measurements included transverse and parasagittal oblique views of the interlaminar space. The epidural space measurements were compared with the CLORD during the performance of the prone epidural injections.

MRI測量計算皮膚與后硬膜外間隙之間的距離，而US測量包括層間間隙的橫向和矢狀斜位視圖。將俯臥位硬膜外注射時的硬膜外間隙測量與CLORD進行比較。

Results MRI was equivalent to CLORD with a mean difference of –0.2 cm (95%CI –0.39 to –0.11). US transverse and US parasagittal oblique measurements were not equivalent to and underestimated CLORD with mean differences of –0.98 cm (90%CI –1.8 to –0.77) and –0.79 cm (90% CI −1.0 to −5.9), respectively. The intraclass correlation coefficients between MRI and CLORD were the highest at 0.85, compared with 0.65 and 0.73 for transverse and parasagittal oblique US views, respectively.

MRI與CLORD相當，平均差值為-0.2 cm （95%CI -0.39 ~ -0.11）。US橫向和US副矢狀面斜向測量不等于或低估了CLORD，平均差異分別為-0.98 cm （90%CI -1.8至-0.77）和-0.79 cm （90%CI - 1.0至- 5.9）。MRI與CLORD之間的類內相關系數(shù)最高，為0.85，而橫向和副矢狀面斜位US分別為0.65和0.73。

Conclusions MRI measurements are preferable over US for preprocedural assessment of patients receiving lumbar ESIs for predicting CLORD.

結論 MRI測量在術前評估腰椎ESIs患者預測CLORD方面優(yōu)于US。

結  果

1.US measurements and MRI measurements.

硬膜外間隙橫向（左）和斜矢狀旁（右）測量。橫切面顯示棘間韌帶（ISL）。鞘內間隙☆周圍可見后椎體（PVB）和橫突（TP）。黃韌帶（LF）也用測量線末端的x表示。在矢狀旁斜位面，L4和L5椎板在L4-5間隙清晰可見。

腰椎MRI矢狀位T2圖像（右）顯示L4-L5水平（右）從皮膚表面到硬膜外間隙后側的測量。

2.CLORD needle measurements臨床穿刺阻力消失時，穿刺針的深度測量

The average depth in MRI was 6.46±1.48cm, and the CLORD was 6.66±1.72cm. In comparison, transverse and parasagittal oblique US views averaged 5.68±1.3cm and 5.86±1.28cm, respectively (table 1).

MRI平均深度為6.46±1.48cm， CLORD為6.66±1.72cm。相比之下，橫切面和副矢狀面斜位US片平均分別為5.68±1.3cm和5.86±1.28cm（表1）。

3.Equivalency tests between imaging measurements and CLORD

成像測量與CLORD之間的等效性測試

MRI was found to be equivalent to CLORD with a mean difference of −0.2cm (90% CI –0.39 to –0.01, TOST p value =0.005) (table 2). US transverse and parasagittal oblique views were not found to be equivalent to CLORD (p values both =0.99), with mean differences of −0.98cm (90%CI −1.2 to –0.77) and −0.79cm (90% CI −1.0 to –0.59), respectively (table 2). Using a Bonferroni correction for the three tests, the significance cutoff becomes alpha =0.017, and the difference between MRI and CLORD remains significant.

MRI發(fā)現(xiàn)與CLORD相當，平均差值為- 0.2cm (90%CI -0.39至-0.01，TOST p值=0.005)（表2）。US橫切面和副矢狀面斜位視圖未發(fā)現(xiàn)與CLORD相當（p值均=0.99），平均差值分別為- 0.98cm （90%CI - 1.2至-0.77）和- 0.79cm (90%CI - 1.0至-0.59)（表2）。對三個測試使用Bonferroni校正，顯著性截止值為α =0.017。MRI和CLORD之間的差異仍然顯著。

4.The difference between the imaging modalities and CLORD did not significantly vary with age and sex. However, for those with a BMI of 30 or greater, the difference between CLORD and US parasagittal oblique was 1.29 (0.92) compared with 0.46 (0.87) for those with BMI lower than 30 (p value <0.001). Similarly, the difference in the CLORD and US transverse view measurements was 1.47 (0.92) for the higher BMI group compared with 0.61 (0.83) for the lower BMI group (p value <0.001).

成像方式和CLORD之間的差異在年齡和性別上沒有顯著差異。然而，對于BMI為30或更高的患者，CLORD和US旁矢狀斜位的差異為1.29(0.92)，而BMI低于30的患者為0.46 (0.87)（p值<0.001）。同樣，高BMI組的CLORD和US橫斷面測量值的差異為1.47(0.92)，而低BMI組的差異為0.61 (0.83)（p值<0.001）

總  結

本研究分析了CLORD（硬膜外穿刺過程中阻力消失時的穿刺深度）與超聲和MRI腰椎硬膜外深度測量的相關性。研究發(fā)現(xiàn)US和MRI測量與clod相關。然而，MRI在預測皮膚與后硬膜外間隙之間的距離方面似乎比US更準確。腰椎ESIs(硬膜外類固醇注射)應用，MRI比US預測CLORD更具有等效性、一致性和相關性。

       原文標題 : 【文獻精讀】超聲和MRI測量的硬膜外間隙深度與腰椎硬膜外類固醇注射時臨床阻力消失的相關性