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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

超声和MRI测量的硬膜外间隙深度与腰椎硬膜外类固醇注射时临床阻力消失的相关性

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).

本前瞻性研究评估了MRI和超声（US）测量作为预测透视引导下腰椎硬膜外类固醇注射（ESIs）过程中临床穿刺阻力消失深度（CLORD）的术前评估工具的准确性。

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

60例患者在慢性疼痛门诊接受腰椎穿刺治疗。

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测量计算皮肤与后硬膜外间隙之间的距离，而US测量包括层间间隙的横向和矢状斜位视图。将俯卧位硬膜外注射时的硬膜外间隙测量与CLORD进行比较。

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与CLORD相当，平均差值为-0.2 cm （95%CI -0.39 ~ -0.11）。US横向和US副矢状面斜向测量不等于或低估了CLORD，平均差异分别为-0.98 cm （90%CI -1.8至-0.77）和-0.79 cm （90%CI - 1.0至- 5.9）。MRI与CLORD之间的类内相关系数最高，为0.85，而横向和副矢状面斜位US分别为0.65和0.73。

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

结论 MRI测量在术前评估腰椎ESIs患者预测CLORD方面优于US。

结  果

1.US measurements and MRI measurements.

硬膜外间隙横向（左）和斜矢状旁（右）测量。横切面显示棘间韧带（ISL）。鞘内间隙☆周围可见后椎体（PVB）和横突（TP）。黄韧带（LF）也用测量线末端的x表示。在矢状旁斜位面，L4和L5椎板在L4-5间隙清晰可见。

腰椎MRI矢状位T2图像（右）显示L4-L5水平（右）从皮肤表面到硬膜外间隙后侧的测量。

2.CLORD needle measurements临床穿刺阻力消失时，穿刺针的深度测量

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平均深度为6.46±1.48cm， CLORD为6.66±1.72cm。相比之下，横切面和副矢状面斜位US片平均分别为5.68±1.3cm和5.86±1.28cm（表1）。

3.Equivalency tests between imaging measurements and CLORD

成像测量与CLORD之间的等效性测试

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发现与CLORD相当，平均差值为- 0.2cm (90%CI -0.39至-0.01，TOST p值=0.005)（表2）。US横切面和副矢状面斜位视图未发现与CLORD相当（p值均=0.99），平均差值分别为- 0.98cm （90%CI - 1.2至-0.77）和- 0.79cm (90%CI - 1.0至-0.59)（表2）。对三个测试使用Bonferroni校正，显著性截止值为α =0.017。MRI和CLORD之间的差异仍然显著。

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之间的差异在年龄和性别上没有显著差异。然而，对于BMI为30或更高的患者，CLORD和US旁矢状斜位的差异为1.29(0.92)，而BMI低于30的患者为0.46 (0.87)（p值<0.001）。同样，高BMI组的CLORD和US横断面测量值的差异为1.47(0.92)，而低BMI组的差异为0.61 (0.83)（p值<0.001）

总  结

本研究分析了CLORD（硬膜外穿刺过程中阻力消失时的穿刺深度）与超声和MRI腰椎硬膜外深度测量的相关性。研究发现US和MRI测量与clod相关。然而，MRI在预测皮肤与后硬膜外间隙之间的距离方面似乎比US更准确。腰椎ESIs(硬膜外类固醇注射)应用，MRI比US预测CLORD更具有等效性、一致性和相关性。

       原文标题 : 【文献精读】超声和MRI测量的硬膜外间隙深度与腰椎硬膜外类固醇注射时临床阻力消失的相关性