What Degree of Radiological Compression Predicts Cauda Equina Syndrome: A Retrospective Study at a National Tertiary Centre.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-09-11 DOI:10.1016/j.wneu.2024.09.025

Dineth Foneska,Sayan Biswas,Hamza Ahmed,Ved Sarkar,Joshua MacArthur,K Joshi George

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Abstract

OBJECTIVE Cauda Equina Syndrome (CES) is diagnosed both clinically and radiologically. However, it's unclear if a specific degree of cauda equina compression (CEC) on imaging can confirm the diagnosis. This study aimed to identify an optimal percentage of prolapse to canal ratio (PCR) on MRI that correlates with CEC, facilitating reliable decision-making for CES symptoms. METHODS A single-center retrospective case series analysis was conducted from 2020 to 2021. Sixty-one patients who underwent emergency lumbar discectomy within 48 hours of presentation were included, divided into a CES group and a disc prolapse (DP) group. CES cases were identified using ICD-10 code G83.4. PCR was calculated by dividing the width of the disc herniation by the total width of the spinal canal at the level of the herniation on single mid-sagittal T2 MRI scans, using the IC Measure software on Windows. RESULTS CES most frequently occurred at the L4/5 level (37/61). The median PCR in CES cases was 76.19% (66.67 - 85.71), significantly higher than in DP cases, 48.08% (31.33 - 55.56) (p<0.001). A PCR threshold of 40% maximized sensitivity at 100% but had a specificity of 45%. Conversely, a threshold of 75% maximized specificity at 100% with a sensitivity of 50%. The optimal PCR, determined by the Youden index, was 66%, yielding a sensitivity of 75% and specificity of 97%, with an area under the curve (AUC) of 0.923. CONCLUSIONS Simple radiological measurements of PCR can potentially triage CES patients and guide their management. Future studies should correlate PCR with clinical signs and symptoms for a comprehensive assessment.

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放射学压迫程度如何预测马尾综合征？一家国家三级医疗中心的回顾性研究

目的马尾综合征（CES）可通过临床和放射学诊断。然而，目前还不清楚影像学上特定程度的马尾受压（CEC）能否确诊。本研究旨在确定核磁共振成像上与 CEC 相关的脱垂与椎管比率（PCR）的最佳百分比，从而有助于对 CES 症状做出可靠的决策。方法在 2020 年至 2021 年期间进行了一项单中心回顾性病例系列分析。61名患者在发病48小时内接受了急诊腰椎间盘切除术，分为CES组和椎间盘脱出（DP）组。CES病例使用ICD-10代码G83.4进行鉴定。PCR 的计算方法是，使用 Windows 上的 IC Measure 软件，将椎间盘突出的宽度除以椎间盘突出水平的椎管总宽度。CES 病例的 PCR 中位数为 76.19% (66.67 - 85.71)，明显高于 DP 病例的 48.08% (31.33 - 55.56)（P<0.001）。PCR 阈值为 40% 时，灵敏度最高可达 100%，但特异性仅为 45%。相反，75% 的阈值可使特异性达到 100%，灵敏度为 50%。根据尤登指数确定的最佳 PCR 为 66%，灵敏度为 75%，特异性为 97%，曲线下面积 (AUC) 为 0.923。未来的研究应将 PCR 与临床症状和体征相关联，以进行综合评估。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.