脊髓型颈椎病患者颈椎动态MRI检查价值与安全性分析

目的 探究脊髓型颈椎病（CSM）患者颈椎动态MRI（DMRI）检查的价值与安全性。方法 2019年1月—2021年9月，87例CSM患者于苏州大学附属第二医院行颈椎DMRI检查。在矢状面前屈、后伸和中立位MRI T2加权像上观察是否存在脊髓隐匿性压迫。记录患者在DMRI检查前后的症状及体征、疼痛视觉模拟量表（VAS）评分。以DMRI检查后原有症状或体征加重或出现新的症状与体征考虑为短期内脊髓损伤加重。结果 87例患者中17例（19.5%）存在脊髓隐匿性压迫，其中2例在前屈位MRI检查中发现，15例在后伸位MRI检查中发现。DMRI检查后73例患者无明显不适，出现颈肩部不适5例，轻度头晕4例，呼吸不畅、轻度胸闷3例，恶心2例，DMRI检查后VAS评分无下降。85例患者无脊髓神经损伤加重，2例脊髓钳夹伴MRI T2加权像高信号改变患者检查后症状、体征加重。结论 颈椎DMRI是一种相对安全的补充检查，19.5%（17/87）的CSM患者在屈、伸位MRI检查中可发现脊髓隐匿压迫，脊髓钳夹损伤伴MRI T2加权像高信号改变的CSM患者应慎行DMRI检查。

Value and safety analysis of dynamic MRI examination in cervical spondylotic myelopathy patient

Objective To explore the value and safety of cervical vertebra dynamic MRI(DMRI) examination for cervical spondylotic myelopathy(CSM) patients. Methods From January 2019 to September 2021,eighty-seven CSM patients underwent cervical DMRI examination in the Second Affiliated Hospital of Soochow University. The presence of occult spinal cord compression was observed on sagittal flexion,extension and neutral MRI T2 weighted images. The symptoms,signs and visual analogue scale(VAS) score before and after DMRI examination were recorded. The exacerbation of original symptoms or signs after DMRI examination or the occurrence of new symptoms and signs were considered as exacerbation of spinal cord injury in the short term. Results Among 87 patients,17(19.5%) had occult spinal cord compression,of which 2 were found in the flexion position and 15 in the extension position. Among 87 patients,73 patients had no obvious discomfort after DMRI examination;and 5 cases with neck discomfort,4 with dizziness,3 with dyspnea and chest tightness,and 2 with nausea;and the VAS score did not decrease after DMRI examination. There was no aggravation of spinal cord injury in 85 patients,and the symptoms and signs of 2 patients with spinal cord clamping and hyperintensity signal on T2 weighted MRI images were aggravated after DMRI examination. Conclusions Cervical DMRI is a relatively safe supplementary examination. 19.5%(17/87) of CSM patients can be found to have occult spinal cord compression in flexion and extension MRI examinations. CSM patients with spinal cord clamp injury and hyperintensity signal on T2 weighted MRI images should be cautious in DMRI examination.