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Accuracy of transcranial magnetic stimulation and a Bayesian latent class model for diagnosis of spinal cord dysfunction in horses.
Journal of Veterinary Internal Medicine ( IF 2.6 ) Pub Date : 2020-02-06 , DOI: 10.1111/jvim.15699
Joke Rijckaert 1 , Els Raes 2 , Sebastien Buczinski 3 , Michèle Dumoulin 4 , Piet Deprez 1 , Luc Van Ham 5 , Gunther van Loon 1 , Bart Pardon 1
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BACKGROUND Spinal cord dysfunction/compression and ataxia are common in horses. Presumptive diagnosis is most commonly based on neurological examination and cervical radiography, but the interest into the diagnostic value of transcranial magnetic stimulation (TMS) with recording of magnetic motor evoked potentials has increased. The problem for the evaluation of diagnostic tests for spinal cord dysfunction is the absence of a gold standard in the living animal. OBJECTIVES To compare diagnostic accuracy of TMS, cervical radiography, and neurological examination. ANIMALS One hundred seventy-four horses admitted at the clinic for neurological examination. METHODS Retrospective comparison of neurological examination, cervical radiography, and different TMS criteria, using Bayesian latent class modeling to account for the absence of a gold standard. RESULTS The Bayesian estimate of the prevalence (95% CI) of spinal cord dysfunction was 58.1 (48.3%-68.3%). Sensitivity and specificity of neurological examination were 97.6 (91.4%-99.9%) and 74.7 (61.0%-96.3%), for radiography they were 43.0 (32.3%-54.6%) and 77.3 (67.1%-86.1%), respectively. Transcranial magnetic stimulation reached a sensitivity and specificity of 87.5 (68.2%-99.2%) and 97.4 (90.4%-99.9%). For TMS, the highest accuracy was obtained using the minimum latency time for the pelvic limbs (Youden's index = 0.85). In all evaluated models, cervical radiography performed poorest. CLINICAL RELEVANCE Transcranial magnetic stimulation-magnetic motor evoked potential (TMS-MMEP) was the best test to diagnose spinal cord disease, the neurological examination was the second best, but the accuracy of cervical radiography was low. Selecting animals based on neurological examination (highest sensitivity) and confirming disease by TMS-MMEP (highest specificity) would currently be the optimal diagnostic strategy.

中文翻译:

经颅磁刺激的准确性和贝叶斯潜伏类模型对马脊髓功能障碍的诊断。

背景技术脊髓功能障碍/压迫和共济失调在马中很常见。推定性诊断最常见的是基于神经系统检查和颈椎X线摄片,但是对经颅磁刺激(TMS)的诊断价值的记录和对磁电机诱发电位的记录的兴趣增加了。评估脊髓功能障碍的诊断测试的问题是在活体动物中缺乏金标准。目的比较TMS,宫颈X线摄片和神经系统检查的诊断准确性。动物174匹马在诊所接受了神经系统检查。方法采用贝叶斯潜伏类模型来解释缺乏黄金标准的情况,对神经系统检查,宫颈X线照相和不同的TMS标准进行回顾性比较。结果贝叶斯估计脊髓功能障碍的患病率(95%CI)为58.1(48.3%-68.3%)。神经系统检查的敏感性和特异性分别为97.6(91.4%-99.9%)和74.7(61.0%-96.3%),放射线照相分别为43.0(32.3%-54.6%)和77.3(67.1%-86.1%)。经颅磁刺激的敏感性和特异性分别为87.5(68.2%-99.2%)和97.4(90.4%-99.9%)。对于TMS,使用最短的骨盆四肢潜伏时间可获得最高的准确性(Youden指数= 0.85)。在所有评估的模型中,宫颈X光片表现最差。临床相关性经颅磁刺激-磁电机诱发电位(TMS-MMEP)是诊断脊髓疾病的最佳方法,神经系统检查次之,但宫颈X线摄片的准确性较低。
更新日期:2020-02-06
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