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Quantitative assessment of brachial plexus MRI for the diagnosis of chronic inflammatory neuropathies.
Journal of Neurology ( IF 6 ) Pub Date : 2020-09-23 , DOI: 10.1007/s00415-020-10232-8
Marieke H J van Rosmalen 1, 2 , H Stephan Goedee 1 , Anouk van der Gijp 2 , Theo D Witkamp 2 , Ruben P A van Eijk 1, 3 , Fay-Lynn Asselman 1 , Leonard H van den Berg 1 , Stefano Mandija 4, 5 , Martijn Froeling 2 , Jeroen Hendrikse 2 , W Ludo van der Pol 1
Affiliation  

OBJECTIVE This study aimed at developing a quantitative approach to assess abnormalities on MRI of the brachial plexus and the cervical roots in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) and to evaluate interrater reliability and its diagnostic value. METHODS We performed a cross-sectional study in 50 patients with CIDP, 31 with MMN and 42 disease controls. We systematically measured cervical nerve root sizes on MRI bilaterally (C5, C6, C7) in the coronal [diameter (mm)] and sagittal planes [area (mm2)], next to the ganglion (G0) and 1 cm distal from the ganglion (G1). We determined their diagnostic value using a multivariate binary logistic model and ROC analysis. In addition, we evaluated intra- and interrater reliability. RESULTS Nerve root size was larger in patients with CIDP and MMN compared to controls at all predetermined anatomical sites. We found that nerve root diameters in the coronal plane had optimal reliability (intrarater ICC 0.55-0.87; interrater ICC 0.65-0.90). AUC was 0.78 (95% CI 0.69-0.87) for measurements at G0 and 0.81 (95% CI 0.72-0.91) for measurements at G1. Importantly, our quantitative assessment of brachial plexus MRI identified an additional 10% of patients that showed response to treatment, but were missed by nerve conduction (NCS) and nerve ultrasound studies. CONCLUSION Our study showed that a quantitative assessment of brachial plexus MRI is reliable. MRI can serve as an important additional diagnostic tool to identify treatment-responsive patients, complementary to NCS and nerve ultrasound.

中文翻译:

臂丛神经 MRI 对慢性炎症性神经病诊断的定量评估。

目的 本研究旨在开发一种定量方法来评估慢性炎症性脱髓鞘性多发性神经病 (CIDP) 和多灶性运动神经病 (MMN) 患者臂丛神经和颈根的 MRI 异常,并评估评估者间的可靠性及其诊断价值。方法 我们对 50 名 CIDP 患者、31 名 MMN 患者和 42 名疾病对照者进行了横断面研究。我们在 MRI 双侧(C5、C6、C7)上系统地测量了冠状面 [直径 (mm)] 和矢状面 [面积 (mm2)]、靠近神经节 (G0) 和距神经节 1 cm 处的颈神经根大小(G1)。我们使用多元二元逻辑模型和 ROC 分析确定了它们的诊断价值。此外,我们评估了内部和内部可靠性。结果 在所有预先确定的解剖部位,与对照组相比,CIDP 和 MMN 患者的神经根尺寸更大。我们发现冠状平面中的神经根直径具有最佳可靠性(评估者 ICC 0.55-0.87;评估者 ICC 0.65-0.90)。G0 时测量的 AUC 为 0.78 (95% CI 0.69-0.87),G1 时测量的 AUC 为 0.81 (95% CI 0.72-0.91)。重要的是,我们对臂丛神经 MRI 的定量评估确定了另外 10% 的患者对治疗有反应,但被神经传导 (NCS) 和神经超声研究遗漏了。结论 我们的研究表明,臂丛神经 MRI 的定量评估是可靠的。MRI 可以作为一种重要的额外诊断工具来识别对治疗有反应的患者,补充 NCS 和神经超声。
更新日期:2020-09-23
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