Predictive Value of Computed Tomographic Myelography in Obstetrical Brachial Plexus Palsy
Predictive Value of Computed Tomographic Myelography in Obstetrical Brachial Plexus Palsy
复制标题
计算机断层脊髓造影对产科臂丛神经麻痹的预测价值
DOI：
10.1097/00006534-200010000-00001
复制
发表时间：
2000
影响因子：
3.6
通讯作者：
H. Clarke
中科院分区：
文献类型：
--
作者：
B.L.C. Chow;S. Blaser;H. Clarke
术前的放射学检查，以发现由产伤引起的臂丛根性撕脱，被认为有助于手术计划的重建。在这项研究中，我们确定了计算机断层扫描(CT)脊髓造影术在检测神经根性撕脱中的预测价值。选择63例产瘫患者，均行CT脊髓造影术和重建手术。所有的CT脊髓图都由一位神经放射科医生在不了解手术结果的情况下进行分析。在臂丛的每个根部水平，假性脊膜膨出的存在以及在每个已识别的假性脊膜脊膜膨出内有或不存在根状突起。随后在手术中确定的孔外根性撕脱，由一名外科医生以一种无视放射学结果的方式进行审查。然后在每个相应的牙根水平比较手术和放射学结果。共检查了281根。假性脊膜膨出根性撕脱的敏感度为0.63，特异度为0.85，阳性预测值为0.40，似然比为4.2。对于假性脊膜膨出，不能辨认出横贯囊内的细根，这些值分别为0.37、0.98、0.74和18.5。假性脊膜膨出伴或不伴神经根性撕脱不是根性撕脱的敏感指标。假性脊膜脊膜膨出中没有根状突能更好地预测根性撕脱。CT脊髓造影的这种缺失可能被用来提示孔外根性撕脱，因为它具有高的特异性和高的似然比。
Preoperative radiologic studies to detect root avulsions of the brachial plexus caused by birth trauma are considered useful in assisting with surgical planning for reconstruction. In this study, the predictive value of computed tomographic (CT) myelography in detecting nerve root avulsions at our institution was determined. Sixty-three consecutive patients with an obstetrical brachial plexus palsy who had had both preoperative CT myelography and reconstructive surgery were selected. All CT myelograms were analyzed post hoc by a single neuroradiologist in a manner blind to the surgical findings. At each root level of the brachial plexus, the presence of a pseudomeningocele was noted along with the presence or absence of rootlets within each identified pseudomeningocele. Extraforaminal root avulsions later determined at surgery were reviewed by a single surgeon in a manner blind to the radiographic results. Surgical and radiographic findings were then compared at each corresponding root level. A total of 281 roots were examined. The sensitivity, specificity, positive predictive value, and likelihood ratio for root avulsions with pseudomeningoceles were 0.63, 0.85, 0.40, and 4.2, respectively. For pseudomeningoceles for which rootlets traversing the sac could not be identified, these values were 0.37, 0.98, 0.74, and 18.5, respectively. The presence of pseudomeningoceles with or without rootlets was not a sensitive indicator of root avulsions. Root avulsions were better predicted by identifying the absence of rootlets in a pseudomeningocele. This absence on CT myelography may be used to suggest an extraforaminal root avulsion due to its high specificity and high likelihood ratio.