Limitations of invasive modalities in the diagnosis of primary angiitis of the central nervous system.
Limitations of invasive modalities in the diagnosis of primary angiitis of the central nervous system.
复制标题
侵入性方式诊断中枢神经系统原发性血管炎的局限性。
DOI：
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发表时间：
1995
期刊：
影响因子：
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通讯作者：
L. Calabrese
中科院分区：
文献类型：
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作者：
G. Duna;L. Calabrese
目的
经常咨询风湿病学家来评估怀疑患有中枢神经系统原发性血管炎（PACNS）的患者。诊断过程在很大程度上依赖于解释脑血管造影和脑活检的结果。我们评估了PACNS诊断中这些侵入性方式的操作特征：
方法
回顾性分析了30例连续患者的记录，以评估可能的PACNS。根据临床情况对患者进行评估，并相应延长诊断过程，直到出现可定义疾病的合理可能性。所有患者均接受了脑血管造影和/或脑活检。评估以下诊断试验的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）：脑血管造影、脑活检、脑脊液（CSF）检查和磁共振成像（MRI）。
结果
最终诊断结果为：PACNS 7例，淋巴组织增生性疾病4例，感染4例，脱髓鞘疾病2例，可逆性血管痉挛性疾病6例，其他各种非血管炎性疾病7例。脑血管造影对PACNS的特异性和PPV低于30%：脑活检的敏感性和NPV有限（分别为53%和70%）。CSF检查和MRI虽然敏感，但缺乏特异性。
结论
对于怀疑有PACNS的患者，应谨慎解释侵入性诊断方法的结果。准确的诊断不应依赖于任何单一的研究，而应遵循仔细的临床，放射学和病理学的相关性。
OBJECTIVE
Rheumatologists are often consulted to evaluate patients suspected of having primary angiitis of the central nervous system (PACNS). The diagnostic process relies heavily on interpreting the results of cerebral angiography and brain biopsy. We have assessed the operating characteristics of those invasive modalities in the diagnosis of PACNS:
METHODS
The records of 30 consecutive patients referred for the evaluation of possible PACNS were retrospectively analyzed. Patients were evaluated on clinical grounds, and the diagnostic process was extended accordingly until a reasonable probability of a definable disease was present. All patients had cerebral angiography and/or brain biopsy. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed for each of the following diagnostic tests: cerebral angiography, brain biopsy, cerebrospinal fluid (CSF) examination, and magnetic resonance imaging (MRI).
RESULTS
The final diagnostic outcomes were: PACNS in 7, lymphoproliferative disease in 4, infection in 4, demyelinating disease in 2, reversible vasospastic disorder in 6, and a variety of other nonvasculitic conditions in 7. Cerebral angiography had less than 30% specificity and PPV for PACNS: Brain biopsy had limited sensitivity and NPV (53% and 70%, respectively). CSF examination and MRI, although sensitive, lacked specificity.
CONCLUSION
In patients suspected of having PACNS, the results of invasive diagnostic modalities should be interpreted with caution. Accurate diagnosis should rarely rely on any single study and should only follow careful clinical, radiographic and pathologic correlation.