The Diagnostic Value of CT Myelography, MR Myelography, and Both in Neonatal Brachial Plexus Palsy
The Diagnostic Value of CT Myelography, MR Myelography, and Both in Neonatal Brachial Plexus Palsy
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DOI：
10.3174/ajnr.a3878
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发表时间：
2014-07-01
影响因子：
3.5
通讯作者：
Ishak, G. E.
中科院分区：
文献类型：
--
作者：
Tse, R.;Nixon, J. N.;Ishak, G. E.
背景和目的：虽然大多数臂丛神经麻痹婴儿的功能会自行恢复，但大约 10-30% 的婴儿可从手术治疗中受益。术前筛查神经根撕脱伤有助于规划重建。我们的目的是比较 CT 脊髓造影、MR 脊髓造影以及两者与检测出生性臂丛神经麻痹中完全神经根撕脱伤的手术标准的诊断价值。 材料和方法：纳入了 19 名接受术前 CT 和/或 MR 脊髓造影以及随后臂丛神经探查的患者。分析影像学研究是否存在可能预测神经根撕脱的异常情况。以手术探查时神经根撕脱的结果作为评估影像学结果预测价值的标准。结果：检查了95个神经根水平。当使用任何假性脑膜膨出作为预测因子时，CT 成像的敏感性为 0.73，MR 成像的敏感性为 0.68，CT 成像的特异性为 0.96，MR 成像的特异性为 0.97。当存在无细根的假性脑膜膨出作为预测因子时，CT 成像的敏感性为 0.68，MR 成像的敏感性为 0.68，CT 成像的特异性为 0.96，MR 成像的特异性为 0.97。 CT 和 MR 成像的使用并没有提高诊断准确性。不存在假性脑膜膨出的根部检查结果对于预测完全性神经根撕脱没有帮助。结论：CT 和 MR 脊髓造影的结果高度相关。鉴于磁共振脊髓造影的优点，它现已成为我院术前评估神经根撕脱伤的唯一技术。
BACKGROUND AND PURPOSE: Although most infants with brachial plexus palsy recover function spontaneously, approximately 10-30% benefit from surgical treatment. Pre-operative screening for nerve root avulsions is helpful in planning reconstruction. Our aim was to compare the diagnostic value of CT myelography, MR myelography, and both against a surgical criterion standard for detection of complete nerve root avulsions in birth brachial plexus palsy.MATERIALS AND METHODS: Nineteen patients who underwent a preoperative CT and/or MR myelography and subsequent brachial plexus exploration were included. Imaging studies were analyzed for the presence of abnormalities potentially predictive of nerve root avulsion. Findings of nerve root avulsion on surgical exploration were used as the criterion standard to assess the predictive value of imaging findings.RESULTS: Ninety-five root levels were examined. When the presence of any pseudomeningocele was used as a predictor, the sensitivity was 0.73 for CT and 0.68 for MR imaging and the specificity was 0.96 for CT and 0.97 for MR imaging. When presence of pseudomeningocele with absent rootlets was used as the predictor, the sensitivity was 0.68 for CT and 0.68 for MR imaging and the specificity was 0.96 for CT and 0.97 for MR imaging. The use of both CT and MR imaging did not increase diagnostic accuracy. Rootlet findings in the absence of pseudomeningocele were not helpful in predicting complete nerve root avulsion.CONCLUSIONS: Findings of CT and MR myelography were highly correlated. Given the advantages of MR myelography, it is now the single technique for preoperative evaluation of nerve root avulsion at our institution.