Impact of high resolution 3 tesla MR neurography (MRN) on diagnostic thinking and therapeutic patient management
Impact of high resolution 3 tesla MR neurography (MRN) on diagnostic thinking and therapeutic patient management
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DOI：
10.1007/s00330-015-3958-y
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发表时间：
2016-05-01
影响因子：
5.9
通讯作者：
Carrino, John A.
中科院分区：
文献类型：
--
作者：
Chhabra, Avneesh;Belzberg, Allan J.;Carrino, John A.
目的评价磁共振神经成像（MRN）对可疑周围神经病变患者的诊断思维和治疗选择的影响。在MRN之前（前测）和之后（后测），对85例疑似周围神经病变患者的诊断和治疗进行了6名外科医生的问卷调查。与诊断信心和手术决策相关的多个结果指标进行了评估。结果最终队列包括81例患者（30例男性和51例女性，年龄47 +/- 17岁）。从测试前到测试后的问卷调查中观察到以下变化：23%神经受累（P < 0.05），神经受累程度可信度为48（P < 0.01），损伤程度为27（P < 0.05），鉴别诊断率为33（P < 0.05），63%的患者对是否需要手术有信心（P < 0.001），手术时机为41（P < 0.01），手术入路30对手术入路的信心度为58%（P < 0.001），估计手术长度为30%（P < 0.05），切口长度为27%（P < 0.05）。关于手术或非手术治疗的二分法决定从赞成改变为反对17%.Conclusion MRN结果显着影响周围神经外科医生的诊断思路和治疗建议。
Objective To evaluate the impact of magnetic resonance neurography (MRN) on diagnostic thinking and therapeutic choices in patients with suspected peripheral neuropathy.Methods IRB approval was obtained for this HIPAA-compliant study. Questionnaires were administered to six surgeons regarding the diagnosis and treatment in 85 patients suspected of having peripheral neuropathy, before (pretest) and after (posttest) MRN. Multiple outcome measures related to diagnostic confidence and surgical decision-making were assessed.Results The final cohort included 81 patients (30 men and 51 women, age 47 +/- 17 years). The following changes were observed from pretest to posttest questionnaires: 23 % in nerve involvement (P < 0.05), 48 % in degree of confidence of nerve involvement (P < 0.01), 27 % in grade of injury (P < 0.05), 33 % in differential diagnosis (P < 0.05), 63 % in degree of confidence in need for surgery (P < 0.001), 41 % in timing of surgery (P < 0.01), 30 % in approach to surgery (P < 0.05), 58 % in degree of confidence in approach to surgery (P < 0.001), 30 % in estimated length of surgery (P < 0.05) and 27 % in length of incision (P < 0.05). The dichotomous decision regarding surgical or nonsurgical treatment changed from pro to con in 17 %.Conclusion MRN results significantly influenced the diagnostic thinking and therapeutic recommendations of peripheral nerve surgeons.