Sensitivity and specificity of diagnostic ultrasound in the diagnosis of phrenic neuropathy
Sensitivity and specificity of diagnostic ultrasound in the diagnosis of phrenic neuropathy
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DOI：
10.1212/wnl.0000000000000841
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发表时间：
2014-09-30
期刊：
影响因子：
9.9
通讯作者：
Sorenson, Eric J.
中科院分区：
文献类型：
--
作者：
Boon, Andrea J.;Sekiguchi, Hiroshi;Sorenson, Eric J.
目的：探讨b超诊断膈肌神经功能障碍（包括膈神经病变）的敏感性和特异性。方法：一项前瞻性研究，连续招募到肌电图实验室评估神经肌肉呼吸衰竭的呼吸困难患者，并对其进行超声检查，以检查可能的膈肌功能障碍。超声结果测量隔膜的绝对厚度和最大吸气时厚度增加的程度。诊断膈功能障碍的比较标准是临床医生对膈超声结果不知情的最终临床诊断，但考虑到其他诊断检查，包括胸片、透视、膈神经传导研究、膈肌电图和/或肺功能检查。结果：在2年的时间里，82名患者中有66名被纳入研究。16例患者因参比检测不确定或不充分而被排除。一个半膈不能充分显像；因此，我们对66例患者共131个半膈进行了半膈评估。在82例异常半膈中，76例超声表现异常（萎缩或收缩性下降）。在49例正常的半膈中，没有一例超声假阳性。膈超声诊断膈神经肌功能障碍的敏感性为93%，特异性为100%。结论：横膈膜b超成像是诊断神经肌肉横膈膜功能障碍的一种灵敏度高、特异性强的工具。证据分类：本研究提供了II级证据，由训练有素的个体进行膈超声可准确识别神经肌肉膈呼吸衰竭患者（敏感性93%，特异性100%）。
Objectives: To determine the sensitivity and specificity of B-mode ultrasound in the diagnosis of neuromuscular diaphragmatic dysfunction, including phrenic neuropathy.Methods: A prospective study of patients with dyspnea referred to the EMG laboratory over a 2-year time frame for evaluation of neuromuscular respiratory failure who were recruited consecutively and examined with ultrasound for possible diaphragm dysfunction. Sonographic outcome measures were absolute thickness of the diaphragm and degree of increased thickness with maximal inspiration. The comparison standard for diagnosis of diaphragm dysfunction was the final clinical diagnosis of clinicians blinded to the diaphragm ultrasound results, but taking into account other diagnostic workup, including chest radiographs, fluoroscopy, phrenic nerve conduction studies, diaphragm EMG, and/or pulmonary function tests.Results: Of 82 patients recruited over a 2-year period, 66 were enrolled in the study. Sixteen patients were excluded because of inconclusive or insufficient reference testing. One hemidiaphragm could not be adequately visualized; therefore, hemidiaphragm assessment was conducted in a total of 131 hemidiaphragms in 66 patients. Of the 82 abnormal hemidiaphragms, 76 had abnormal sonographic findings (atrophy or decreased contractility). Of the 49 normal hemidiaphragms, none had a false-positive ultrasound. Diaphragmatic ultrasound was 93% sensitive and 100% specific for the diagnosis of neuromuscular diaphragmatic dysfunction.Conclusion: B-mode ultrasound imaging of the diaphragm is a highly sensitive and specific tool for diagnosis of neuromuscular diaphragm dysfunction. Classification of evidence: This study provides Class II evidence that diaphragmatic ultrasound performed by well-trained individuals accurately identifies patients with neuromuscular diaphragmatic respiratory failure (sensitivity 93%; specificity 100%).