Pillen Sigrid, van Keimpema Mieke, Nievelstein Rutger A J, Verrips Aad, van Kruijsbergen-Raijmann Wilma, Zwarts Machiel J
Department of Clinical Neurophysiology, Institute of Neurology, Nijmegen, The Netherlands.
Ultrasound Med Biol. 2006 Sep;32(9):1315-21. doi: 10.1016/j.ultrasmedbio.2006.05.028.
In this study, we compared the sensitivity and specificity of visual versus quantitative evaluation of skeletal muscle ultrasound in children suspected of having a neuromuscular disorder (NMD). Ultrasonography (US) scans of four muscles (biceps brachii, forearm flexors, quadriceps femoris, anterior tibial muscle) were made in 76 children. All images were visually evaluated using the Heckmatt criteria and quantitatively evaluated with computer-assisted grey-scale analysis of muscle echo intensity. Visual evaluation could achieve a sensitivity up to 71%, with a specificity of 92%. With quantification, a sensitivity of 87% accompanied by a specificity of 67% was found, but other diagnostic values could be achieved, depending on the cut-off point. Quantification resulted in a higher interobserver agreement (kappa 0.86) compared with visual evaluation (kappa 0.53). We conclude that quantification of echo intensity is a more objective and accurate method. Because it can achieve higher sensitivities, it is better-suited for the screening task in the diagnostic phase of children with a NMD.
在本研究中，我们比较了视觉评估与定量评估对疑似患有神经肌肉疾病（NMD）儿童骨骼肌超声检查的敏感性和特异性。对76名儿童的四块肌肉（肱二头肌、前臂屈肌、股四头肌、胫骨前肌）进行了超声（US）扫描。所有图像均使用赫克马特标准进行视觉评估，并通过计算机辅助的肌肉回声强度灰度分析进行定量评估。视觉评估的敏感性可达71%，特异性为92%。通过定量评估，发现敏感性为87%，特异性为67%，但根据截断点的不同，可获得其他诊断值。与视觉评估（kappa 0.53）相比，定量评估的观察者间一致性更高（kappa 0.86）。我们得出结论，回声强度的定量评估是一种更客观、准确的方法。由于它可以实现更高的敏感性，因此更适合在NMD儿童诊断阶段的筛查任务。
