Department of Neuroradiology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
Radiology. 2011 Jul;260(1):199-206. doi: 10.1148/radiol.11102357. Epub 2011 Apr 14.
To assess nerve T2 signal and caliber as diagnostic signs at magnetic resonance (MR) neurography in ulnar neuropathy at the elbow (UNE).
This prospective study was approved by the institutional review board, and written informed consent was obtained from all participants. Twenty patients with UNE were graded by using clinical criteria and nerve conduction studies as mild (n = 12) and severe (n = 8) and were compared with 20 healthy control subjects. All subjects underwent ulnar nerve MR neurography (in-plane resolution of 0.4 × 0.4 mm) covering the elbow region, including T2-weighted imaging with fat suppression (turbo inversion-recovery magnitude sequence: repetition time msec/echo time msec/inversion time msec, 6, 120/66/180) and T1-weighted turbo spin-echo imaging (843/16). Nerve T2 signal increase, measured by using T2-weighted contrast-to-noise ratios across the cubital tunnel, and nerve caliber, determined by using T1-weighted pixelwise measurement of cross-sectional nerve area, were evaluated as diagnostic signs. Qualitative assessment by using visual grading was performed additionally.
Diagnostic performance, as determined with area under the receiver operating characteristic curve (AUC), was excellent for nerve T2 signal to discriminate UNE from a normal finding (AUC = 0.94; 95% confidence interval [CI]: 0.87, 1.00) and was excellent for nerve caliber to discriminate severe from mild UNE (AUC = 0.95; 95% CI: 0.85, 1.00). Qualitative assessment demonstrated sensitivity of 83% and specificity of 85% for MR neurography of UNE.
Nerve T2 signal increase seems to be an accurate sign to determine the presence of UNE. Nerve caliber enlargement discriminates severe from mild UNE. UNE may be diagnosed with high accuracy by means of quantitative or qualitative evaluation of these signs.
评估磁共振神经成像（MR 神经成像）中肘部尺神经病变（UNE）的神经 T2 信号和口径作为诊断标志。
这项前瞻性研究获得了机构审查委员会的批准，并获得了所有参与者的书面知情同意。根据临床标准和神经传导研究，将 20 例 UNE 患者分为轻度（n=12）和重度（n=8），并与 20 名健康对照者进行比较。所有患者均接受尺神经 MR 神经成像（平面分辨率为 0.4×0.4mm），包括肘部区域的 T2 加权成像（带脂肪抑制的涡轮反转恢复幅度序列：重复时间 msec/回波时间 msec/反转时间 msec，6、120/66/180）和 T1 加权涡轮自旋回波成像（843/16）。通过测量肘管内 T2 加权对比噪声比来评估神经 T2 信号增加，并通过 T1 加权像素测量横截面积来评估神经口径，将其作为诊断标志。此外，还进行了定性评估。
根据受试者工作特征曲线下面积（AUC）确定的诊断性能，神经 T2 信号区分 UNE 与正常发现的诊断性能非常出色（AUC=0.94；95%置信区间[CI]：0.87，1.00），神经口径区分严重和轻度 UNE 的诊断性能也非常出色（AUC=0.95；95%CI：0.85，1.00）。定性评估显示，UNE 的 MR 神经成像的敏感性为 83%，特异性为 85%。
神经 T2 信号增加似乎是确定 UNE 存在的准确标志。神经口径增大可区分严重和轻度 UNE。通过这些标志的定量或定性评估，可以准确诊断 UNE。
