Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
Neurology. 2013 Apr 30;80(18):1634-40. doi: 10.1212/WNL.0b013e3182904f3f. Epub 2013 Apr 3.
To compare accuracy of ultrasound and MRI for detecting focal peripheral nerve pathology, excluding idiopathic carpal or cubital tunnel syndromes.
We performed a retrospective review of patients referred for neuromuscular ultrasound to identify patients who had ultrasound and MRI of the same limb for suspected brachial plexopathy or mononeuropathies, excluding carpal/cubital tunnel syndromes. Ultrasound and MRI results were compared to diagnoses determined by surgical or, if not performed, clinical/electrodiagnostic evaluation.
We identified 53 patients who had both ultrasound and MRI of whom 46 (87%) had nerve pathology diagnosed by surgical (n = 39) or clinical/electrodiagnostic (n = 14) evaluation. Ultrasound detected the diagnosed nerve pathology (true positive) more often than MRI (43/46 vs 31/46, p < 0.001). Nerve pathology was correctly excluded (true negative) with equal frequency by MRI and ultrasound (both 6/7). In 25% (13/53), ultrasound was accurate (true positive or true negative) when MRI was not. These pathologies were typically (10/13) long (>2 cm) and only occasionally (2/13) outside the MRI field of view. MRI missed multifocal pathology identified with ultrasound in 6 of 7 patients, often (5/7) because pathology was outside the MRI field of view.
Imaging frequently detects peripheral nerve pathology and contributes to the differential diagnosis in patients with mononeuropathies and brachial plexopathies. Ultrasound is more sensitive than MRI (93% vs 67%), has equivalent specificity (86%), and better identifies multifocal lesions than MRI. In sonographically accessible regions ultrasound is the preferred initial imaging modality for anatomic evaluation of suspected peripheral nervous system lesions.
比较超声和 MRI 检测局限性周围神经病变的准确性，不包括特发性腕管或肘管综合征。
我们对接受神经肌肉超声检查的患者进行了回顾性分析，以确定有同一肢体超声和 MRI 的患者，这些患者患有疑似臂丛神经病或单神经病，不包括腕管/肘管综合征。将超声和 MRI 结果与通过手术确定的诊断进行比较，如果未进行手术，则与临床/电诊断评估进行比较。
我们共确定了 53 例同时进行超声和 MRI 的患者，其中 46 例（87%）通过手术（n = 39）或临床/电诊断（n = 14）评估诊断为神经病变。与 MRI 相比，超声更常发现诊断出的神经病变（真阳性）（43/46 对 31/46，p < 0.001）。MRI 和超声以相同的频率正确排除（真阴性）神经病变（均为 6/7）。在 25%（13/53）的情况下，当 MRI 不准确时，超声是准确的（真阳性或真阴性）。这些病变通常（10/13）较长（>2 cm），且很少（2/13）在 MRI 视野之外。MRI 漏诊了 7 例患者中 6 例超声发现的多灶性病变，通常（5/7）是因为病变在 MRI 视野之外。
影像学经常检测到周围神经病变，并有助于鉴别诊断患有单神经病和臂丛神经病的患者。超声比 MRI 更敏感（93%对 67%），特异性相当（86%），并且比 MRI 更能识别多灶性病变。在超声可及的区域，超声是疑似周围神经系统病变解剖评估的首选初始影像学方法。
