Bignotti Bianca, Ghio Massimo, Panico Nicoletta, Tagliafico Giulio, Martinoli Carlo, Tagliafico Alberto
Department of Health Sciences (DISSAL), University of Genoa, Largo Rosanna Benzi 8, 16132, Genoa, Italy.
Department of Internal Medicine IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
Skeletal Radiol. 2015 Dec;44(12):1761-7. doi: 10.1007/s00256-015-2230-5. Epub 2015 Aug 12.
To quantitatively evaluate and compare nerve density in patients with limited cutaneous systemic sclerosis (lcSSc) and control subjects using high-resolution ultrasound (US) with a computer-aided assessment.
Forty patients and 40 age- and sex-matched control subjects were prospectively enrolled. Ultrasound (US) examination (17-5 MHz probe) of the median nerve at the elbow was performed bilaterally by one radiologist. A software quantified the ratio between the hypoechoic and hyperechoic areas of peripheral nerves on ultrasound. Two observers set the threshold in the images acquired, and three observers performed the digital analysis of nerve density. Statistical analysis included Mann-Whitney U-test of patients versus control subjects and subgroup analysis of symptomatic and non-symptomatic patients. Intra and inter-observer agreement of the three observers were assessed with the kappa statistic.
In all, 160 median nerves were evaluated. According to the US, nerve density was significantly reduced in lcSSc patients compared to control subjects (mean and standard deviation: 41 ± 3 vs 56 ± 4, p < 0.01). Subgroup analysis showed that symptomatic patients (n = 15) had reduced nerve density compared to non-symptomatic (n = 25) patients (39 ± 5 vs 43 ± 4, p < 0.01). Intra-observer agreement was very good (K = 0.82). Inter-observer agreements were good: reader 1 vs reader 2: k = 0.78 (95% confidence interval 0.65 to 0.91); reader 2 vs reader 3: k = 0.72 (95% confidence interval 0.65 to 0.82); reader 3 vs reader 1: k = 0.71 (95% confidence interval 0.64-0.81).
In lcSSc patients, nerve density was reduced, especially in the symptomatic group, compared to control subjects.
使用高分辨率超声（US）及计算机辅助评估，对局限性皮肤型系统性硬化症（lcSSc）患者和对照者的神经密度进行定量评估和比较。
前瞻性纳入40例患者和40例年龄及性别匹配的对照者。由一名放射科医生对双侧肘部正中神经进行超声（US）检查（17 - 5MHz探头）。一款软件对超声图像中外周神经的低回声区和高回声区的比例进行量化。两名观察者设定采集图像中的阈值，三名观察者进行神经密度的数字分析。统计分析包括患者与对照者的Mann-Whitney U检验以及有症状和无症状患者的亚组分析。使用kappa统计量评估三名观察者的观察者内和观察者间一致性。
共评估了160条正中神经。根据超声检查，与对照者相比，lcSSc患者的神经密度显著降低（均值和标准差：41±3 vs 56±4，p<0.01）。亚组分析显示，有症状患者（n = 15）与无症状患者（n = 25）相比，神经密度降低（39±5 vs 43±4，p<0.01）。观察者内一致性非常好（K = 0.82）。观察者间一致性良好：读者1与读者2：k = 0.78（95%置信区间0.65至0.91）；读者2与读者3：k = 0.72（95%置信区间0.65至0.82）；读者3与读者1：k = 0.71（95%置信区间0.64 - 0.81）。
与对照者相比，lcSSc患者的神经密度降低，尤其是在有症状组中。
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