Carpio Arturo, Fleury Agnès, Romo Matthew L, Abraham Ronaldo, Fandiño Jaime, Durán Juan C, Cárdenas Graciela, Moncayo Jorge, Leite Rodrigues Cleonísio, San-Juan Daniel, Serrano-Dueñas Marcos, Takayanagui Oswaldo, Sander Josemir W
Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca, Ecuador.
G.H. Sergievsky Center, Columbia University, New York, NY.
Ann Neurol. 2016 Sep;80(3):434-42. doi: 10.1002/ana.24732. Epub 2016 Aug 13.
The diagnosis of neurocysticercosis (NCC) remains problematic because of the heterogeneity of its clinical, immunological, and imaging characteristics. Our aim was to develop and assess a new set of diagnostic criteria for NCC, which might allow for the accurate detection of, and differentiation between, parenchymal and extraparenchymal disease.
A group of Latin American NCC experts developed by consensus a new set of diagnostic criteria for NCC. A multicenter, retrospective study was then conducted to validate it. The reference standard for diagnosis of active NCC was the disappearance or reduction of cysts after anthelmintic treatment. In total, three pairs of independent neurologists blinded to the diagnosis evaluated 93 cases (with NCC) and 93 controls (without NCC) using the new diagnostic criteria. Mixed-effects logistic regression models were used to estimate sensitivity and specificity.
Inter-rater reliability (kappa) of diagnosis among evaluators was 0.60. For diagnosis of NCC versus no NCC, the new criteria had a sensitivity of 93.2% and specificity of 81.4%. For parenchymal NCC, the new criteria had a sensitivity of 89.8% and specificity of 80.7% and for extraparenchymal NCC, the new criteria had a sensitivity of 65.9% and specificity of 94.9%.
These criteria have acceptable reliability and validity and could be a new tool for clinicians and researchers. An advantage of the new criteria is that they consider parasite location (ie, parenchymal or extraparenchymal), which is an important factor determining the clinical, immunological, and radiological presentation of the disease, and importantly, its treatment and prognosis. Ann Neurol 2016;80:434-442.
由于神经囊尾蚴病（NCC）的临床、免疫和影像学特征具有异质性，其诊断仍然存在问题。我们的目的是制定并评估一套新的NCC诊断标准，该标准可能有助于准确检测实质性和脑外疾病，并对两者进行区分。
一组拉丁美洲的NCC专家通过共识制定了一套新的NCC诊断标准。随后进行了一项多中心回顾性研究以验证该标准。活动性NCC诊断的参考标准是驱虫治疗后囊肿消失或缩小。共有三对独立的、对诊断不知情的神经科医生使用新的诊断标准对93例（患有NCC）和93例对照（未患NCC）进行了评估。使用混合效应逻辑回归模型来估计敏感性和特异性。
评估者之间诊断的评分者间信度（kappa）为0.60。对于NCC与非NCC的诊断，新标准的敏感性为93.2%，特异性为81.4%。对于实质性NCC，新标准的敏感性为89.8%，特异性为80.7%；对于脑外NCC，新标准的敏感性为65.9%，特异性为94.9%。
这些标准具有可接受的信度和效度，可能成为临床医生和研究人员的新工具。新标准的一个优点是它们考虑了寄生虫的位置（即实质性或脑外），这是决定该疾病临床、免疫和放射学表现的重要因素，重要的是，还决定其治疗和预后。《神经病学纪事》2016年；80:434 - 442。
