肩胛上神经的聚焦高分辨率超声检查：一种用于神经性肌萎缩的简单替代标志物？

Focused high-resolution sonography of the suprascapular nerve: A simple surrogate marker for neuralgic amyotrophy?

作者信息

Gruber Leonhard, Loizides Alexander, Löscher Wolfgang, Glodny Bernhard, Gruber Hannes

机构信息

Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria.

出版信息

Clin Neurophysiol. 2017 Aug;128(8):1438-1444. doi: 10.1016/j.clinph.2017.04.030. Epub 2017 May 19.

DOI:10.1016/j.clinph.2017.04.030

PMID:28618294

Abstract

OBJECTIVES

To define the diagnostic value of high-resolution ultrasound (HRUS) of the suprascapular nerve (SSN) in the diagnosis of neuralgic amyotrophy (NA).

METHODS

The cross-section areas (CSA) of the SSN at the C5 root (CSA1) and the omohyoid muscle in the midclavicular line (CSA2) were assessed bilaterally in 15 healthy volunteers and 14 patients with clinically and electrophysiologically verified NA. Receiver-operator-characteristics (ROC) curves were generated and cut-off values, sensitivity, specificity, positive (PPV) and negative predictive values (NPV), likelihood (LR) and odds ratios (OR) were calculated.

RESULTS

Patients with NA had significantly higher CSA2-values than controls (6.36±2.75vs. 2.79±0.83mm, p<0.0001) and significantly higher ratios of SSN CSA2-values of the affected vs. contralateral side (224.6±78.5% vs. 127.7±51.1%, p<0.0001). The ratios of SSN CSA2-values vs. CSA1-values (146.7±74.5% vs. 99.9±28.3%, p=0.008) and CSA1-values were also significantly higher (4.70±2.00vs. 2.90±0.90mm, p=0.0028) than in controls. Beyond a CSA2 cut-off value of 4.2mm, the ROC-AUC was 0.939 [0.861-1.00] when compared against healthy volunteers and 0.971 [0.901-1.00] when compared to patients with degenerative shoulder pain. Sensitivity was 85.7% [57.2-98.2%], specificity 96.7% [82.8-99.9%], PPV 92.3% [64.0-99.8%], NPV 93.5% [78.6-99.2%], OR 174.0 [14.4-2106.0] and LR 25.7 (95% confidence intervals in brackets).

CONCLUSION

SSN swelling in the lateral cervical region could be a supportive finding to identify NA patients.

SIGNIFICANCE

This method allows for the rapid sonographic identification of NA.

摘要

目的

确定肩胛上神经（SSN）的高分辨率超声（HRUS）在神经性肌萎缩（NA）诊断中的价值。

方法

对15名健康志愿者和14名经临床及电生理证实为NA的患者双侧评估C5神经根处SSN的横截面积（CSA1）以及锁骨中线处肩胛舌骨肌处的SSN横截面积（CSA2）。绘制受试者操作特征（ROC）曲线，并计算截断值、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）、似然比（LR）和比值比（OR）。

结果

NA患者的CSA2值显著高于对照组（6.36±2.75对2.79±0.83mm，p<0.0001），患侧与对侧SSN的CSA2值之比也显著更高（224.6±78.5%对127.7±51.1%，p<0.0001）。SSN的CSA2值与CSA1值之比（146.7±74.5%对99.9±28.3%，p=0.008）以及CSA1值（4.70±2.00对2.90±0.90mm，p=0.0028）也显著高于对照组。当CSA2截断值超过4.2mm时，与健康志愿者相比，ROC曲线下面积（AUC）为0.939[0.861 - 1.00]，与退行性肩部疼痛患者相比，AUC为0.971[0.901 - 1.00]。敏感性为85.7%[57.2 - 98.2%]，特异性为96.7%[82.8 - 99.9%]，PPV为92.3%[64.0 - 99.8%]，NPV为93.5%[78.6 - 99.2%]，OR为174.0[14.4 - 2106.0]，LR为25.7（括号内为95%置信区间）。