Invest Radiol. 2018 Mar;53(3):158-166. doi: 10.1097/RLI.0000000000000422.
The aim of this study was to assess the imaging appearance and diagnostic value of plexus and peripheral nerve magnetic resonance neurography (MRN) in cervical radiculopathy.
This prospective study was approved by our institutional ethics committee and written informed consent was obtained from all participants. A total of 24 patients were included with a diagnosis of cervical radiculopathy based on clinical examination, supporting electrophysiological examinations and spinal imaging consistent with the clinical syndrome. All patients then underwent a high-resolution MRN protocol including the brachial plexus from nerve roots to plexus cords using a 3-dimensional turbo spin echo with variable flip angle short tau inversion recovery and sagittal-oblique T2-weighted spectral adiabatic inversion recovery sequence, and ulnar, median, and radial nerves at the upper arm and elbow in T2-weighted fat saturated sequences. Two readers independently rated plexus elements regarding the presence of lesions at neuroforaminal levels, roots, trunks, and cord segments. Median, ulnar, and radial nerves were likewise rated. Findings were then compared to a referenced standard of cervical radiculopathy that was defined as the combined diagnosis of clinical syndrome including supporting electrophysiological exams and matching positive spinal imaging, and diagnostic performance parameters were calculated. Additional quantitative and qualitative analysis assessed peripheral nerve caliber and normalized T2-signal at arm level in cervical radiculopathy and compared them to 25 inflammatory neuropathy controls.
Cervical radiculopathy resulted in distinct plexus lesion patterns for each level of neuroforaminal stenosis. Overall, brachial plexus MRN in cervical radiculopathy reached a sensitivity of 81%, a specificity of 96%, a positive predictive value of 87%, and overall diagnostic accuracy of 87%. Initial spinal magnetic resonance imaging showed multiple positive findings for clinically unaffected root levels and resulted in a specificity of 69%, a positive predictive value of 54%, and an overall diagnostic accuracy of 78%.T2-weighted peripheral nerve lesions were detected in 79% of cervical radiculopathy cases and imitated imaging appearance of inflammatory neuropathies both quantitatively and qualitatively.
Complementing spine imaging in cervical radiculopathy with brachial plexus MRN can improve diagnostic accuracy by increasing specificity and positive predictive value. T2-weighted lesions of peripheral nerves can be caused by cervical radiculopathy, which must be considered a relevant diagnostic pitfall in MRN of peripheral neuropathies.
本研究旨在评估颈椎神经根病丛神经和周围神经磁共振神经成像（MRN）的影像学表现和诊断价值。
本前瞻性研究经我院伦理委员会批准，所有参与者均签署书面知情同意书。共纳入 24 例颈椎神经根病患者，根据临床检查、支持电生理检查和与临床综合征一致的脊柱影像学诊断为颈椎神经根病。所有患者均行高分辨率 MRN 检查，包括臂丛神经从神经根到丛索的 3 维涡轮自旋回波，可变翻转角短 tau 反转恢复和矢状斜 T2 加权谱绝热反转恢复序列，以及在上臂和肘部的尺神经、正中神经和桡神经的 T2 加权脂肪饱和序列。两位读者独立评估神经孔水平、神经根、干和索段的丛神经病变情况。同样对正中神经、尺神经和桡神经进行评分。然后将结果与颈椎神经根病的参考标准进行比较，颈椎神经根病的定义为包括支持电生理检查和匹配阳性脊柱影像学的临床综合征的综合诊断，并计算诊断性能参数。额外的定量和定性分析评估了颈椎神经根病中臂丛神经的周围神经直径和手臂水平的归一化 T2 信号，并与 25 例炎症性神经病对照进行比较。
颈椎神经根病导致每个神经孔狭窄水平的丛神经病变模式明显不同。总体而言，颈椎神经根病的臂丛神经 MRN 达到了 81%的灵敏度、96%的特异性、87%的阳性预测值和 87%的总体诊断准确性。初始脊柱磁共振成像显示多个临床无症状神经根水平的阳性发现，特异性为 69%、阳性预测值为 54%和总体诊断准确性为 78%。79%的颈椎神经根病病例中检测到 T2 加权周围神经病变，在数量和质量上都模仿了炎症性神经病的影像学表现。
在颈椎神经根病中，用臂丛神经 MRN 补充脊柱成像可以通过提高特异性和阳性预测值来提高诊断准确性。颈椎神经根病可引起 T2 加权周围神经病变，这在周围神经病变的 MRN 中必须被视为一个相关的诊断陷阱。
