From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands.
Neurology. 2020 Jan 7;94(1):e62-e74. doi: 10.1212/WNL.0000000000008697. Epub 2019 Dec 11.
To assess and compare the diagnostic performance of qualitative and (semi-)quantitative MRI and ultrasound for distinguishing chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) from segmental spinal muscular atrophy (sSMA).
Patients with CIDP (n = 13), MMN (n = 10), or sSMA (n = 12) and healthy volunteers (n = 30) were included. MRI of the brachial plexus, using short tau inversion recovery (STIR), nerve-specific T2-weighted (magnetic resonance neurography [MRN]), and diffusion tensor imaging (DTI) sequences, was evaluated. Furthermore, with ultrasound, cross-sectional areas of the nerves were evaluated. Three radiologists blinded for diagnosis qualitatively scored hypertrophy and increased signal intensity (STIR and MRN), and intraobserver and interobserver agreement was assessed. For the (semi-)quantitative modalities, group differences and receiver operator characteristics were calculated.
Hypertrophy and increased signal intensity were found in all groups including healthy controls. Intraobserver and interobserver agreements varied considerably (intraclass correlation coefficients 0.00-0.811 and 0.101-0.491, respectively). DTI showed significant differences ( < 0.05) among CIDP, MMN, sSMA, and controls for fractional anisotropy, axial diffusivity, and radial diffusivity in the brachial plexus. Ultrasound showed significant differences in cross-sectional area ( < 0.05) among CIDP, MMN, and sSMA in upper arm and brachial plexus. For distinguishing immune-mediated neuropathies (CIDP and MMN) from sSMA, ultrasound yielded the highest area under the curve (0.870).
Qualitative assessment of hypertrophy and signal hyperintensity on STIR or MRN is of limited value. DTI measures may discriminate among CIDP, MMN, and sSMA. Currently, ultrasound may be the most appropriate diagnostic imaging aid in the clinical setting.
评估和比较定性和（半）定量 MRI 和超声在区分慢性炎症性脱髓鞘性多发性神经病（CIDP）和多发性运动神经病（MMN）与节段性脊髓性肌萎缩（sSMA）方面的诊断性能。
纳入 CIDP（n=13）、MMN（n=10）或 sSMA（n=12）患者和健康志愿者（n=30）。评估臂丛的短 tau 反转恢复（STIR）、神经特异性 T2 加权（磁共振神经成像[MRN]）和弥散张量成像（DTI）序列。此外，使用超声评估神经的横截面积。三位放射科医生对诊断结果不知情，对肥大和信号强度增加（STIR 和 MRN）进行定性评分，并评估观察者内和观察者间的一致性。对于（半）定量模式，计算组间差异和接收者操作特征。
肥大和信号强度增加在包括健康对照组在内的所有组中均有发现。观察者内和观察者间的一致性差异很大（组内相关系数 0.00-0.811 和 0.101-0.491）。DTI 显示在臂丛的各向异性分数、轴向弥散度和径向弥散度方面，CIDP、MMN、sSMA 和对照组之间存在显著差异（<0.05）。超声显示在 CIDP、MMN 和 sSMA 上臂和臂丛的横截面积方面存在显著差异（<0.05）。在区分免疫介导性神经病（CIDP 和 MMN）与 sSMA 方面，超声的曲线下面积最高（0.870）。
STIR 或 MRN 上肥大和信号高信号的定性评估价值有限。DTI 测量可能有助于区分 CIDP、MMN 和 sSMA。目前，超声可能是临床环境中最适当的诊断成像辅助手段。
