Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Department of Veterinary medical imaging and small animal orthopedics, Ghent University, Merelbeke, Belgium.
J Vet Intern Med. 2020 Mar;34(2):964-971. doi: 10.1111/jvim.15699. Epub 2020 Feb 6.
Spinal cord dysfunction/compression and ataxia are common in horses. Presumptive diagnosis is most commonly based on neurological examination and cervical radiography, but the interest into the diagnostic value of transcranial magnetic stimulation (TMS) with recording of magnetic motor evoked potentials has increased. The problem for the evaluation of diagnostic tests for spinal cord dysfunction is the absence of a gold standard in the living animal.
To compare diagnostic accuracy of TMS, cervical radiography, and neurological examination.
One hundred seventy-four horses admitted at the clinic for neurological examination.
Retrospective comparison of neurological examination, cervical radiography, and different TMS criteria, using Bayesian latent class modeling to account for the absence of a gold standard.
The Bayesian estimate of the prevalence (95% CI) of spinal cord dysfunction was 58.1 (48.3%-68.3%). Sensitivity and specificity of neurological examination were 97.6 (91.4%-99.9%) and 74.7 (61.0%-96.3%), for radiography they were 43.0 (32.3%-54.6%) and 77.3 (67.1%-86.1%), respectively. Transcranial magnetic stimulation reached a sensitivity and specificity of 87.5 (68.2%-99.2%) and 97.4 (90.4%-99.9%). For TMS, the highest accuracy was obtained using the minimum latency time for the pelvic limbs (Youden's index = 0.85). In all evaluated models, cervical radiography performed poorest.
Transcranial magnetic stimulation-magnetic motor evoked potential (TMS-MMEP) was the best test to diagnose spinal cord disease, the neurological examination was the second best, but the accuracy of cervical radiography was low. Selecting animals based on neurological examination (highest sensitivity) and confirming disease by TMS-MMEP (highest specificity) would currently be the optimal diagnostic strategy.
脊髓功能障碍/压迫和共济失调在马中很常见。推测诊断最常基于神经检查和颈椎放射照相，但对经颅磁刺激（TMS）记录磁运动诱发电位的诊断价值的兴趣有所增加。评估脊髓功能障碍诊断测试的问题是，在活体动物中缺乏金标准。
比较 TMS、颈椎放射照相和神经检查的诊断准确性。
174 匹因神经检查而在诊所就诊的马。
使用贝叶斯潜在类别建模来考虑缺乏金标准，对神经检查、颈椎放射照相和不同 TMS 标准进行回顾性比较。
脊髓功能障碍的贝叶斯估计患病率（95%CI）为 58.1（48.3%-68.3%）。神经检查的敏感性和特异性分别为 97.6（91.4%-99.9%）和 74.7（61.0%-96.3%），放射照相的敏感性和特异性分别为 43.0（32.3%-54.6%）和 77.3（67.1%-86.1%）。TMS 达到了 87.5（68.2%-99.2%）的敏感性和 97.4（90.4%-99.9%）的特异性。在所有评估的模型中，颈椎放射照相的性能最差。
经颅磁刺激-磁运动诱发电位（TMS-MMEP）是诊断脊髓疾病的最佳测试，神经检查是第二好的测试，但颈椎放射照相的准确性较低。根据神经检查选择动物（最高敏感性）并通过 TMS-MMEP 确认疾病（最高特异性）目前将是最佳诊断策略。
