Department of Radiology, University of São Paulo Medical School, São Paulo, SP, Brazil.
Peripheral Nerve Surgery Unit, Division of Functional Neurosurgery, Department of Neurosurgery, Institute of Psychiatry, University of São Paulo Medical School, Rua Virgilio de Carvalho Pinto, 381 / apt. 42, São Paulo, SP, 05415-030, Brazil.
Acta Neurochir (Wien). 2020 Dec;162(12):3189-3196. doi: 10.1007/s00701-020-04465-9. Epub 2020 Jun 26.
There is no consensus about which type of imaging study, computed tomography myelography (CTM) or magnetic resonance imaging (MRI), provides better information concerning root avulsion in adult brachial plexus injuries.
Patients with upper brachial plexus traumatic injuries underwent both CTM and MRI and surgical exploration. The imaging studies were analyzed by two independent radiologists and the data were compared with the intraoperative findings. The statistical analysis was based on dichotomous classification of the nerve roots (normal or altered). The interobserver agreement was assessed using Cohen's Kappa. The accuracy of CTM and MRI in comparison with the intraoperative findings was evaluated using the same methodology.
Fifty-two adult patients were included. CTM tended to yield slightly higher percentages of alterations than MRI The interobserver agreement was better on CTM than on MRI for all nerve roots: C5, 0.9960 (strong) vs. 0.145 (poor); C6, 0.970 (strong) vs. 0.788 (substantial); C7, 0.969 (strong) vs. 0.848 (strong). The accuracy regarding the intraoperative findings was also higher on CTM (moderate, kappa 0.40-0.59) than on MRI (minimal, kappa 0.20-0.39) for all nerve roots. Accordingly, the overall percentage concordance (both normal or both altered) was superior in the CTM evaluation (approx. 70-75% vs. 60-65%). CTM was superior for both sensitivity and specificity at all nerve roots.
CTM had greater interobserver agreement and higher diagnostic accuracy than MRI in adult patients with root avulsions due to brachial plexus injury.
对于成人臂丛神经损伤的根性撕脱，哪种影像学检查（CT 脊髓造影[CTM]或磁共振成像[MRI]）能提供更好的信息，目前尚无共识。
对上肢臂丛创伤性损伤的患者同时进行 CTM 和 MRI 检查和手术探查。由两位独立的放射科医生对影像学检查进行分析，并将数据与术中发现进行比较。统计分析基于神经根的二分分类（正常或改变）。使用 Cohen's Kappa 评估观察者间的一致性。使用相同的方法评估 CTM 和 MRI 与术中发现的准确性。
共纳入 52 例成年患者。CTM 改变的百分比略高于 MRI。对于所有神经根，观察者间的一致性在 CTM 上优于 MRI：C5，0.9960（强）比 0.145（差）；C6，0.970（强）比 0.788（中等）；C7，0.969（强）比 0.848（强）。对于所有神经根，CTM 术中发现的准确性也高于 MRI（中度，kappa 值为 0.40-0.59）（轻度，kappa 值为 0.20-0.39）。因此，CTM 评估的总体一致性（均正常或均改变）优于 MRI（约 70-75%比 60-65%）。CTM 在所有神经根的敏感性和特异性方面均优于 MRI。
在成人臂丛神经损伤导致的根性撕脱中，CTM 与 MRI 相比，具有更好的观察者间一致性和更高的诊断准确性。
