Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands.
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
J Neurol. 2021 Mar;268(3):978-988. doi: 10.1007/s00415-020-10232-8. Epub 2020 Sep 23.
This study aimed at developing a quantitative approach to assess abnormalities on MRI of the brachial plexus and the cervical roots in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) and to evaluate interrater reliability and its diagnostic value.
We performed a cross-sectional study in 50 patients with CIDP, 31 with MMN and 42 disease controls. We systematically measured cervical nerve root sizes on MRI bilaterally (C5, C6, C7) in the coronal [diameter (mm)] and sagittal planes [area (mm)], next to the ganglion (G) and 1 cm distal from the ganglion (G). We determined their diagnostic value using a multivariate binary logistic model and ROC analysis. In addition, we evaluated intra- and interrater reliability.
Nerve root size was larger in patients with CIDP and MMN compared to controls at all predetermined anatomical sites. We found that nerve root diameters in the coronal plane had optimal reliability (intrarater ICC 0.55-0.87; interrater ICC 0.65-0.90). AUC was 0.78 (95% CI 0.69-0.87) for measurements at G and 0.81 (95% CI 0.72-0.91) for measurements at G. Importantly, our quantitative assessment of brachial plexus MRI identified an additional 10% of patients that showed response to treatment, but were missed by nerve conduction (NCS) and nerve ultrasound studies.
Our study showed that a quantitative assessment of brachial plexus MRI is reliable. MRI can serve as an important additional diagnostic tool to identify treatment-responsive patients, complementary to NCS and nerve ultrasound.
本研究旨在开发一种定量方法来评估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）患者的臂丛和颈神经根 MRI 上的异常，并评估其观察者间可靠性及其诊断价值。
我们对 50 例 CIDP 患者、31 例 MMN 患者和 42 例疾病对照组患者进行了横断面研究。我们在冠状位（直径，mm）和矢状位（面积，mm）双侧系统地测量了颈神经根的大小（C5、C6、C7），紧邻神经节（G）和神经节 1 cm 远端（G）。我们使用多变量二项逻辑模型和 ROC 分析来确定其诊断价值。此外，我们还评估了观察者内和观察者间的可靠性。
CIDP 和 MMN 患者的神经根大小均大于对照组在所有预定的解剖部位。我们发现冠状面神经根直径具有最佳的可靠性（观察者内 ICC 0.55-0.87；观察者间 ICC 0.65-0.90）。在 G 处测量的 AUC 为 0.78（95%CI 0.69-0.87），在 G 处测量的 AUC 为 0.81（95%CI 0.72-0.91）。重要的是，我们对臂丛 MRI 的定量评估发现了另外 10%的对治疗有反应的患者，但这些患者被神经传导（NCS）和神经超声研究漏诊。
我们的研究表明，臂丛 MRI 的定量评估是可靠的。MRI 可以作为一种重要的附加诊断工具，用于识别对治疗有反应的患者，与 NCS 和神经超声互补。
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