From the Department of Medical Imaging and Intervention (Y.J.Y., Y.M.W.) and Center for Big Data Analytics and Statistics (J.L.H.), Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC; and Department of Medical Imaging and Intervention, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan, ROC (K.M.Y., I.H.S., C.M.C., J.H.T.).
Radiology. 2021 Jul;300(1):141-151. doi: 10.1148/radiol.2021202817. Epub 2021 Apr 13.
Background MRI, Tinel test, and rhomboid electromyography (EMG) can be used to predict whether C5 spinal nerve stumps are healthy and eligible for grafting in acute adult brachial plexus injuries, but their comparative diagnostic efficacies have not been evaluated. Purpose To compare diagnostic performances of MRI, Tinel test, and rhomboid EMG in predicting healthy C5 spinal nerve stumps that are eligible for grafting. Materials and Methods This retrospective study included consecutive adult patients with acute brachial plexus injury who underwent microreconstructions between January 2008 and December 2018. Healthy C5 spinal nerve stumps eligible for grafting with preceding normal intradural nerve rootlets were diagnosed by an experienced neuroradiologist using an avulsion severity score system based on fast imaging employing steady-state acquisition or FIESTA neurography, which separates intradural nerve rootlets into normal, partial mild, severe, and complete avulsions. Tinel test and rhomboid EMG results were assessed by an experienced nerve surgeon and neurologist, respectively. The accuracy, sensitivity, and specificity of the three tests were compared using microdissection as the reference standard. < .05 was considered to indicate a significant difference. Results A total of 251 patients (mean age, 31 years ± 13 [standard deviation]; 217 men) with brachial plexus injuries who had -undergone MRI ( = 251), Tinel test ( = 235), rhomboid EMG ( = 181) and MRI, Tinel test, and EMG ( = 172) were -included. Accuracy, sensitivity, and specificity, respectively, in predicting healthy C5 spinal nerve stumps eligible for grafting were 93% (233 of 251), 84% (58 of 69), and 96% (175 of 182) for MRI; 59% (139 of 235), 56% (37 of 66), and 60% (102 of 169) for Tinel test; and 39% (71 of 181), 85% (43 of 50), and 21% (28 of 131) for rhomboid EMG. MRI (area under the receiver operating characteristic curve [AUC], 0.90; < .001) -outperformed MRI and Tinel test (AUC, 0.74), Tinel test (AUC, 0.59), and rhomboid EMG (AUC, 0.53). Conclusion MRI performed best in the prediction of healthy graftable C5 spinal nerve stumps in acute adult brachial plexus injuries. © RSNA, 2021 .
背景 MRI、Tinel 试验和菱形肌肌电图（EMG）可用于预测急性成人臂丛神经损伤中 C5 脊神经根残端是否健康且适合移植，但尚未评估它们的比较诊断效能。目的 比较 MRI、Tinel 试验和菱形肌 EMG 预测健康、适合移植的 C5 脊神经根残端的诊断性能。材料与方法 本回顾性研究纳入了 2008 年 1 月至 2018 年 12 月期间连续接受急性臂丛神经损伤显微重建的成年患者。有经验的神经放射科医生使用基于快速成像稳态采集或 FIESTA 神经成像的撕脱严重程度评分系统，将先前正常的硬脊神经根分为正常、部分轻度、严重和完全撕脱，诊断出有资格进行移植的健康 C5 脊神经根残端。Tinel 试验和菱形肌 EMG 结果分别由有经验的神经外科医生和神经科医生评估。使用显微解剖作为参考标准，比较三种检测方法的准确性、敏感性和特异性。<.05 表示差异有统计学意义。结果 共纳入 251 例（平均年龄 31 岁±13[标准差]；217 例男性）臂丛神经损伤患者，分别行 MRI（ = 251）、Tinel 试验（ = 235）、菱形肌 EMG（ = 181）和 MRI、Tinel 试验和 EMG（ = 172）。MRI 预测健康、适合移植的 C5 脊神经根残端的准确性、敏感性和特异性分别为 93%（233/251）、84%（58/69）和 96%（175/182）；Tinel 试验分别为 59%（139/235）、56%（37/66）和 60%（102/169）；菱形肌 EMG 分别为 39%（71/181）、85%（43/50）和 21%（28/131）。MRI（受试者工作特征曲线下面积[AUC]，0.90；<.001）优于 MRI 和 Tinel 试验（AUC，0.74）、Tinel 试验（AUC，0.59）和菱形肌 EMG（AUC，0.53）。结论 在预测急性成人臂丛神经损伤中健康、适合移植的 C5 脊神经根残端方面，MRI 表现最佳。©RSNA，2021 年。
