Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY, 10016, USA.
Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA.
Skeletal Radiol. 2021 Dec;50(12):2483-2494. doi: 10.1007/s00256-021-03812-w. Epub 2021 May 22.
To evaluate the effect of intravenous (IV) contrast on sensitivity, specificity, and accuracy of magnetic resonance (MR) neurography of the knee with attention to the common peroneal nerve (CPN) in identifying nerve lesions and active muscle denervation changes.
A retrospective search for contrast-enhanced MR neurography cases evaluating the CPN at the knee was performed. Patients with electrodiagnostic testing (EDX) within 3 months of imaging were included and those with relevant prior surgery were excluded. Two radiologists independently reviewed non-contrast sequences and then 4 weeks later evaluated non-contrast and contrast sequences. McNemar's tests were performed to detect a difference between non-contrast only and combined non-contrast and contrast sequences in identifying nerve lesions and active muscle denervation changes using EDX as the reference standard.
Forty-four exams in 42 patients (2 bilateral) were included. Twenty-eight cases had common peroneal neuropathy and 29, 21, and 9 cases had active denervation changes in the anterior, lateral, and posterior compartment/proximal muscles respectively on EDX. Sensitivity, specificity, and accuracy of non-contrast versus combined non-contrast and contrast sequences for common peroneal neuropathy were 50.0%, 56.2%, and 52.3% versus 50.0%, 56.2%, and 52.3% for reader 1 and 57.1%, 50.0%, and 54.5% versus 64.3%, 56.2%, and 61.4% for reader 2. Sensitivity, specificity, and accuracy of non-contrast and combined non-contrast and contrast sequences in identifying active denervation changes for anterior, lateral, and posterior compartment muscles were not significantly different. McNemar's tests were all negative.
IV contrast does not improve the ability of MR neurography to detect CPN lesions or active muscle denervation changes.
评估静脉（IV）对比剂对膝关节磁共振（MR）神经成像的敏感性、特异性和准确性的影响，重点关注腓总神经（CPN）在识别神经病变和活动性肌肉失神经支配变化方面的作用。
对膝关节行对比增强 MR 神经成像的病例进行回顾性检索。将在影像学检查后 3 个月内进行电诊断检测（EDX）的患者纳入研究，并排除有相关既往手术史的患者。两位放射科医生分别独立阅片，然后在 4 周后评估非对比和对比序列。采用 McNemar 检验比较仅行非对比序列和联合行非对比和对比序列检查在识别神经病变和活动性肌肉失神经支配变化方面的差异，以 EDX 作为参考标准。
共纳入 42 例患者（2 例双侧）的 44 次检查。28 例患者有腓总神经病，29、21 和 9 例患者在 EDX 上分别有前、外和后间隔/近端肌肉的活动性失神经支配改变。在腓总神经病变方面，非对比序列与联合非对比和对比序列检查的敏感性、特异性和准确性分别为 50.0%、56.2%和 52.3%比 50.0%、56.2%和 52.3%（读者 1）和 57.1%、50.0%和 54.5%比 64.3%、56.2%和 61.4%（读者 2）。在识别前、外和后间隔肌肉活动性失神经支配改变方面，非对比和联合非对比和对比序列检查的敏感性、特异性和准确性无显著差异。McNemar 检验均为阴性。
IV 对比剂并不能提高 MR 神经成像检测 CPN 病变或活动性肌肉失神经支配改变的能力。
