Nischal Neha, Gupta Saurabh, Lal Kanhaiya, Singh Jatinder Pal
Department of Radiology, Fortis Escorts Hospital, Faridabad, Haryana, India.
Consultation Diagnostic and Intervention Radiology, JK Medicity Super Speciality Hospital, Jammu, India.
Indian J Radiol Imaging. 2021 Jan;31(1):43-48. doi: 10.1055/s-0041-1729130. Epub 2021 Apr 19.
High-resolution ultrasound (HRUS) and magnetic resonance neurography (MRN) are considered complementary to clinical and neurophysiological assessment for neuropathies. The aim of our study was to compare the accuracy of HRUS and MRN for detecting various peripheral nerve pathologies, to choose the correct investigation to facilitate prompt patient management. This prospective study was done using HRUS with 14 MHz linear-transducer and 3 or 1.5T MR in cases referred for the assessment of peripheral nerve pathologies. Image interpretation was done using a scoring system (score 0-3 confidence level) to assess for nerve continuity/discontinuity, increased nerve signal/edema, fascicular change, caliber change, and neuroma/mass lesion. We determined the accuracy, sensitivity, and specificity of these modalities compared with the diagnostic standard determined by surgical and/or histopathological, if not performed then clinical and/or electrodiagnostic evaluation. The overall accuracy of MRN was 89.3% (specificity: 66.6%, sensitivity: 92.6%, negative predictive value [NPV]: 57.1%, positive predictive value [PPV]: 95%) and that of HRUS was 82.9% (specificity: 100%, sensitivity: 80.4%, NPV: 42.8, PPV: 100). The confidence level for detecting nerve discontinuity and change in nerve caliber was found to be higher on ultrasonography than magnetic resonance imaging (MRI) (100 vs. 70% and 100 vs. 50%, respectively). Pathology of submillimeter caliber nerves was accurately detected by HRUS and these could not be well-visualized on MRI. HRUS is a powerful tool that may be used as the first-line imaging modality for the evaluation of peripheral nerve pathologies, and a better means of evaluation of peripheral nerves with submillimeter caliber.
高分辨率超声（HRUS）和磁共振神经成像（MRN）被认为是对神经病进行临床和神经生理学评估的补充手段。我们研究的目的是比较HRUS和MRN检测各种周围神经病变的准确性，以选择正确的检查方法，促进患者的及时管理。这项前瞻性研究对因周围神经病变评估而转诊的病例使用14MHz线性换能器的HRUS和3T或1.5T磁共振成像。图像解读采用评分系统（0 - 3分置信水平）评估神经连续性/中断、神经信号增强/水肿、束状改变、管径改变以及神经瘤/肿块病变。我们将这些检查方法的准确性、敏感性和特异性与通过手术和/或组织病理学确定的诊断标准进行比较，如果未进行手术和/或组织病理学检查，则与临床和/或电诊断评估进行比较。MRN的总体准确率为89.3%（特异性：66.6%，敏感性：92.6%，阴性预测值[NPV]：57.1%，阳性预测值[PPV]：95%），HRUS的总体准确率为82.9%（特异性：100%，敏感性：80.4%，NPV：42.8，PPV：100）。发现超声检查在检测神经中断和神经管径改变方面的置信水平高于磁共振成像（MRI）（分别为100%对70%和100%对50%）。HRUS能准确检测亚毫米管径神经的病变，而这些病变在MRI上无法很好地显示。HRUS是一种强大的工具，可作为评估周围神经病变的一线成像方式，也是评估亚毫米管径周围神经的更好方法。
