From the Department of Radiology (M.H.B., V.S.)
Loyola University Medical Center (C.J.), Maywood, Illinois.
AJNR Am J Neuroradiol. 2022 Apr;43(4):592-596. doi: 10.3174/ajnr.A7451. Epub 2022 Mar 24.
Several CT findings are thought to be indicative of vocal cord paralysis; however, these signs have never been validated in a blinded fashion. This study attempts to compare and validate these signs and determine their accuracy in predicting vocal cord paralysis.
A retrospective chart review was performed, and CT scans from patients with known unilateral vocal cord paralysis and known normal vocal cord movement were reviewed by 3 radiologists who were blinded to the status of the patients' laryngeal function. The scans were reviewed and scored for 8 accepted signs of vocal cord paralysis as well as for predicting a final diagnostic conclusion. Statistical analysis using odds ratios for signs and the Fleiss κ for criterion agreement among the radiologists was performed for diagnostic accuracy.
The presence of medial displacement of the posterior ipsilateral vocal fold margin and ipsilateral laryngeal ventricular dilation yielded the greatest positive predictive value. Other signs demonstrated high specificity, but interrater discrepancy was greater than expected and diminished the reliability of these signs in predicting vocal cord paralysis. Overall, sensitivity and negative predictive values were low.
Predicting vocal cord paralysis on the basis of CT findings is not as accurate or straightforward in prospectively predicting vocal cord paralysis as implied in prior studies.
一些 CT 表现被认为提示声带麻痹；然而，这些征象从未经过盲法验证。本研究旨在比较并验证这些征象，并确定其预测声带麻痹的准确性。
回顾性图表审查，对 3 名对患者的喉部功能状态不知情的放射科医生进行了已知单侧声带麻痹和已知正常声带运动的 CT 扫描审查。对 8 种公认的声带麻痹征象以及预测最终诊断结论的征象进行了回顾和评分。采用优势比进行了征象的统计学分析，并采用 Fleiss κ 对放射科医生之间的标准一致性进行了分析，以评估诊断准确性。
患侧声带后缘内侧移位和同侧喉室扩张征象具有最大的阳性预测值。其他征象特异性较高，但组内差异大于预期，降低了这些征象预测声带麻痹的可靠性。总体而言，敏感性和阴性预测值较低。
基于 CT 表现预测声带麻痹，并不像之前的研究中暗示的那样在预测声带麻痹方面具有很高的准确性或简单性。
