Wu Fei, Wang Weiwei, Yang Yang, Li Chong, Wu Jie, Liu Hanqiu, Ren Yan
Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
Department of Radiology, Shijiazhuang People's Hospital, Shijiazhuang, China.
Quant Imaging Med Surg. 2022 Oct;12(10):4875-4884. doi: 10.21037/qims-22-156.
Magnetic resonance (MR) neurography is an imaging technique focused on the peripheral nerves. Its role in the diagnosis and differential diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) has yet to be investigated. This study explored the value of MR neurography in identifying CIDP and differentiating it from acquired axonal polyneuropathies.
In this study, 20 patients with CIDP, 10 patients with acquired axonal polyneuropathies, and 20 healthy controls were prospectively enrolled. Three-dimensional T2-weighted image fat-suppressed and diffusion tensor imaging sequences of the lumbosacral plexus were completed in all participants. The cross-sectional area (CSA) and diffusion parameters, including the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the L3 to S1 nerve roots, were measured and compared across the 3 groups using Kruskal-Wallis 1-way analysis of variance. Receiver operating characteristic (ROC) curves were plotted to determine the value of CSA and diffusion parameters in the diagnosis and differential diagnosis of CIDP.
CSA and ADC increased in CIDP patients but didn't differ between patients with axonal polyneuropathies and healthy controls [CAS: 45.35±23.889, 22.25±3.878, 22.81±4.079 mm, ADC: (1.64±0.269)×10, (1.37±0.204)×10 and (1.39±0.156)×10 mm/s, in CIDP, axonal polyneuropathies and healthy controls, respectively, both P<0.001]. Compared with healthy controls, FA reduced in patients with CIDP and axonal polyneuropathies but no difference was observed in the two groups (FA: 0.24±0.053, 0.27±0.014 and 0.32±0.045, in CIDP, axonal polyneuropathies and healthy controls, respectively, P<0.001). To identify CIDP, ROC analysis showed that FA had better efficiency with cut-off value of 0.278 and sensitivity and specificity of 85% and 90% respectively. To differentiate CIDP from axonal polyneuropathies, CSA had better diagnostic accuracy with cut-off value of 29.46 mm and sensitivity and specificity of 75% and 100% respectively.
CSA and ADC values of lumbosacral nerve roots can help to identify patients with CIDP and further distinguish them from patients with axonal polyneuropathies. FA decreased in both types of polyneuropathies and may thus have limited value in the discrimination of the 2 types of neuropathies.
磁共振神经成像（MRN）是一种聚焦于周围神经的成像技术。其在慢性炎症性脱髓鞘性多发性神经病（CIDP）的诊断及鉴别诊断中的作用尚待研究。本研究探讨了MRN在识别CIDP并将其与获得性轴索性多发性神经病相鉴别的价值。
本研究前瞻性纳入了20例CIDP患者、10例获得性轴索性多发性神经病患者及20名健康对照者。对所有参与者均完成了腰骶丛的三维T2加权脂肪抑制成像序列和扩散张量成像序列。测量了L3至S1神经根的横截面积（CSA）及扩散参数，包括分数各向异性（FA）和表观扩散系数（ADC），并采用Kruskal-Wallis单因素方差分析在3组间进行比较。绘制受试者工作特征（ROC）曲线以确定CSA和扩散参数在CIDP诊断及鉴别诊断中的价值。
CIDP患者的CSA和ADC升高，但轴索性多发性神经病患者与健康对照者之间无差异[CSA：CIDP组为45.35±23.889mm²，轴索性多发性神经病组为22.25±3.878mm²，健康对照组为22.81±4.079mm²；ADC：CIDP组为(1.64±0.269)×10⁻³mm²/s，轴索性多发性神经病组为(1.37±0.204)×10⁻³mm²/s，健康对照组为(1.39±0.156)×10⁻³mm²/s，P均<0.001]。与健康对照者相比，CIDP患者和轴索性多发性神经病患者的FA均降低，但两组间无差异（FA：CIDP组为0.24±0.053，轴索性多发性神经病组为0.27±0.014，健康对照组为0.32±0.045，P<0.001）。为识别CIDP，ROC分析显示FA效率更佳，截断值为0.278，敏感性和特异性分别为85%和90%。为鉴别CIDP与轴索性多发性神经病，CSA诊断准确性更佳，截断值为29.46mm，敏感性和特异性分别为75%和100%。
腰骶神经根的CSA和ADC值有助于识别CIDP患者，并进一步将其与轴索性多发性神经病患者区分开来。两种类型的多发性神经病中FA均降低，因此其在鉴别这两种类型的神经病方面可能价值有限。
