Plaza-Manzano Gustavo, Fernández-de-Las-Peñas César, Díaz-Arribas María José, Navarro-Santana Marcos José, Sánchez-Jorge Sandra, Romero-Morales Carlos, Valera-Calero Juan Antonio
Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain.
Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
Healthcare (Basel). 2024 Oct 5;12(19):1987. doi: 10.3390/healthcare12191987.
The aim of this study was to determine and compare the capability of several B-mode ultrasound (US) and shear wave elastography (SWE) metrics to differentiate subjects with chronic non-specific neck pain from asymptomatic subjects.
A diagnostic accuracy study recruiting a sample of patients with chronic neck pain and asymptomatic controls was conducted. Data collection included sociodemographic information (i.e., gender, age, height, weight and body mass index), clinical information (pain intensity assessed using the Visual Analogue Scale and pain-related disability using the Neck Disability Index) and B-mode ultrasound and shear wave elastography features of the cervical multifidus muscle (cross-sectional area, perimeter, mean echo intensity, fat infiltration, shear wave speed and Young's modulus). After analyzing between-group differences for left/right sides, cases and controls, and males and females, the area under the receiver operating characteristic (ROC) curve, the optimal cut-off point, the sensitivity, the specificity, the positive likelihood ratio (LR) and negative LR for each metric were calculated. A total of 316 individuals were recruited in this study ( = 174 cases with neck pain and = 142 asymptomatic controls).
No significant differences ( > 0.05) were found between cases and controls for most variables, except for fatty infiltration, which was significantly higher in chronic neck pain cases ( < 0.001). Gender differences were significant across all US and SWE metrics (all, < 0.001 except = 0.015 for fatty infiltrates). A slight asymmetry was observed between the left and right sides for area ( = 0.038). No significant interactions between group, gender and side (all metrics, > 0.008) were identified. Fatty infiltration was the most effective discriminator, with a ROC value of 0.723, indicating acceptable discrimination. The optimal cut-off point for fatty infiltration was 25.77, with a moderate balance between sensitivity (59.8%) and specificity (20.5%). However, its positive likelihood ratio (LR) of 0.75 suggests limited usefulness in confirming the condition.
Fatty infiltration was significantly higher in individuals with chronic idiopathic neck pain compared to those without symptoms, while other muscle metrics were similar between both groups. However, since fat infiltration had moderate diagnostic accuracy and the other metrics showed poor discriminatory power, US cannot be used solely to discriminate patients with idiopathic neck pain.
本研究旨在确定并比较几种B型超声（US）和剪切波弹性成像（SWE）指标区分慢性非特异性颈部疼痛患者与无症状受试者的能力。
进行了一项诊断准确性研究，招募了慢性颈部疼痛患者样本和无症状对照。数据收集包括社会人口统计学信息（即性别、年龄、身高、体重和体重指数）、临床信息（使用视觉模拟量表评估的疼痛强度和使用颈部残疾指数评估的与疼痛相关的残疾）以及颈多裂肌的B型超声和剪切波弹性成像特征（横截面积、周长、平均回声强度、脂肪浸润、剪切波速度和杨氏模量）。在分析左侧/右侧、病例与对照以及男性与女性之间的组间差异后，计算每个指标的受试者操作特征（ROC）曲线下面积、最佳截断点、敏感性、特异性、阳性似然比（LR）和阴性LR。本研究共招募了316名个体（n = 174例颈部疼痛患者和n = 142名无症状对照）。
除脂肪浸润外，大多数变量在病例与对照之间未发现显著差异（P > 0.05），慢性颈部疼痛病例中的脂肪浸润显著更高（P < 0.001）。所有US和SWE指标在性别上的差异均显著（所有指标，P < 0.001，脂肪浸润P = 0.015除外）。面积在左侧和右侧之间观察到轻微不对称（P = 0.038）。未发现组、性别和侧之间的显著交互作用（所有指标，P > 0.008）。脂肪浸润是最有效的鉴别指标，ROC值为0.723，表明具有可接受的鉴别能力。脂肪浸润的最佳截断点为25.77，敏感性（59.8%）和特异性（20.5%）之间具有适度平衡。然而，其阳性似然比（LR）为0.75，表明在确诊病情方面的有用性有限。
与无症状个体相比，慢性特发性颈部疼痛个体的脂肪浸润显著更高，而两组之间的其他肌肉指标相似。然而，由于脂肪浸润具有中等诊断准确性，而其他指标显示出较差的鉴别能力，超声不能仅用于鉴别特发性颈部疼痛患者。
