目的:腓骨神经病的磁共振成像(MRI)发现尚不明确,影像学的预后价值仍不确定。已经建立了超声(US)横截面积(CSA)的上限,但是关于普遍性的不确定性仍然存在。我们旨在描述患者和健康对照者腓骨神经的MRI发现,并将这些结果与US发现和临床特征进行比较。
方法:我们前瞻性纳入足下垂和电诊断证实腓骨神经病变的患者,并进行了临床随访,两个腓骨神经的US和MRI。我们将MRI结果与健康对照进行了比较。在对图像进行匿名化和随机化后,两名放射科医生在探索性分析中评估了MRI特征。
结果:包括22例患者和38例健康对照。而患者的MRICSA值显着增加(平均CSA20mm2与健康对照中的13mm2),观察者内部和观察者之间的变异性很大(变异性,分别,在95%的重复测量中,平均值附近为7和9mm2)。在52.6%的患者中发现了神经的病理性T2高信号(50%的观察者同意)。增加CSA测量(MRI/US),病理T2高强度神经和肌肉水肿不能预测恢复。
结论:所有腓骨神经病患者都建议进行影像学检查,以排除压迫性内在和外在肿块,但我们不建议常规MRI诊断或预测腓骨神经病患者的预后,因为观察者的变异性较高。进一步的研究应旨在通过半自动化降低MRI观察者的变异性。
OBJECTIVE: Magnetic resonance imaging (MRI) findings in peroneal neuropathy are not well documented and the prognostic value of imaging remains uncertain. Upper limits of cross-sectional area (CSA) on ultrasound (US) have been established, but uncertainty regarding generalizability remains. We aimed to describe MRI findings of the peroneal nerve in patients and healthy controls and to compare these results to US findings and clinical characteristics.
METHODS: We prospectively included patients with foot drop and electrodiagnostically confirmed peroneal neuropathy, and performed clinical follow-up, US and MRI of both peroneal nerves. We compared MRI findings to healthy controls. Two radiologists evaluated MRI features in an exploratory analysis after images were anonymized and randomized.
RESULTS: Twenty-two patients and 38 healthy controls were included. Whereas significant increased MRI CSA values were documented in patients (mean CSA 20 mm2 vs. 13 mm2 in healthy controls), intra- and interobserver variability was substantial (variability of, respectively, 7 and 9 mm2 around the mean in 95% of repeated measurements). A pathological T2 hyperintense signal of the nerve was found in 52.6% of patients (50% interobserver agreement). Increased CSA measurements (MRI/US), pathological T2 hyperintensity of the nerve and muscle edema were not predictive for recovery.
CONCLUSIONS: Imaging is recommended in all patients with peroneal neuropathy to exclude compressive intrinsic and extrinsic masses but we do not advise routine MRI for diagnosis or prediction of outcome in patients with peroneal neuropathy due to high observer variability. Further studies should aim at reducing MRI observer variability potentially by semi-automation.