目的:探讨诊断测试在将最初诊断为可能的梅尼埃病(MD)的患者准确地重新分类为明确或非MD类别中的功效。
方法:一项回顾性队列研究于2016年1月5日至2022年5月在神经科诊所进行。患者接受了一系列测试,从哪个敏感度,特异性,阳性和阴性预测值,以及正似然比和负似然比,被计算。此外,制定了预测列线图。
结果:在69名患者中,25(36.2%)最初被归类为明确的MD,21(30.4%),可能的MD,和23(33.4%)非MD。平均随访时间为3.5年。ECochG的灵敏度最高(92%),负似然比为15%。MD方案的磁共振成像(MRI)具有最高的特异性(100%),正似然比为100%。视频眼震描记术,视频头脉冲测试,和子宫颈前庭诱发的肌源性电位,敏感性和特异性较低。我们能够对18例(86%)可能的MD患者进行重新分类:12例(57%)被诊断为明确的MD,和6(29%)被诊断为非MD,与他们的临床过程一致。
结论:ECochG和MRI与MD协议的结合提供了最可靠的方法来重新分类可能的MD患者,确保精确和准确的诊断。前庭测试表明迷宫的功能状态,可能不可靠。我们的发现为可能的MD患者的临床决策提供了有价值的见解,并提出了对其他诊断测试的考虑,以补充现有的仅临床诊断标准。
OBJECTIVE: To explore the efficacy of diagnostic tests in accurately reclassifying patients initially diagnosed with probable Meniere\'s disease (MD) into either definite or non-MD categories.
METHODS: A retrospective cohort study was conducted at a neurotology clinic between 1/2016 and 5/2022. Patients underwent a battery of tests, from which sensitivity, specificity, positive and negative predictive values, as well as positive and negative likelihood ratios, were calculated. Additionally, prediction nomograms were developed.
RESULTS: Of the 69 patients, 25 (36.2 %) were initially classified as definite MD, 21 (30.4 %), probable MD, and 23 (33.4 %) non-MD. The mean follow-up was 3.5 years. The sensitivity of electrocochleography (ECochG) was the highest (92 %), with a negative likelihood ratio of 15 %. Magnetic resonance imaging (MRI) with MD-protocol had the highest specificity (100 %), with a positive likelihood ratio of 100 %. Videonystagmography, video head impulse test, and cervical vestibular-evoked myogenic potentials, had lower sensitivity and specificity. We were able to reclassify 18 (86 %) patients with probable MD: 12 (57 %) were diagnosed with definite MD, and 6 (29 %) were diagnosed with non-MD, consistent with their clinical course.
CONCLUSIONS: The combination of ECochG and MRI with MD-protocol provides the most reliable approach to reclassify patients with Probable MD, ensuring a precise and accurate diagnosis. Vestibular tests express the functional status of the labyrinth and may not be reliable. Our findings provide valuable insights into clinical decision-making for patients with Probable MD and raise the consideration of additional diagnostic tests as supplementary to the existing clinical-only diagnosis criteria.