Outcome Prediction by Diffusion Tensor Imaging (DTI) in Patients with Traumatic Injuries of the Median Nerve.

IF 3.2 Q2 CLINICAL NEUROLOGY
Théa Voser, Manuel Martin, Issiaka Muriset, Michaela Winkler, Jean-Baptiste Ledoux, Yasser Alemán-Gómez, Sébastien Durand
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Abstract

Background/Objectives: The accurate quantification of peripheral nerve axonal regeneration after injury is critically important. Current strategies are limited to detecting early reinnervation. DTI is an MRI modality permitting the assessment of fractional anisotropy, which increases with axonal regeneration. The aim of this pilot study is to evaluate DTI as a potential predictive factor of clinical outcome after median nerve section and microsurgical repair. Methods: We included 10 patients with a complete section of the median nerve, who underwent microsurgical repair up to 7 days after injury. The follow-up period was 1 year, including the current strategy with clinical visits, the Rosén-Lundborg score and electroneuromyography. Additionally, DTI MRI of the injured wrist was planned 1, 3 and 12 months post-operatively and once for the contralateral wrist. Results: The interobserver reliability of DTI measures was almost perfect (ICC 0.802). We report an early statistically significant increase in the fractional anisotropy value after median nerve repair, especially in the region located distal to the suture. Meanwhile, Rosén-Lundborg score gradually increased between the third and sixth month, and continued to increase between the sixth and twelfth month. Conclusions: DTI outcomes three months post-operation could offer greater predictability compared to current strategies. This would enable faster decision-making regarding the need for a potential re-operation in cases of inadequate early reinnervation.

通过弥散张量成像 (DTI) 预测正中神经外伤患者的预后。
背景/目的:准确量化损伤后的周围神经轴突再生至关重要。目前的策略仅限于检测早期神经再支配。DTI 是一种磁共振成像模式,可评估随轴突再生而增加的分数各向异性。本试验研究旨在评估 DTI 作为正中神经切片和显微手术修复后临床结果的潜在预测因素。研究方法我们纳入了 10 名正中神经完全断裂的患者,他们在受伤后 7 天内接受了显微手术修复。随访期为 1 年,包括临床访视、Rosén-Lundborg 评分和电神经肌电图等现行策略。此外,还计划在术后 1、3 和 12 个月对受伤的手腕进行 DTI MRI 检查,并对对侧手腕进行一次检查。结果:DTI 测量的观察者间可靠性几乎完美(ICC 0.802)。我们报告称,正中神经修复术后,尤其是缝合远端区域的分数各向异性值在早期出现了统计学意义上的显著增加。同时,Rosén-Lundborg 评分在第三个月至第六个月期间逐渐上升,并在第六个月至第十二个月期间持续上升。结论与目前的策略相比,术后三个月的 DTI 结果可提供更高的可预测性。这将有助于在早期神经支配不足的情况下更快地决定是否需要再次手术。
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来源期刊
Neurology International
Neurology International CLINICAL NEUROLOGY-
CiteScore
3.70
自引率
3.30%
发文量
69
审稿时长
11 weeks
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