Andrew Hannaford, Nathan Pavey, Parvathi Menon, Mehdi A J van den Bos, Matthew C Kiernan, Neil Simon, Steve Vucic
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引用次数: 0
摘要
目的：肌萎缩侧索硬化症（ALS）需要更好的诊断工具。我们的目的是评估肌肉超声作为 ALS 患者诊断工具的作用，并确定一个简化的筛查方案，以帮助临床实践的实施：方法：对所有转诊至一家中心的疑似 ALS 患者进行球部和四肢肌肉超声检查。同时还记录了疾病严重程度和上运动神经元损伤的临床指标。通过计算接收者操作特征曲线（ROC）来评估肌肉超声的诊断效用：这项观察性队列研究共招募了 94 名初步怀疑为 ALS 的患者。结果：这项观察性队列研究共招募了 94 名初步怀疑为 ALS 的患者，其中 44 人随后被诊断为 ALS，50 人被诊断为疾病模拟者。与模拟患者相比，肌萎缩性脊髓侧索硬化症患者出现筋束的频率更高，分布更广。简化的5块肌肉筛查方案在区分肌萎缩性脊髓侧索硬化症和模拟患者方面的AUC为0.94（95 %CI 0.89-0.99）。使用该筛查方案检测到≥3块筋膜样肌肉时，诊断ALS的敏感性为89%，特异性为88%：结论：肌肉超声可筛查少至 5 块肌肉，对 ALS 具有诊断作用：意义：肌肉超声检查可提高 ALS 的临床诊断率。
Muscle ultrasound aids diagnosis in amyotrophic lateral sclerosis.
Objective: There is a need for improved diagnostic tools in Amyotrophic Lateral Sclerosis (ALS). Our objective was to assess muscle ultrasound as a diagnostic tool in patients with ALS and determine a simplified screening protocol to aid implementation in clinical practice.
Methods: Ultrasound of bulbar and limb muscles was prospectively performed on all patients referred to a single centre with suspected ALS. Clinical measures of disease severity and upper motor neuron impairment were also recorded. Receiver operating characteristic (ROC) curves were calculated to assess the diagnostic utility of muscle ultrasound.
Results: 94 patients initially suspected of ALS were recruited to this observational cohort study. Forty-four were subsequently diagnosed as ALS and 50 as disease mimics. ALS patients demonstrated a higher frequency and more generalised distribution of fasciculations compared to mimics. A simplified 5 muscle screening protocol exhibited an AUC of 0.94 (95 %CI 0.89-0.99) in discriminating ALS from mimics. The presence of ≥ 3 fasciculating muscles detected using this screening protocol was 89 % sensitive and 88 % specific for the diagnosis of ALS.
Conclusions: Muscle ultrasound, screening as few as 5 muscles, has diagnostic utility in ALS.
Significance: Muscle ultrasound enhances clinical diagnosis in ALS.
期刊介绍：
As of January 1999, The journal Electroencephalography and Clinical Neurophysiology, and its two sections Electromyography and Motor Control and Evoked Potentials have amalgamated to become this journal - Clinical Neurophysiology.
Clinical Neurophysiology is the official journal of the International Federation of Clinical Neurophysiology, the Brazilian Society of Clinical Neurophysiology, the Czech Society of Clinical Neurophysiology, the Italian Clinical Neurophysiology Society and the International Society of Intraoperative Neurophysiology.The journal is dedicated to fostering research and disseminating information on all aspects of both normal and abnormal functioning of the nervous system. The key aim of the publication is to disseminate scholarly reports on the pathophysiology underlying diseases of the central and peripheral nervous system of human patients. Clinical trials that use neurophysiological measures to document change are encouraged, as are manuscripts reporting data on integrated neuroimaging of central nervous function including, but not limited to, functional MRI, MEG, EEG, PET and other neuroimaging modalities.
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