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Crus Atrophy: Accuracy of Computed Tomography in Diagnosis of Diaphragmatic Paralysis
Warawut Sukkasem1, Sherine G Moftah, Gregory Kicska
1*Department of Diagnostic and Therapeutic Radiology, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand †Department of Diagnostic Radiology, Ain Shams University Faculty of Medicine, Cairo, Egypt ‡Department of Radiology, University of Washington Medical Center, Seattle, WA.
Insights
Computed tomography (CT) can identify crus atrophy, indicating hemidiaphragmatic paralysis. This finding is crucial for diagnosing diaphragmatic dysfunction when other methods are inconclusive.
Area of Science:
- Radiology
- Anatomy
- Pulmonary Medicine
Background:
- Diaphragmatic dysfunction is challenging to diagnose.
- Hemidiaphragmatic paralysis can result from various conditions.
- Accurate diagnosis is essential for appropriate patient management.
Purpose of the Study:
- To assess the association between crus atrophy on CT scans and fluoroscopic diagnosis of hemidiaphragmatic paralysis.
- To determine if crus thinning is a reliable indicator of diaphragmatic paralysis.
Main Methods:
- Retrospective review of 90 patients with suspected diaphragmatic dysfunction.
- Measurement of crus thickness on CT scans at celiac and L1 vertebral levels.
- Receiver operating characteristic (ROC) analysis to identify diagnostic thresholds.
Main Results:
- Hemidiaphragmatic paralysis was significantly associated with crus thinning at both celiac and L1 levels.
- CT measurements showed high sensitivity (100%) for detecting paralysis.
- Specificities ranged from 64% to 88% depending on the view and level.
Conclusions:
- CT-assessed crus atrophy is a valuable tool for discriminating between paralyzed and non-paralyzed hemidiaphragms.
- This imaging finding aids in diagnosing diaphragmatic dysfunction.
Purpose:
The aim of this study was to measure the association between crus atrophy as depicted by computed tomography (CT) and fluoroscopic diagnosis of hemidiaphragmatic paralysis in patients with suspected diaphragmatic dysfunction.
Materials And Methods:
A retrospective review of patient data was approved by our institutional review board and was HIPPA-compliant. We reviewed 90 patients who had undergone diaphragmatic fluoroscopy; 72 had CT scans available for measurement of crus thickness at the levels of the celiac and superior mesenteric arteries and the L1 vertebral body. Receiver operating characteristic analysis was used to determine the threshold of crus thinning that best distinguished a paralyzed hemidiaphragm from a nonparalyzed one.
Results:
Hemidiaphragmatic paralysis caused significant crus thinning at the celiac artery level (mean±SD, 1.7±0.6 vs. 3.6±1.3 mm, P=0.017, on the right; 1.1±0.4 vs. 3.0±1.4 mm, P=0.001, on the left) and the L1 vertebral level (mean±SD, 1.5±0.7 vs. 4.4±1.6 mm, P=0.018, on the right; 1.5±0.6 vs. 3.6+1.7 mm, P=0.017, on the left). On axial CT, thinning to ≤2.5 mm at the celiac artery level identified paralysis of the hemidiaphragm with a sensitivity of 100% and a specificity of 86% on the right and with a sensitivity of 100% and a specificity of 64% on the left. On coronal CT, thinning to ≤2.5 mm at the L1 vertebral level identified paralysis of the hemidiaphragm with a sensitivity of 100% and a specificity of 88% on the right and with a sensitivity of 100% and a specificity of 77% on the left.
Conclusions:
Atrophy of the crus assessed by CT is a good discriminator of paralyzed versus nonparalyzed hemidiaphragm in patients with suspected diaphragmatic dysfunction.
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