MRI在格林-巴利综合征(GBS)胫神经、腓总神经损伤评估中的应用
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摘要
目的分析核磁共振成像(Magnetic Resonance Imaging,MRI)在格林-巴利综合征(Guillain-Barre syndrome,GBS)胫神经、腓总神经损伤评估中的应用。方法选取我院60例GBS患者与同期60名正常志愿者纳入研究,分为研究组与对照组,均给予MRI检查,包括MR扩散张量成像(Diffusion Tensor Imaging,DTI),比较2组胫神经与腓总神经检查结果[径向扩散系数(RD)、轴向扩散系数(AD)、各向异性分数(FA)、表观扩散系数(ADC)],并采取纤维束示踪成像(Diffusion Tensor Tractography,DTT)技术获取影像学图像。结果研究组胫神经RD、 AD、 FA明显小于对照组(P<0.05),且ADC明显大于对照组(P<0.05);研究组腓总神经RD、AD、FA明显小于对照组(P<0.05),ADC显著大于对照组(P<0.05);MRI检查GBS,SPAIR T2WI像显示患者去神经支配骨骼肌可见肌肉信号增强,并且边界欠清晰;GBS患者DTT中胫神经、腓总神经影像较清晰或者稍差,呈现边缘模糊及扭曲变形现象,信号强度有所减弱,显示神经纤细毛糙,相较于正常志愿者,其纤维数量有所减少。结论 MRI检查相关参数能用于GBS胫神经与腓总神经损伤方面的评估,MR可清晰显示胫神经与腓总神经相应支配区骨骼肌产生的去神经变化,具有较高临床应用价值。
Objective To analyze the application of magnetic resonance imaging(MRI) in the evaluation of tibial and common peroneal nerve injuries in Green-Barre syndrome(GBS). Methods A total of 60 patients with GBS in the hospital and 60 normal volunteers were enrolled in the study. They were included in the study group and the control group, respectively. All of them were examined by MRI, including MR diffusion tensor imaging(DTI). The examination results of tibial and common peroneal nerves [radial diffusion coefficient(RD), axial diffusion coefficient(AD), fractional anisotropy(FA), apparent diffusion coefficient(ADC)] were compared between the two groups. The images were obtained by diffusion tensor tractography(DTT). Results The RD, AD and FA of tibial nerve in the study group were significantly lower than those in the control group(P<0.05), while the ADC was significantly larger than that in the control group(P<0.05). The RD, AD and FA of the common peroneal nerve in the study group were significantly lower than those in the control group(P<0.05), while the ADC was significantly larger than that in the control group(P<0.05). In terms of MRI examination for GBS, SPAIR T2 WI images showed muscle signal enhancement of the denervated skeletal muscles and unclear boundaries. The DTT for GBS found that the images of tibial and peroneal nerves were clear or slightly unclear, showing blurred boundaries and distorted phenomenon. The signal intensity was weakened, indicating that the nerve was fine and rough. Compared with normal volunteers, the number of fibers was decreased. Conclusion The related parameters of MRI examination can be used to evaluate the tibial and peroneal nerve injuries in CBS. MR can show the denervated changes in skeletal muscles in the corresponding dominating area of the tibial and peroneal nerves clearly, which is of great clinical value.
Objective To analyze the application of magnetic resonance imaging(MRI) in the evaluation of tibial and common peroneal nerve injuries in Green-Barre syndrome(GBS). Methods A total of 60 patients with GBS in the hospital and 60 normal volunteers were enrolled in the study. They were included in the study group and the control group, respectively. All of them were examined by MRI, including MR diffusion tensor imaging(DTI). The examination results of tibial and common peroneal nerves [radial diffusion coefficient(RD), axial diffusion coefficient(AD), fractional anisotropy(FA), apparent diffusion coefficient(ADC)] were compared between the two groups. The images were obtained by diffusion tensor tractography(DTT). Results The RD, AD and FA of tibial nerve in the study group were significantly lower than those in the control group(P<0.05), while the ADC was significantly larger than that in the control group(P<0.05). The RD, AD and FA of the common peroneal nerve in the study group were significantly lower than those in the control group(P<0.05), while the ADC was significantly larger than that in the control group(P<0.05). In terms of MRI examination for GBS, SPAIR T2 WI images showed muscle signal enhancement of the denervated skeletal muscles and unclear boundaries. The DTT for GBS found that the images of tibial and peroneal nerves were clear or slightly unclear, showing blurred boundaries and distorted phenomenon. The signal intensity was weakened, indicating that the nerve was fine and rough. Compared with normal volunteers, the number of fibers was decreased. Conclusion The related parameters of MRI examination can be used to evaluate the tibial and peroneal nerve injuries in CBS. MR can show the denervated changes in skeletal muscles in the corresponding dominating area of the tibial and peroneal nerves clearly, which is of great clinical value.
引文
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[11]王素云,李燕,杨洁,等.滤泡性淋巴瘤合并格林-巴利综合征1例报告[J].第二军医大学学报,2016,37(10):1319-1321.
[12]管昭锐,龚阳,刘学东.格林-巴利综合征伴颅神经损伤37例临床特点及相关因素分析[J].陕西医学杂志,2017,46(7):938-940.
[13]郝纪锟,张航,陈定章,等.超声联合电生理检查在胫与腓总神经损伤诊断中的应用[J].中国超声医学杂志,2017,33(7):635-638.
[14]曹金凤,王姗姗,王光彬等.格林-巴利综合征胫神经与腓总神经MR扩散张量成像的定量研究[J].中华放射学杂志,2017,51(5):372-376.
[2]姜颖,赵欢.甲泼尼龙联合丙种球蛋白治疗急性格林巴利综合征的临床效果[J].实用临床医药杂志,2017,21(9):179-180.
[3]张锐.鼠神经生长因子联合免疫球蛋白对GBS儿童血液指标及神经电生理指标的影响[J].海南医学院学报,2016,22(3):280-283.
[4]Wakerley B R,Uncini A,Yuki N,et al.Guillain-Barre and Miller Fisher syndromes[mdash]new diagnostic classification[J].Nat Rev Neurol,2014,10(9):537-544.
[5]高修明,项洁.格林-巴利综合征的康复治疗进展[J].中华物理医学与康复杂志,2016,38(7):555-558.
[6]夏银银,孙平.乙肝重叠戊肝合并格林-巴利综合征1例报告[J].安徽医药,2016,20(12):2297-2299.
[7]翟丽萍,朱宇,官俏兵,等.伴有疼痛的格林-巴利综合征52例临床分析[J].中国药物与临床,2016,16(4):552-554.
[8]郭芳,张拥波,王瑞金.格林-巴利综合征/急性脊髓炎重叠综合征的临床特点及机制分析[J].临床和实验医学杂志,2016,15(4):339-342.
[9]乔凌燕,孙裕平,于洪波,等.神经电生理检查对吉兰-巴雷综合征患儿临床严重度和预后的判断价值[J].中国临床研究,2016,29(10):1333-1335.
[10]孙光霞,林耀发,张强,等.胫神经和腓总神经损伤修复后相应脊髓节段神经元细胞Bcl-2、Bax蛋白表达差异的实验研究[J].实用临床医药杂志,2017,21(15):5-9.
[11]王素云,李燕,杨洁,等.滤泡性淋巴瘤合并格林-巴利综合征1例报告[J].第二军医大学学报,2016,37(10):1319-1321.
[12]管昭锐,龚阳,刘学东.格林-巴利综合征伴颅神经损伤37例临床特点及相关因素分析[J].陕西医学杂志,2017,46(7):938-940.
[13]郝纪锟,张航,陈定章,等.超声联合电生理检查在胫与腓总神经损伤诊断中的应用[J].中国超声医学杂志,2017,33(7):635-638.
[14]曹金凤,王姗姗,王光彬等.格林-巴利综合征胫神经与腓总神经MR扩散张量成像的定量研究[J].中华放射学杂志,2017,51(5):372-376.