磁共振神经成像序列在臂丛神经损伤中的应用
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摘要
目的探讨磁共振神经成像(MRN)序列对臂丛神经损伤的诊断价值。方法采用3.0T MRI对43例临床诊断为臂丛神经损伤患者行术前常规MRI及MRN序列扫描,对手术探查、术中肌电图及术前MRI/MRN检查结果进行比较分析。结果 MRN对节前神经损伤诊断的敏感度为76.2%,特异度为83.6%,准确率为80.0%。MRN对臂丛神经节后损伤诊断的敏感度为74.8%,特异度为88.1%,准确率为79.2%。结论 MRN可作为早期臂丛神经损伤定性及定位诊断的影像学检查方法之一。
Aim To evaluate the diagnostic value of magnetic resonance neurography(MRN) in brachial plexus injury. Methods A total of 43 patients enrolled with brachial plexus injury underwent routine MRI and MRN at 3.0T before surgery. Intraoperative findings and intraoperative EMG were used as the reference standard. MRN findings, sensitivity, specificity with 95 % confidence intervals and accuracy were compared for investigating the diagnostic value of MRI in brachial plexus injury at early stage. Results The sensibility, specificity and accuracy of MRN in diagnosing preganglionic brachial plexus injury was 76.2%, 83.6%, 80.0%, respectively. The sensitivity, specificity and accuracy of MRN in diagnosing postganglionic injury were 74.8%, 88.1%, 79.2%, respectively. Conclusion MRN can provide accurate diagnosis of the location and nature of brachial plexus injury, especially for early injury cases.
Aim To evaluate the diagnostic value of magnetic resonance neurography(MRN) in brachial plexus injury. Methods A total of 43 patients enrolled with brachial plexus injury underwent routine MRI and MRN at 3.0T before surgery. Intraoperative findings and intraoperative EMG were used as the reference standard. MRN findings, sensitivity, specificity with 95 % confidence intervals and accuracy were compared for investigating the diagnostic value of MRI in brachial plexus injury at early stage. Results The sensibility, specificity and accuracy of MRN in diagnosing preganglionic brachial plexus injury was 76.2%, 83.6%, 80.0%, respectively. The sensitivity, specificity and accuracy of MRN in diagnosing postganglionic injury were 74.8%, 88.1%, 79.2%, respectively. Conclusion MRN can provide accurate diagnosis of the location and nature of brachial plexus injury, especially for early injury cases.
引文
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[14]李新春,陈健宇,王欣璐,等.兔坐骨神经急性挤压伤的MRI与病理学对比初步研究[J].中华放射学杂志,2004,38:133-138
[15]陈建宇,刘庆余,沈君,等.臂丛神经损伤的MRI诊断[J].中华放射学杂志,2007,41:563-568
[2]俞永林,顾玉东,沈丽英,等.周围神经卡压与神经根型颈椎病的神经肌电图鉴别[J].中国临床神经科学,2001,9:166-167
[3]梁银杏,劳镇国,戚剑,等.神经-肌电图与MRI检查结合诊断臂丛神经损伤[J].中山大学学报医学科学版,2002,23:471-473
[4]Hashimoto T,Mitomo M,Hirabuki N,et al.Nerve root avulsion of birth palsy:comparison of myelography with CT myelography and somatosensory evoked potential[J].Radiology,1991,178:841-845
[5]Doi K,Otsuka K,Okamoto Y,et al.Cervical nerve root avulsion in brachial plexus injuries:magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography[J].J Neurosurg,2002,96:277-284
[6]Sunderland S.Mechanisms of cervical nerve root avulsion in injuries of the neck and shoulder[J].J Neurosurg,1974,41:705-714
[7]高明勇,梁碧玲,许扬滨,等.臂丛神经根损伤的MR诊断及其应用价值[J].中华创伤杂志,1999,15:151-152
[8]李新春,陈健宇,沈君,等.臂丛神经损伤的MRI表现与功能恢复的关系[J].中国医学影像学杂志,2005,13:419-422
[9]杨蓊勃,虞聪,赵秋枫.MRM在臂丛神经节前损伤诊断中的运用[J].中华手外科杂志,2008,24:239-242
[10]Hayashi N,Masumoto T,Abe O,et al.Accuracy of abnormal paraspinal muscle findings on contrast-enhanced MR images as indirectsigns of unilateral cervical root-avulsion injury[J].Radiology,2002,223:397-402
[11]Tagliafico A,Succio G,Serafini G,et al.Diagnostic accuracy of MRI in adults with suspect brachial plexus lesions:a multicentre retrospective study with surgical findings and clinical follow-up as reference standard[J].Eur J Radiol,2012,81:2666-2672
[12]孔凡标.臂丛神经磁共振成像技术的临床应用[J].医疗卫生装备,2008,29:102-104
[13]宋海岩,雷益,林帆,等.臂丛神经MRI扫描方案探讨[J].海南医学,2011,22:95-97
[14]李新春,陈健宇,王欣璐,等.兔坐骨神经急性挤压伤的MRI与病理学对比初步研究[J].中华放射学杂志,2004,38:133-138
[15]陈建宇,刘庆余,沈君,等.臂丛神经损伤的MRI诊断[J].中华放射学杂志,2007,41:563-568