磁共振可变翻转角快速自旋回波三维成像联合真稳态进动快速成像在臂丛神经节前及节后病变诊断中的应用
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摘要
目的:探讨磁共振(MR)可变翻转角快速自旋回波三维成像(3DSTIRSPACE)序列联合真稳态进动快速三维成像(3DTrueFISP)序列在臂丛神经节前及节后病变诊断中的应用效果。方法:回顾性分析医院收治的56例臂丛神经疾病患者,皆采用MR可变翻转角3D STIR SPACE序列和3D True FISP序列扫描,对所得影像结果进行分析,并与手术探查结果比较。结果:臂丛神经节前病变的主要影像学表现为神经根的缺损或者断裂,间接征象主要为硬膜囊的撕裂或形变、脊膜囊水肿或膨出;臂丛神经节后病变的主要征象有臂丛神经膨大或水肿、软组织撕裂或水肿。臂丛神经损伤共56例,患侧臂丛神经根为230根,经计算MR的3D成像技术在诊断节前神经损伤中其灵敏度、特异度和准确率分别为84.4%、91.4%和88.7%;经计算MR诊断臂丛神经节后损伤的灵敏度、特异度和准确率分别为75.0%、42.9%和73.9%;3DSTIRSPACE序列联合3DTrueFISP序列对臂丛神经损伤诊断的灵敏度、特异度和准确率分别为82.0%、87.0%和84.8%。结论:MR可变翻转角3D STIR SPACE序列联合3D True FISP序列诊断臂丛神经节前及节后病变的灵敏度高,特异性强,准确性好,且简便、无创,具有临床应用意义。
Objective: To explore the application effect of the combination of magnetic resonance three-dimensional short inversion time inversion recovery sampling perfection with application optimized contrasts using different flip angle evolutions(MR 3D STIR SPACE) sequence and three-dimensional true fast imaging with steady-state-precession(3D True FISP) sequence in diagnosing the pre and postganglionic diseases of brachial plexus. Methods: 56 patients with disease of brachial plexus were retrospectively analyzed. All of patients were scanned by using 3D STIR SPACE sequence and 3D True FISP sequence, and all of imaging results were analyzed and were compared with results of surgical exploration. Results: The main imaging performance of preganglionic lesion of brachial plexus were the defect or rupture of nerve root, and the mainly indirect signs were the tear or deformation of dural sac, and the edema or the swelling of the spinal capsule. The main imaging performance of postganglionic lesion of brachial plexus included swelling or edema of brachial plexus, and tear or edema of soft tissue. In these patients, 56 cases were injuries of brachial plexus, and 230 roots of brachial plexus were at the side of lesion. The results of calculation indicated that the sensitivity, specificity and accuracy rate of MR 3D imaging technique in diagnosing preganglionic injury were 84.4%, 91.4% and 88.7%, respectively. And these indicators of MR in diagnosing postganglionic injury of brachial plexus were 75.0%, 42.9% and 73.9%, respectively. The sensitivity, specificity and accuracy of the combined diagnosis of two imaging sequences in diagnosing the injury of brachial plexus were 82.0%, 87.0% and 84.8%, respectively. Conclusion: The combination of MR 3D STIR SPACE sequence and 3D True FISP has many advantages include high sensitivity, strong specificity, good accuracy, simple and noninvasive in diagnosing pre and postganglionic lesions of brachial plexus. Therefore, it has clinical application value.
Objective: To explore the application effect of the combination of magnetic resonance three-dimensional short inversion time inversion recovery sampling perfection with application optimized contrasts using different flip angle evolutions(MR 3D STIR SPACE) sequence and three-dimensional true fast imaging with steady-state-precession(3D True FISP) sequence in diagnosing the pre and postganglionic diseases of brachial plexus. Methods: 56 patients with disease of brachial plexus were retrospectively analyzed. All of patients were scanned by using 3D STIR SPACE sequence and 3D True FISP sequence, and all of imaging results were analyzed and were compared with results of surgical exploration. Results: The main imaging performance of preganglionic lesion of brachial plexus were the defect or rupture of nerve root, and the mainly indirect signs were the tear or deformation of dural sac, and the edema or the swelling of the spinal capsule. The main imaging performance of postganglionic lesion of brachial plexus included swelling or edema of brachial plexus, and tear or edema of soft tissue. In these patients, 56 cases were injuries of brachial plexus, and 230 roots of brachial plexus were at the side of lesion. The results of calculation indicated that the sensitivity, specificity and accuracy rate of MR 3D imaging technique in diagnosing preganglionic injury were 84.4%, 91.4% and 88.7%, respectively. And these indicators of MR in diagnosing postganglionic injury of brachial plexus were 75.0%, 42.9% and 73.9%, respectively. The sensitivity, specificity and accuracy of the combined diagnosis of two imaging sequences in diagnosing the injury of brachial plexus were 82.0%, 87.0% and 84.8%, respectively. Conclusion: The combination of MR 3D STIR SPACE sequence and 3D True FISP has many advantages include high sensitivity, strong specificity, good accuracy, simple and noninvasive in diagnosing pre and postganglionic lesions of brachial plexus. Therefore, it has clinical application value.
引文
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[11]吴斌,金彪,王永杰,等.MR动态增强定量参数对鉴别前列腺良恶性病变的价值及与血清PSA的相关性[J].中国医学计算机成像杂志,2017,23(3):252-255.
[12]景国东,金爱国,吴骋,等.前列腺癌、增生结节及外周带非癌组织在3.0T MR动态增强灌注成像中的强化表现[J].放射学实践,2016,31(8):756-759.
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[14]赵艳娥,唐春香,周长圣,等.3.0T MR动态对比增强肺动脉成像评估肾病综合征患者肺栓塞[J].放射学实践,2016,31(9):833-837.
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[17]Ahmed OMA,O'Donnell BD,Gallagher AG,et al.Construct validity of a novel assessment tool for ultrasound-guided axillary brachial plexus block[J].Anaesthesia,2016,71(11):1324-1331.
[18]魏乐群,陈殿森,孙聚葆,等.MR体素内不相干运动成像对乳腺良恶性病变的鉴别诊断价值[J].中国医学影像学杂志,2016,24(12):906-908.
[19]陈丽娟,潘自来,房炜桓.3.0TMR动态增强成像对宫腔良恶性占位病变的鉴别诊断价值[J].中国医学计算机成像杂志,2017(5):447-452.
[20]王晶波,陶晓峰,袁瑛,等.MR指纹技术在医学影像诊断中的应用[J].中国介入影像与治疗学,2018,15(1):59-62.
[2]王龙胜,郑穗生,李欢,等.增强三维短反转时间反转恢复变角激发T2WI快速自旋回波序列臂丛神经成像[J].中华放射学杂志,2016,50(5):371-375.
[3]顾程,李秀明,孟祥鹿,等.磁共振三维可变翻转角快速自旋回波序列扫描技术在复杂性肛瘘诊断中的应用[J].山东医药,2017,57(10):60-62.
[4]Naganawa S,Koshikawa T,Fukatsu H,et al.MR cisternography of the cerebellopontine angle:comparison of three-dimensional fast asymmetrical spin-echo and three-dimensional constructive interference in the steady-state sequences[J].AJNR Am J Neuroradiol,2016,22(6):1179-1185.
[5]邵赛,王姗姗,王光彬,等.MR三维神经鞘信号增高并背景抑制弛豫增强的快速采集成像序列在节后臂丛神经显示及临床应用的初步探讨[J].中华放射学杂志,2017,51(1):8-12.
[6]Yu A,WangS,ChengX,etal.Functional connectivity of motor cortical network in patients with brachial plexus avulsion injury after contralateral cervical nerve transfer:a resting-state fMRI study[J].Neuroradiology,2017,59(3):1-7.
[7]王健,王溯源,余方正,等.MR(3.0T)3D-SPACE-STIR增强扫描在臂丛节后神经源性肿瘤中的应用[J].中华手外科杂志,2016,32(2):130-132.
[8]周彩红,钟小玲,麦发泽.三维快速稳态进动成像序列诊断颅内良性脊索细胞瘤[J].中国医学影像技术,2016,32(9):1349-1352.
[9]Leonhard V,Landreth R,Caldwell G,et al.Anatomical variations in the brachial plexus roots:implications for diagnosis of neurogenicthoracic outlet syndrome[J].Ann Anat,2016,206:21-26.
[10]赵晓梅,黄耀渠,伍琼慧,等.2D与3D MR快速自旋回波序列对膝关节交叉韧带及半月板损伤的诊断价值比较[J].放射学实践,2017,32(1):73-78.
[11]吴斌,金彪,王永杰,等.MR动态增强定量参数对鉴别前列腺良恶性病变的价值及与血清PSA的相关性[J].中国医学计算机成像杂志,2017,23(3):252-255.
[12]景国东,金爱国,吴骋,等.前列腺癌、增生结节及外周带非癌组织在3.0T MR动态增强灌注成像中的强化表现[J].放射学实践,2016,31(8):756-759.
[13]文宝红,杨鸽,程敬亮,等.MR三维成像在高度近视中的应用探讨[J].放射学实践,2016,31(8):709-711.
[14]赵艳娥,唐春香,周长圣,等.3.0T MR动态对比增强肺动脉成像评估肾病综合征患者肺栓塞[J].放射学实践,2016,31(9):833-837.
[15]Brochard S,Mozingo JD,Alter KE,et al.Three Dimensionality of Gleno-Humeral Deformities In Obstetrical Brachial Plexus Palsy[J].J OrthopRes,2016,34(4):675-682.
[16]袁思殊,王梓,阳军,等.非对比增强MR肺动脉血管成像诊断肺栓塞血流抑制反转时间的选择[J].放射学实践,2016,31(9):826-832.
[17]Ahmed OMA,O'Donnell BD,Gallagher AG,et al.Construct validity of a novel assessment tool for ultrasound-guided axillary brachial plexus block[J].Anaesthesia,2016,71(11):1324-1331.
[18]魏乐群,陈殿森,孙聚葆,等.MR体素内不相干运动成像对乳腺良恶性病变的鉴别诊断价值[J].中国医学影像学杂志,2016,24(12):906-908.
[19]陈丽娟,潘自来,房炜桓.3.0TMR动态增强成像对宫腔良恶性占位病变的鉴别诊断价值[J].中国医学计算机成像杂志,2017(5):447-452.
[20]王晶波,陶晓峰,袁瑛,等.MR指纹技术在医学影像诊断中的应用[J].中国介入影像与治疗学,2018,15(1):59-62.