磁共振扩散加权神经成像技术在腕掌部神经中的初步应用

发布时间：2017-12-28 22:02

本文关键词：磁共振扩散加权神经成像技术在腕掌部神经中的初步应用　出处：《山东大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的利用磁共振扩散加权神经成像(DW-MRN)技术对正常志愿者及腕掌部神经病变患者进行腕掌部神经成像,探讨DW-MRN技术在腕掌部正中神经、尺神经及其分支成像中的可行性及临床价值。材料与方法本研究获得本单位伦理委员会批准,所有健康志愿者及患者行MR扫描前均签署知情同意书。本研究共纳入42名健康志愿者及20名可疑腕掌部神经病变的患者,所有健康志愿者均无任何神经疾病相关病史,无腕部及掌部外伤史、手术史,无糖尿病、风湿病等慢性疾病史,无MR检查禁忌症。所有患者在行MR扫描前均行患侧上肢肌电图检查,提示腕掌部正中神经或尺神经损伤。纳入的42名健康志愿者其中男18名,女24名,年龄范围20岁-65岁,中位年龄37岁。病例组20名患者男8名,女12名,年龄范围8岁-64岁,中位年龄40岁。扫描采用Philips Achieva 3.0 T TX超导MR扫描仪,接收线圈为8通道腕关节相控阵线圈。所有检查者均采用头先进、俯卧位,伸手过头姿势进行MR检查。所有患者及健康志愿者同时接受单侧(健康志愿者)或患侧(患者)常规磁共振检查及DW-MRN检查,包括轴位或冠状位T1加权成像(T1 WI)、频率反转恢复脂肪抑制T2加权成像(T2WI-SPAIR)、频率反转恢复脂肪抑制质子加权成像序列(PDWI-SPAIR)。DW-MRN检查均在前后方向施加扩散敏感梯度(MPGs)。扫描范围包全腕部及掌部。对DW-MRN原始图像进行最大信号投影(MIP)重建,并裁剪掉周围影响神经显示的高信号,得到冠状位三维立体图像。对健康志愿者组,由两名高年资放射科医生分别根据神经显示形态及信号强度对腕掌部正中神经、尺神经及其分支DW-MRN图像质量进行主观评分,评分标准如下：4分,显示满意(神经显示清晰,边缘锐利,信号均匀一致)；3分,显示较满意(神经显示较清晰,边缘较模糊,信号强度中等)；2分,显示不满意(神经显示较清晰,但边缘模糊或扭曲变形,信号强度较弱)；1分,未显示(神经显示不良,变形明显,难以辨认)。应用SPSS20.0统计学软件进行统计学分析,对于两名阅片者评分结果进行Kappa一致性检验。由两位高年资放射科医师共同对轴位PDWI-SPAIR图像及重建后的DW-MRN图像进行分析评价,计算两个序列可清晰显示的腕掌部正中神经主干、尺神经主干、第一、二、三指掌侧总神经及尺神经深支、浅支的数目,对神经的显示率进行配对资料的x2检验。对于病例组,由两名高年资的放射科医师共同分析重建后DW-MRN和PDWI-SPAIR图像所显示病变与神经的关系,DW-MRN和PDWI-SPAIR图像分开进行评价,并按照如下三级评分标准进行评分：①1分,无法显示病变与神经的关系,或评价结果与手术中所见相差很大；②2分,可能显示病变与神经的关系或与手术中所见有一定差别；③3分,病变与神经的关系显示清晰或与病理或手术结果完全一致。行手术治疗的患者病变评价以病理或者手术结果作为金标准。病例组DW-MRN和PDWI-SPAIR图像评分对比采用两独立样本间Mann-whitney U检验。取α=0.05为检验水准,P0.05为差异有统计学意义。结果在健康志愿者中,DW-MRN图像中神经表现为连续走行且信号均匀的高信号,腕部正中神经及尺神经主干,掌部正中神经发出的第一、二、三指掌侧总神经,尺神经浅支、深支显示较清,正中神经返支及拇指固有神经显示不清。两名阅片者对正中神经显示情况的评分分别为4.0±0.0和4.0±0.0,两名阅片者之间的一致性很好(K=1),对尺神经显示情况的评分分别为3.45±0.74和3.43±0.67,两名阅片者之间的一致性良好(K＝0.793)。DW-MRN能清晰显示正中神经及尺神经主干、第一、二、三指掌侧总神经及尺神经深支、浅支的数目分别为42、42、42、42、42、38、37,在PDWI-SPAIR序列上为42、39、27、28、25、17、21。DW-MRN对第一、二、三指掌侧总神经及尺神经深支、浅支显示率要高于PDWI-SPAIR序列(x2分别为18.26、16.80、21.31、23.23、14.26,P值均0.05)。对正中神经主干、尺神经主干的显示两者间无明显统计学差异。病例组20例患者中包括5例腕管综合征患者(包括屈肌腱鞘炎2例、腕管内腱鞘囊肿正中神经受压1例、大鱼际肌肌间隙脂肪瘤1例、大鱼际肌炎性肿胀推压正中神经1例)、3例尺管综合征患者(均为腱鞘囊肿压迫尺神经深支)、8例腕掌部神经损伤患者(正中神经损伤患者3例、尺神经损伤患者2例、正中神经合并尺神经损伤3例)、2例腕掌部尺神经慢性炎症患者、1例腕部正中神经鞘瘤患者、1例纤维脂肪瘤性错构瘤患者。DW-MRN序列除两例急性神经损伤患者术后评分为2分,1例尺神经慢性炎症患者评分为1分外,其余患者评分均为3分,而PDWI-SPAIR序列仅有10例患者评分为3分。DW-MRN能够三维立体的显示腕掌部神经病变及范围,并较PDWI-SPAIR序列能更有效的判断病变与神经的关系(Z值为-2.306,P值0.05)。结论DW-MRN能够清晰三维立体显示腕部正中神经、尺神经主干,掌部正中神经发出的第一、二、三指掌侧总神经,尺神经浅支、深支,较PDWI-SPAIR序列能更清晰显示病变与神经的关系,有助于累及腕掌部神经疾病的检出及定位、定性诊断、术前及术后评估。
[Abstract]:Objective using magnetic resonance diffusion weighted imaging (DW-MRN) of the wrist and palm nerve imaging in healthy volunteers and patients with wrist palmar neuropathy, to investigate the feasibility and clinical value of DW-MRN in the palm of the wrist median nerve, ulnar nerve and its branches in imaging. Materials and methods were approved by the unit ethics committee. All healthy volunteers and patients signed informed consent before MR scan. This study included 42 healthy volunteers and 20 suspected carpal palm neuropathy patients were all healthy volunteers without any nerve disease history, operation without the wrist and palm injury history, history of diabetes, rheumatism and other chronic disease history, no MR contraindication. All patients underwent MR scan was performed before the upper limb EMG, suggesting that volar wrist median or ulnar nerve injury. Of the 42 healthy volunteers, 18 were male and 24 women were aged 20 years old, with a median age of 37 years. The 20 patients in the case group were 8 men and 12 women. The age range was 8 years old, and the median age was 40 years old. The scan uses a Philips Achieva 3 T TX superconducting MR scanner and a receiving coil of 8 channels of the wrist joint phased array coil. All the examiners used the advanced head, prone position, and extended hand posture for MR examination. All patients and healthy volunteers (healthy volunteers) underwent unilateral and contralateral (patients) or conventional MRI and DW-MRN examination, including axial or coronal T1 weighted imaging (T1 WI), frequency inversion recovery fat suppression T2 weighted imaging (T2WI-SPAIR), frequency of reverse recovery of fat suppressed proton weighted imaging sequence (PDWI-SPAIR). The diffusion sensitivity gradient (MPGs) was applied in the direction of DW-MRN. The scanning range of the whole package of wrist and palm. The original image of DW-MRN is reconstructed with maximum signal projection (MIP), and the high signal that affects the peripheral nerve display is cut off, and the three-dimensional image of the coronal position is obtained. In the group of healthy volunteers, by two senior radiologists respectively according to the display of nerve morphology and signal intensity of the subjective scoring of volar wrist median nerve and ulnar nerve and its branches DW-MRN image quality, standard for evaluation are as follows: 4 points, showing satisfactory (nerve show clear, sharp edges, uniform signals); 3 points, showing satisfactory (nerve showing more clearly, the edge is fuzzy, the signal intensity of medium); 2 points were not satisfied (nerve showing more clearly, but edge blurring or distortion, the signal strength is weak); 1, not shown (neural display bad, obvious deformation, illegible). The statistical analysis was carried out by SPSS20.0 statistics software, and the Kappa consistency test was carried out for the results of two movie - reading subjects. By two senior radiologists together on DW-MRN images in axial PDWI-SPAIR images and reconstruction after the analysis and evaluation, calculation of the two series wrist palmar median nerve trunk, can clearly show the ulnar nerve trunk, first, second, third common palmar digital nerve and deep branch of ulnar nerve and superficial branch number, the neurological display rate of x2 test paired data. For the case group, composed of two senior radiologists jointly analyze the reconstruction of DW-MRN and PDWI-SPAIR images showed the relationship between lesions and nerve, DW-MRN and PDWI-SPAIR images were evaluated separately, according to the following three levels: the standard for evaluation of 1 points, to display the relationship between disease and nerve, or the evaluation results and operation see great difference; the 2 points, can show the relationship between lesions and nerve or surgical findings have certain difference; the 3, the relationship between lesions and nerve showed clear or consistent with pathological results or surgery. Patients undergoing surgical treatment were evaluated for pathological or surgical results as the gold standard. The score of DW-MRN and PDWI-SPAIR images in the case group was compared with the Mann-whitney U test between two independent samples. The level of alpha =0.05 was tested, and the difference in P0.05 was statistically significant. Results in healthy volunteers, DW-MRN neural images for higher signal line and even signal, the main wrist median nerve and ulnar nerve, median nerve palmar first, second, third common palmar digital nerve, superficial branch of ulnar nerve, deep branch display is clear, the recurrent branch of median nerve and nerve thumb proper display is not clear. The score of median nerve in two readers was 4 + 0 and 4 + 0 respectively, the consistency between two readers was good (K=1), and the score of ulnar nerve showed 3.45, 0.74 and 3.43 0.67, respectively, and the consistency between two readers was good (K = two). DW-MRN can clearly show the median nerve and ulnar nerve trunk, first, second, third common palmar digital nerve and deep branch of ulnar nerve and superficial branch number were 42, 42, 42, 42, 42, 38, 37, in the sequence of PDWI-SPAIR was 42, 39, 27, 28, 25, 17, 21. DW-MRN of first, second, third common palmar digital nerve and deep branch of ulnar nerve and superficial branch of the display rate is higher than that of PDWI-SPAIR sequence (x2 = 18.26, 16.80, 21.31, 23.23, 14.26, P 0.05). There was no significant difference between the main trunk of the median nerve and the trunk of the ulnar nerve. There were 20 patients including 5 cases of carpal tunnel syndrome patients (including 2 cases of flexor tenosynovitis, carpal ganglion cysts of median nerve compression in 1 cases, 1 cases, thenar muscle of thenar space lipoma myositis swelling pushed median nerve in 1 cases), 3 cases of ulnar tunnel syndrome patients (both ganglion cyst compression of the deep branch of the ulnar nerve), 8 cases of wrist and palm nerve injury patients (median nerve injury were 3 cases, 2 cases of patients with injury of the ulnar nerve, median nerve and ulnar nerve injury in 3 cases), 2 cases of volar wrist ulnar nerve, 1 cases of patients with chronic inflammation, 1 cases of patients with median neurilemmoma of lipofibroma hamartoma tumor patients. In the DW-MRN sequence, the score of two patients with acute nerve injury was 2. The score of 1 cases of chronic inflammation of the ulnar nerve was 1, and the rest of the patients were all 3 points, and PD
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R445.2;R688

【相似文献】