臂丛神经病变的磁共振功能成像应用基础研究

发布时间：2018-07-02 21:23

本文选题：臂丛神经 + 早期损伤　；参考：《复旦大学》2014年博士论文

【摘要】：第一部分臂丛神经损伤的常规MRI及MR神经成像序列的应用目的探讨臂丛神经损伤的MR表现特点及其诊断价值。材料与方法采用3OT MRI扫描仪对43例临床诊断为臂丛神经损伤的患者行术前常规MRI及MR神经成像序列扫描,常规MRI扫描序列包括横轴位SE T1W1、FSE T2W1、TIRM, MR神经成像序列包括冠状位SPACE、TIRM及T1 FLASH。将手术探查、术中肌电图及术前MRI检查结果进行比较,探讨臂丛神经损伤的MRI表现及对于早期损伤患者的诊断价值。结果纳入统计的215对节前神经中有105对损伤,MRI共检出98对,诊断的敏感度为76.2%(80/105),特异度为83.6%(92/110),准确率为80.0%(172/215)。损伤间隔在1月内的MRI诊断的准确率为79.1%,1月至3月内的准确率为80.0%,两组准确率差异无统计学意义(P0.05)。臂丛神经节前损伤的直接征象包括：完全性撕脱伤：(1)椎管内神经前后根连续性中断或消失68对,(2)神经前后根增粗、僵硬、迂曲或无法连续追踪至椎间孔处8对；部分性撕脱：(1)神经前根或后根消失、连续性中断10对；(2)冠状面图像示神经前后根根丝数较对侧明显减少13对。间接征象包括：(1)椎管内局部脑脊液聚集,椎间孔区创伤性脊膜囊肿(假性脊膜膨出)44对,(2)神经根袖形态异常、双侧不对称,重建图像可示神经根袖影消失,根袖末端尖角变钝、消失或延伸至椎间孔外9对；(3)相应水平脊髓变形或移位1对；(4)脊髓损伤1例。MRI对臂丛神经节后损伤诊断的灵敏度为74.8%,特异度为88.1%,准确率为79.2%。损伤间隔在1月内的MRI诊断的准确率为81.4%,损伤间隔1月至3月内的诊断准确率为85.7%,两组准确率差异无统计学意义(P0.05)。臂丛神经节后损伤的MRI表现包括：(1)神经连续性中断、消失、断端分离12根。(2)神经尚连续,但形态增粗,走行迂曲、僵硬20例。(3)神经连续,略增粗,TIRM高信号18例。(4)神经连续性存在,走行自然,结构及信号与健侧基本一致,3例。结论 MRI对臂丛神经损伤的患者可早期准确的做出定位及定性诊断。第二部分臂丛神经损伤的MR功能成像的应用目的探讨臂丛神经损伤的MR功能成像的诊断价值。材料与方法采用3.0T MRI扫描仪对42例临床诊断为臂丛神经损伤的患者行术前DTI扫描。将手术探查、术中肌电图及术前DTI成像参数进行比较,探讨臂丛神损伤的DTI参数意义及对于早期损伤患者的诊断价值。结果42例臂丛神损伤患者经DTI参数测量得患侧C5-C8神经根部的ADC值、FA值分别1.483±0.153,0.434±0.063(×10-3mm2/s),健侧C5-C8神经根部的ADC值、F值分别为1.380±0.163,0.482±0.070(×10-3mm2/s),比较双侧ADC值、FA差异均具有统计学意义(P=0.001,P=0.001)。损伤1月内的患者患侧与健C5-C8神经根部仅FA值差异具有统计学意义(P0.05)。损伤3月内的患患侧与健侧C5-C8神经根部的ADC、FA值差异均具有统计学意义(P0.001P0.001)。结论DTI技术为早期损伤情况的判断提供参考,有利于临床术方案的制定和患者预后的判断。第三部分：臂丛神经肿瘤性病变的MR诊断及应用目的分析臂丛神经肿瘤性病变的MRI特点,探讨其在诊断与鉴别诊断中的价值。材料和方法本研究分析经手术病理证实的13例臂丛神经肿瘤性病变患者及经淋巴结穿刺活检证实的1例转移到臂丛神经的肿瘤的MRI表现,其中神经鞘瘤9例,丛状神经鞘瘤1例,神经纤维瘤1例,侵袭性纤维瘤1例,滑膜肉瘤1例,乳腺癌转移瘤1例。所有患者均行MR常规扫描、神经成像扫描及DTI扫描。结果9例神经鞘瘤均位于臂丛神经节后段,类圆形为主,边界清晰,有包膜,与臂丛神经走行方向一致,其中1例哑铃状延伸入椎间孔,2例病灶内有囊变区；1例丛状神经鞘瘤为右侧臂丛神经根干部肥大增粗,呈团块状,边界清晰,T1WI等信号,T2WI及TIRM序列上呈高信号,内伴小片状低信号,冠状面TIRM图像清晰显示肿块与载瘤神经之间的关系。1例神经纤维瘤为沿臂丛神经生长的类圆形肿块,T1WI等低信号,T2WI及TIRM高信号。1例侵袭性纤维瘤为右侧臂丛神经根干部椭圆形巨大肿块,T1WI等稍低信号,T2WI等信号,TIRM高信号伴混杂低信号影。1例滑膜肉瘤,左侧锁骨下区团块影,紧邻臂丛神经束支部,伴神经轻度肿胀,分界不清,T1WI低信号,T2WI及TIRM均呈高信号。1例乳腺癌转移至臂丛神经为左侧臂丛神经股部梭形肿块,T1等稍低信号,T2WI略高信号,TIRM高低混杂信号。经DTI扫描的13例患者中,8例神经鞘瘤DTT显示纤维受压移位,1例侵袭性纤维瘤DTT显示臂丛神经与肿块关系密切,局部受压改变。结论 MRI可清晰显示常见累及臂丛神经的肿瘤性病变,准确显示病变部位、累及范围及与邻近组织的关系,为临床准确诊断及治疗臂丛神经病变提供可靠信息。
[Abstract]:The application of conventional MRI and MR neuroimaging sequences in the first part of the brachial plexus injury to explore the MR features and diagnostic value of brachial plexus injury. Materials and methods were performed by 3OT MRI scanner in 43 patients with brachial plexus injury by routine preoperative MRI and MR imaging sequence scanning, and routine MRI scanning sequence. The SE T1W1, FSE T2W1, TIRM, and MR neuroimaging sequences, including the coronary SPACE, TIRM and T1 FLASH., were compared with the results of electromyography and preoperative MRI examination. The MRI performance of brachial plexus injury and the diagnostic value for early injury patients were investigated. The results included 105 pairs of lesions in the 215 pairs of preganglionic nerves. 98 pairs of MRI were detected, the sensitivity of the diagnosis was 76.2% (80/105), the specificity was 83.6% (92/110), the accuracy was 80% (172/215). The accuracy rate of the MRI diagnosis within the interval of injury in January was 79.1%, the accuracy rate was 80% from January to March, and the accuracy of the two groups was not statistically significant (P0.05). The direct signs of the brachial plexus preganglionic injury included: Total avulsion injury: (1) the continuous interruption or disappearance of the anterior and posterior nerve roots of the spinal canal was 68 pairs, and (2) the roots were thickened, rigid, tortuous or not continuously traced to 8 pairs of intervertebral foramen; partial avulsion: (1) the anterior or posterior roots of the nerve disappeared, and the continuous interruption was 10 pairs; (2) the number of root filaments before and after the coronary images were significantly reduced by 13 pairs of opposite sides. The indirect signs include: (1) the accumulation of local cerebrospinal fluid in the spinal canal, 44 pairs of traumatic meningeal cyst (pseudocele) in the intervertebral foramen area, and (2) abnormal shape of the sleeve of the nerve root, bilateral asymmetry, the reconstruction image shows the disappearance of the nerve root sleeve shadow, the tip of the root sleeve blunt, disappearing or extending to 9 pairs outside the intervertebral foramen; (3) the corresponding horizontal spinal cord deformation or displacement 1 (4) the sensitivity of.MRI to the brachial plexus postganglionic injury in 1 cases of spinal cord injury was 74.8%, the specificity was 88.1%, the accuracy rate of the MRI diagnosis of the 79.2%. injury interval in January was 81.4%, the diagnostic accuracy of the injury interval from January to March was 85.7%, and the accuracy of the two groups was not statistically significant (P0.05). The postganglionic injury of the brachial plexus was not significant. The MRI manifestations included: (1) interruption of nerve continuity, disappearance and separation of 12 from the broken end. (2) the nerve was still continuous, but the shape was thickened, and 20 cases were tortuous and rigid. (3) nerve continuity, slightly thickening, and TIRM high signal 18 cases. (4) nerve continuity existed, the structure and signal were basically consistent with the healthy side, 3 cases. Conclusion MRI in patients with brachial plexus injury. Early and accurate positioning and qualitative diagnosis. Second the application of MR functional imaging in part of the brachial plexus injury to explore the diagnostic value of MR functional imaging of brachial plexus injury. Materials and methods used the 3.0T MRI scanner for preoperative DTI scan in patients with brachial plexus injury. The DTI parameters of the brachial plexus damage and the diagnostic value for the early injury patients were compared between the electrogram and the preoperative DTI imaging parameters. Results the ADC value of the lateral C5-C8 nerve root was measured by DTI parameters in 42 cases of brachial plexus injury. The value of FA was 1.483 + 0.153,0.434 + 0.063 (x 10-3mm2/s), the ADC value of the healthy side of the healthy side and F value. 1.380 + 0.163,0.482 + 0.070 (x 10-3mm2/s) respectively, compared with bilateral ADC values, the difference of FA was statistically significant (P=0.001, P=0.001). The difference between the injured side and the healthy C5-C8 nerve root in the injured side of the patients in January was statistically significant (P0.05). The FA value difference was statistically significant in the injured side and the C5-C8 nerve root of the healthy side in March. Significance (P0.001P0.001). Conclusion DTI technology provides reference for early damage assessment. It is beneficial to the formulation of clinical procedure and the judgment of patients' prognosis. The third part: the MR diagnosis and application of brachial plexus tumor pathological changes and its application to analyze the MRI special points of the brachial plexus tumor, and discuss its value in the diagnosis and differential diagnosis. Materials and methods this study analyzed the MRI findings of 13 cases of brachial plexus tumor confirmed by operation and pathology and 1 cases of brachial plexus metastasis confirmed by lymph node biopsy, including 9 cases of neurilemmoma, 1 cases of plexiform neurilemmoma, 1 cases of neurofibroma, 1 cases of invasive fibroma, 1 cases of synovial sarcoma, and metastasis of breast cancer. In 1 cases, all the patients underwent MR routine scan, neuroimaging scan and DTI scan. Results 9 cases of neurilemmoma were located in the posterior segment of the brachial plexus, with a circular shape, a clear boundary, a membrane and the same direction as the brachial plexus, of which 1 were dumbbell shaped into the intervertebral foramen, 2 cases had cystic degeneration, and 1 plexiform neurilemmomas were right brachial plexus. Hypertrophy and thickening of nerve root cadres, mass of mass, clear border, clear boundary, T1WI and so on, high signal in T2WI and TIRM sequence, with small flake low signal. The TIRM image of the coronal plane clearly shows the relationship between the lump and the carrier nerve;.1 cases of neurofibroma are round masses along the brachial plexus, T1WI and other low signals, T2WI and TIRM high signal.1 cases Invasive fibroma was an oval mass in the right arm of the brachial plexus, T1WI and other signals such as low signal, T2WI, TIRM high signal with mixed low signal shadow.1 synoviosarcoma, left subclavian area shadow, adjacent to brachial plexus branch, mild swelling of nerve, low demarcation, T1WI low signal, T2WI and TIRM with high signal.1 case mammary gland The metastasis to the brachial plexus was the spindle mass of the left brachial plexus, T1 was slightly low signal, T2WI slightly high signal, and TIRM high and low mixed signal. Among the 13 patients with DTI scan, 8 cases of neurilemmoma DTT showed the fiber compression shift, 1 cases of invasive fibroma DTT showed that the brachial plexus was closely related to the swelling block, and the local compression was changed. Conclusion MRI can be cleared. Conclusion MRI can be cleared. A clear display of the common lesions of the brachial plexus, accurately showing the location of the lesion, the range of involvement and the relationship with the adjacent tissue, provides reliable information for the accurate diagnosis and treatment of brachial plexus neuropathy.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R445.2;R688

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