MRI在臂丛节后神经损伤中的诊断价值

发布时间：2018-08-14 09:40

【摘要】：目的探讨MRI在诊断臂丛节后神经损伤中的影像表现及其临床应用价值材料和方法搜集16例临床怀疑为臂丛神经节后损伤的患者,均存在不同程度的感觉、运动功能障碍或/和肌肉萎缩等表现,术前采用飞利浦Achieva3. OT TX超导型MR扫描仪行臂丛神经扫描检查、神经电生理学检查,同时行手术探查,通过两种检查方法与手术探查、术中电生理所见或临床证实进行比较,分别计算两种检查方法诊断臂丛神经节后损伤的准确率,利用统计学方法,比较两种方法对于节后损伤的准确率有无差异,同时分别计算每个节后神经根在MRI检查中的诊断准确率有无差异。结果MRI检查对臂丛神经节后损伤灵敏度、特异度、准确度分别为94%、72%、83%。节后损伤在MRI中的征象：神经表现正常,神经走形、信号未见明显异常,与健侧一致；神经连续、变性增粗,伴或不伴周围高信影或受压改变；神经瘢痕组织形成,走行僵直、结构紊乱,伴或不伴周围高信号影；神经走行区可见结节,外伤性神经瘤的形成；神经断裂、断端分离消失。臂丛节后各神经根损伤在MRI中的诊断准确率颈5-胸1分别为78%、85%、64%、93%、93%。肌电图诊断节后损伤准确率为80%,MRI和肌电图两种检查方法诊断准确率差异无统计学意义。结论MRI可以清楚的同时显示臂丛神经节前、后损伤的影像诊断,且无创无辐射,对臂丛神经节后损伤可以提供准确而清晰的定位定性诊断,具有较高的准确率,同时在诊断臂丛神经干的诊断效能上是不同的,MRI诊断臂丛节后损伤与肌电图检查结果的准确率差异无统计学意义(P0.05),故MRI可作为严重损伤或疾病急性期的首选检查方法,临床上术前提供手术区组织损伤的情况,早期制定手术方案,有助于预后。
[Abstract]:Objective to investigate the imaging features and clinical value of MRI in the diagnosis of postganglionic nerve injury of brachial plexus. Patients with motor dysfunction or / and muscular atrophy were treated with Philips Achieva3 before operation. OT-TX superconducting Mr scanner was used to examine brachial plexus, nerve electrophysiology and surgical exploration. The two methods were compared with operative exploration, intraoperative electrophysiological findings or clinical evidence. The accuracy of the two methods in the diagnosis of postganglionic injury of brachial plexus was calculated, and the statistical method was used to compare the accuracy of the two methods for postganglionic injury. At the same time, the diagnostic accuracy of each postganglionic nerve root in MRI was calculated. Results the sensitivity, specificity and accuracy of MRI for postganglionic injury of brachial plexus were 9472 and 83, respectively. The signs of postganglionic injury in MRI were as follows: the nerve showed normal appearance, the shape of the nerve was normal, the signal was not abnormal, and the signal was consistent with the healthy side; the nerve was continuous, denatured and thickened, accompanied with or without the surrounding hyperbolic or compressed changes; the nerve scar tissue was formed and walked stiffly. Structure disorder, with or without peripheral hyperintense shadow; nodule was seen in the nerve walk area, traumatic neuroma was formed; nerve was broken, and the broken end was separated and disappeared. Diagnostic accuracy of nerve root injury after brachial plexus in MRI: the accuracy of cervical 5-thorax 1 was 78.85, and 93s were 93s. The accuracy of electromyography in the diagnosis of postganglionic injury was not significantly different from that of MRI and electromyography. Conclusion MRI can clearly display the imaging diagnosis of pre- and post-ganglionic injury of brachial plexus at the same time, and it can provide accurate and clear diagnosis of postganglionic injury of brachial plexus with high accuracy. At the same time, in the diagnosis of brachial plexus trunk, there was no significant difference in the accuracy of MRI in the diagnosis of postganglionic injury of brachial plexus and electromyography (P0.05). Therefore, MRI can be used as the first choice in the diagnosis of severe injury or acute stage of disease. It is helpful for prognosis to provide the condition of tissue injury in the operation area before operation and to make the operation plan in the early stage.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R651.3

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