高频超声在外周神经疾病诊断中的应用

发布时间：2018-05-05 00:14

本文选题：超声检查 + 磁共振　；参考：《山东大学》2014年博士论文

【摘要】：目的：探讨非创伤性上肢神经束扭转的高频超声诊断价值。材料与方法：收集15例上肢神经扭转的患者进行检查,所有患者均行高频超声检查,5例患者同时行磁共振检查。其中,男11例,女4例,年龄18-42岁,15例患者均无明显外伤史,均为单侧上肢发病。将高频探头(9-14MHz)置于上肢体表由近心侧向远心侧直接扫查,二维超声连续扫查臂丛神经、上肢的桡神经、正中神经及尺神经,着重观察上臂中段以远及肘关节水平神经束的走行,特别是桡神经主干及桡神经深支的近心段,观察神经的内径及其回声改变,双侧对比观察,测量并记录患侧神经束及对侧相应位置正常神经束的内径。同时注意神经周围的解剖结构,神经有无卡压等。当发现神经病变,均准确定位病变的位置及病变累及的范围,并体表标记扭转的位置,用“×”表示。其中5例患者行3.0T磁共振检查,对患者主要采用T1加权成像、T2加权成像、T1压脂成像、T2压脂成像及弥散背景抑制成像等序列进行检查,观察神经束的走行、内径及其信号的改变,并观察神经束周围有无异常解剖结构。分析非创伤性上肢神经扭转的高频超声声像图及磁共振影像特征,并与临床外科手术所见进行对照。对扭转神经束的内径与对侧正常肢体相应位置神经束内径进行配对t检验,应用SPSS13.0软件进行统计分析,以p0.05认为有统计学意义。结果：高频超声均可清晰显示各神经束的走行及其内部的束膜结构。本组15例神经束扭转患者高频超声及5例磁共振神经检查均做出准确诊断,诊断符合率为100%。15例非创伤性神经束扭转的患者中,13例为单纯桡神经扭转,1例尺神经扭转,另1例为正中神经合并桡神经扭转。13例单纯桡神经扭转中仅累及桡神经深支的有2例,余11例均累及上臂桡神经主干。15例神经束扭转中单发神经扭转5例,多发神经扭转10例。上肢非创伤性神经束扭转声像图表现为单发或者多节段性沙漏样改变,沙漏样改变两端神经束增粗,回声减低,内部筛网状束膜结构显示不清。扭转的神经束内径约0.284±0.05cm,而对侧健康肢体相应位置神经束宽约0.23+0.04cm,行配对t检验得出t值为9.542(p0.01)。结论：高频超声可作为诊断上肢外周神经非创伤性扭转的首选影像学检查方法,可对临床外周神经手术术前评估及术式的选择具有重要的意义。目的：探讨高频超声对外周神经肿瘤的诊断价值。方法：收集46例外周神经肿瘤患者进行高频超声检查,其中男性28例,女性18例,年龄2-76岁,平均年龄37.8岁。46例患者中36例因单一肿物就诊,另10例为多发肿物。对肿物采用高频探头(9～14MHz)连续扫查,注意与病变部位相连的神经形态、回声及其内部结构等,并与血管、肌腱、韧带等的回声相鉴别。发现病变后,均准确定位病变的位置及病变累及的范围,并作体表标记。其中11例患者行磁共振检查,对患肢主要采用T1加权成像、T2加权成像、T1压脂成像、T2压脂成像等序列进行检查,观察肿瘤的形态、内部信号改变及其与周围的解剖关系等。结果：46例外周神经肿瘤患者中,超声及磁共振检查均发现肿物并准确定位,其中神经鞘瘤29例,神经纤维瘤8例,脂肪纤维错构瘤9例。其中10例多发肿物,均为神经鞘瘤。46例患者中,肿瘤位于正中神经17例,尺神经13例,桡神经5例,腓总神经6例,胫神经5例,皮神经4例,臂丛神经2例。正常外周神经声像图在其长轴表现为条索状相互平行的低回声束,短轴表现为筛网状结构。实时观察外周神经位置相对恒定,不随肌肉、肌腱和韧带而运动。神经鞘瘤纵切面表现为低回声实性肿块,边界清晰,形态规则,呈纺锤形,其两端与神经相连,呈鼠尾样改变,内部回声欠均匀,内部多见囊变及出血等无回声区,彩色多普勒显像显示其内可见较丰富的血流信号显示,部分多发神经鞘瘤声像图为沿神经分布的串珠样结节,边界清晰。神经纤维瘤声像图表现分为三型：结节型、丛状及弥漫型,其中结节型神经纤维瘤瘤最为常见,其声像图与神经鞘瘤类似；丛状及弥漫型神经纤维瘤较为少见,其中丛状表现为皮下多发低回声结节,呈串珠样改变,无明显边界；弥漫型可见皮下浅筋膜层弥漫型增厚,结构紊乱,弥漫分布丛状及类圆形的低回声结节,呈类淋巴水肿样改变。脂肪纤维错构瘤声像图表现为：神经明显增粗,呈膨胀性生长,纵切面神经内可见分布不均的条状低回声神经纤维和高回声脂肪组织相间的结构,呈“电缆状”；横断面表现为点状低回声和强回声相间,呈“莲藕状”。彩色多普勒显示,增粗的神经内未见血流信号显示。结论：高频超声可作为诊断外周神经肿瘤首选的影像学检查方法,可对临床外周神经肿瘤术前评估及术式的选择具有重要的意义。
[Abstract]:Objective: To investigate the diagnostic value of high-frequency ultrasound in the diagnosis of nontraumatic upper extremity nerve tract torsion.
Materials and methods: 15 cases of upper extremity nerve torsion were examined. All the patients were examined by high frequency ultrasound and 5 patients underwent magnetic resonance imaging at the same time. Among them, 11 men, 4 women, 18-42 years old, 15 patients had no obvious history of trauma and were all unilateral upper extremity. High frequency probe (9-14MHz) was placed on the upper extremities from the side of the heart. Direct scanning of the heart side, two dimensional ultrasound scanning of brachial plexus, radial nerve, median nerve and ulnar nerve in the upper limb, focusing on the distance of the middle arm of the upper arm and the horizontal nerve bundle of the elbow joint, especially the proximal segment of the trunk of the radial nerve and the deep branch of the radial nerve, observing the inner diameter of the nerve and the echo change. The internal diameter of the lateral nerve tract and the normal nerve tract on the opposite side. At the same time, attention was made to the anatomy of the nerve and the pressure of the nerve. When the neuropathy was found, the location of the lesion and the extent of the lesion were accurately identified, and the position of the torsion was marked with the body surface. In 5 of them, the 3.0T MRI was performed on the patients. T1 weighted imaging, T2 weighted imaging, T1 compression fat imaging, T2 compression fat imaging and diffuse background suppression imaging were examined to observe the movement of the nerve tract, the changes of the inner diameter and the signal, and to observe the abnormal anatomical structure around the nerve tract. The high frequency ultrasound image and magnetic resonance imaging of the non traumatic upper limb nerve torsion were analyzed. Characteristics, and compared with the clinical surgery, the inner diameter of the torsional nerve bundle and the internal diameter of the normal limb of the opposite side were paired t test, and the statistical analysis was carried out with the SPSS13.0 software, which was considered statistically significant by P0.05.
Results: high frequency ultrasound can clearly show the walking and internal bundle membrane structure of each nerve tract. 15 cases of nerve bundle torsion patients with high frequency ultrasound and 5 cases of magnetic resonance nerve examination have made accurate diagnosis, diagnosis coincidence rate is 100%.15 cases of non traumatic nerve bundle torsion, 13 cases of radial nerve torsion, 1 cases of ulnar nerve torsion. In the other 1 cases, there were 2 cases of.13 with radial nerve torsion and radial nerve torsion only involving the deep branch of the radial nerve. In the remaining 11 cases, 5 cases were involved in the torsion of the nerve trunk of the upper arm of the upper arm, 5 cases of single nerve torsion and 10 cases of multiple nerve torsion. The non traumatic nerve bundle of the upper limb was a single or multiple segmental hourglass. In the case of hourglass change, the nerve bundles were thickened and the echoes were reduced, and the internal screen shaped fascicular membrane structure was not clear. The inner diameter of the nerve bundle was about 0.284 0.05cm, and the corresponding position of the contralateral healthy limbs was about 0.23+0.04cm wide, and the paired t test showed that the t value was 9.542 (P0.01).
Conclusion: high frequency ultrasound can be used as the first choice imaging method to diagnose the non traumatic torsion of peripheral peripheral nerve. It is of great significance for the preoperative evaluation and selection of the surgical procedure.
Objective: To investigate the diagnostic value of high-frequency ultrasound in peripheral nerve tumors.
Methods: 46 patients with peripheral nerve tumors were examined by high frequency ultrasound, including 28 males, 18 females, 2-76 years old and 37.8.46 patients with a mean age 37.8 years old. 36 cases were treated with a single tumor and 10 were multiple. The tumors were continuously scanned with high frequency probe (9 to 14MHz). The location of the lesions, the range of the lesion and the body surface markers were detected accurately after the lesions were found, and 11 of the patients were examined by magnetic resonance imaging, T1 weighted imaging, T2 weighted imaging, T1 compression imaging, and T2 compression imaging were performed on the affected limbs. The morphology, internal signal changes and the anatomic relationship of the tumor were observed.
Results: among the 46 patients with peripheral nerve tumors, ultrasonography and magnetic resonance found the tumor and accurate localization, including 29 neurilemmoma, 8 neurofibroma and 9 adipose fiber hamartoma. Among them, 10 cases were.46 patients with neurilemmoma, 17 cases of median nerve, 13 cases of ulnar nerve, 5 of radial nerve and 6 of peroneal nerve. There were 5 cases of tibial nerve, 4 cases of cutaneous nerve and 2 cases of brachial plexus.
The normal peripheral nerve image on its long axis shows a low back sound beam with parallel lines, and the short axis is a sieve structure. The position of the peripheral nerve is relatively constant, and does not move with the muscles, tendons and ligaments.
The longitudinal section of the neurilemmoma was characterized by a hypoechoic solid mass, with a clear boundary and a spindle shape. The two ends were connected to the nerve, the tail of the rat was changed, the internal echo was not uniform, and the internal echoes of the cysts and bleeding were found. The color Doppler imaging showed that the rich blood flow signals were shown and some of the neurilemmoma were found. The picture shows a bead like nodule along the nerve and its boundary is clear.
The sonogram of neurofibroma is divided into three types: nodular, plexiform and diffuse, among which nodular neurofibromatosis is the most common, and its sonogram is similar to that of neurilemmoma; plexiform and diffuse neurofibroma is rare, in which the plexiform is subcutaneous multiple hypoechoic nodules, beads like changes, no obvious boundaries; diffuse type The subcutaneous superficial fascia was thickened and disordered, diffusely distributed in plexiform and hypoechoic nodules.
The image of the adipose fiber hamartoma shows that the nerve is obviously thickened and expanded, and the structure of the low echo and hyperechoic adipose tissue in the longitudinal section of the longitudinal section is "cable", and the cross section shows a "lotus root" between the dot like low echo and the strong echoes. Color Doppler display There was no blood flow signal in the thickening nerve.
Conclusion: high frequency ultrasound can be used as the first choice imaging method for the diagnosis of peripheral nerve tumor. It is of great significance for the preoperative evaluation and selection of the clinical peripheral nerve tumor.

【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R445.1;R741

【参考文献】