本文關(guān)鍵詞：磁共振擴(kuò)散加權(quán)神經(jīng)成像技術(shù)在腕掌部神經(jīng)中的初步應(yīng)用　出處：《山東大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 擴(kuò)散加權(quán) 磁共振成像 正中神經(jīng) 尺神經(jīng) 腕掌部

【摘要】：目的利用磁共振擴(kuò)散加權(quán)神經(jīng)成像(DW-MRN)技術(shù)對(duì)正常志愿者及腕掌部神經(jīng)病變患者進(jìn)行腕掌部神經(jīng)成像,探討DW-MRN技術(shù)在腕掌部正中神經(jīng)、尺神經(jīng)及其分支成像中的可行性及臨床價(jià)值。材料與方法本研究獲得本單位倫理委員會(huì)批準(zhǔn),所有健康志愿者及患者行MR掃描前均簽署知情同意書(shū)。本研究共納入42名健康志愿者及20名可疑腕掌部神經(jīng)病變的患者,所有健康志愿者均無(wú)任何神經(jīng)疾病相關(guān)病史,無(wú)腕部及掌部外傷史、手術(shù)史,無(wú)糖尿病、風(fēng)濕病等慢性疾病史,無(wú)MR檢查禁忌癥。所有患者在行MR掃描前均行患側(cè)上肢肌電圖檢查,提示腕掌部正中神經(jīng)或尺神經(jīng)損傷。納入的42名健康志愿者其中男18名,女24名,年齡范圍20歲-65歲,中位年齡37歲。病例組20名患者男8名,女12名,年齡范圍8歲-64歲,中位年齡40歲。掃描采用Philips Achieva 3.0 T TX超導(dǎo)MR掃描儀,接收線圈為8通道腕關(guān)節(jié)相控陣線圈。所有檢查者均采用頭先進(jìn)、俯臥位,伸手過(guò)頭姿勢(shì)進(jìn)行MR檢查。所有患者及健康志愿者同時(shí)接受單側(cè)(健康志愿者)或患側(cè)(患者)常規(guī)磁共振檢查及DW-MRN檢查,包括軸位或冠狀位T1加權(quán)成像(T1 WI)、頻率反轉(zhuǎn)恢復(fù)脂肪抑制T2加權(quán)成像(T2WI-SPAIR)、頻率反轉(zhuǎn)恢復(fù)脂肪抑制質(zhì)子加權(quán)成像序列(PDWI-SPAIR)。DW-MRN檢查均在前后方向施加擴(kuò)散敏感梯度(MPGs)。掃描范圍包全腕部及掌部。對(duì)DW-MRN原始圖像進(jìn)行最大信號(hào)投影(MIP)重建,并裁剪掉周?chē)绊懮窠?jīng)顯示的高信號(hào),得到冠狀位三維立體圖像。對(duì)健康志愿者組,由兩名高年資放射科醫(yī)生分別根據(jù)神經(jīng)顯示形態(tài)及信號(hào)強(qiáng)度對(duì)腕掌部正中神經(jīng)、尺神經(jīng)及其分支DW-MRN圖像質(zhì)量進(jìn)行主觀評(píng)分,評(píng)分標(biāo)準(zhǔn)如下：4分,顯示滿意(神經(jīng)顯示清晰,邊緣銳利,信號(hào)均勻一致)；3分,顯示較滿意(神經(jīng)顯示較清晰,邊緣較模糊,信號(hào)強(qiáng)度中等)；2分,顯示不滿意(神經(jīng)顯示較清晰,但邊緣模糊或扭曲變形,信號(hào)強(qiáng)度較弱)；1分,未顯示(神經(jīng)顯示不良,變形明顯,難以辨認(rèn))。應(yīng)用SPSS20.0統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,對(duì)于兩名閱片者評(píng)分結(jié)果進(jìn)行Kappa一致性檢驗(yàn)。由兩位高年資放射科醫(yī)師共同對(duì)軸位PDWI-SPAIR圖像及重建后的DW-MRN圖像進(jìn)行分析評(píng)價(jià),計(jì)算兩個(gè)序列可清晰顯示的腕掌部正中神經(jīng)主干、尺神經(jīng)主干、第一、二、三指掌側(cè)總神經(jīng)及尺神經(jīng)深支、淺支的數(shù)目,對(duì)神經(jīng)的顯示率進(jìn)行配對(duì)資料的x2檢驗(yàn)。對(duì)于病例組,由兩名高年資的放射科醫(yī)師共同分析重建后DW-MRN和PDWI-SPAIR圖像所顯示病變與神經(jīng)的關(guān)系,DW-MRN和PDWI-SPAIR圖像分開(kāi)進(jìn)行評(píng)價(jià),并按照如下三級(jí)評(píng)分標(biāo)準(zhǔn)進(jìn)行評(píng)分：①1分,無(wú)法顯示病變與神經(jīng)的關(guān)系,或評(píng)價(jià)結(jié)果與手術(shù)中所見(jiàn)相差很大；②2分,可能顯示病變與神經(jīng)的關(guān)系或與手術(shù)中所見(jiàn)有一定差別；③3分,病變與神經(jīng)的關(guān)系顯示清晰或與病理或手術(shù)結(jié)果完全一致。行手術(shù)治療的患者病變?cè)u(píng)價(jià)以病理或者手術(shù)結(jié)果作為金標(biāo)準(zhǔn)。病例組DW-MRN和PDWI-SPAIR圖像評(píng)分對(duì)比采用兩獨(dú)立樣本間Mann-whitney U檢驗(yàn)。取α=0.05為檢驗(yàn)水準(zhǔn),P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果在健康志愿者中,DW-MRN圖像中神經(jīng)表現(xiàn)為連續(xù)走行且信號(hào)均勻的高信號(hào),腕部正中神經(jīng)及尺神經(jīng)主干,掌部正中神經(jīng)發(fā)出的第一、二、三指掌側(cè)總神經(jīng),尺神經(jīng)淺支、深支顯示較清,正中神經(jīng)返支及拇指固有神經(jīng)顯示不清。兩名閱片者對(duì)正中神經(jīng)顯示情況的評(píng)分分別為4.0±0.0和4.0±0.0,兩名閱片者之間的一致性很好(K=1),對(duì)尺神經(jīng)顯示情況的評(píng)分分別為3.45±0.74和3.43±0.67,兩名閱片者之間的一致性良好(K＝0.793)。DW-MRN能清晰顯示正中神經(jīng)及尺神經(jīng)主干、第一、二、三指掌側(cè)總神經(jīng)及尺神經(jīng)深支、淺支的數(shù)目分別為42、42、42、42、42、38、37,在PDWI-SPAIR序列上為42、39、27、28、25、17、21。DW-MRN對(duì)第一、二、三指掌側(cè)總神經(jīng)及尺神經(jīng)深支、淺支顯示率要高于PDWI-SPAIR序列(x2分別為18.26、16.80、21.31、23.23、14.26,P值均0.05)。對(duì)正中神經(jīng)主干、尺神經(jīng)主干的顯示兩者間無(wú)明顯統(tǒng)計(jì)學(xué)差異。病例組20例患者中包括5例腕管綜合征患者(包括屈肌腱鞘炎2例、腕管內(nèi)腱鞘囊腫正中神經(jīng)受壓1例、大魚(yú)際肌肌間隙脂肪瘤1例、大魚(yú)際肌炎性腫脹推壓正中神經(jīng)1例)、3例尺管綜合征患者(均為腱鞘囊腫壓迫尺神經(jīng)深支)、8例腕掌部神經(jīng)損傷患者(正中神經(jīng)損傷患者3例、尺神經(jīng)損傷患者2例、正中神經(jīng)合并尺神經(jīng)損傷3例)、2例腕掌部尺神經(jīng)慢性炎癥患者、1例腕部正中神經(jīng)鞘瘤患者、1例纖維脂肪瘤性錯(cuò)構(gòu)瘤患者。DW-MRN序列除兩例急性神經(jīng)損傷患者術(shù)后評(píng)分為2分,1例尺神經(jīng)慢性炎癥患者評(píng)分為1分外,其余患者評(píng)分均為3分,而PDWI-SPAIR序列僅有10例患者評(píng)分為3分。DW-MRN能夠三維立體的顯示腕掌部神經(jīng)病變及范圍,并較PDWI-SPAIR序列能更有效的判斷病變與神經(jīng)的關(guān)系(Z值為-2.306,P值0.05)。結(jié)論DW-MRN能夠清晰三維立體顯示腕部正中神經(jīng)、尺神經(jīng)主干,掌部正中神經(jīng)發(fā)出的第一、二、三指掌側(cè)總神經(jīng),尺神經(jīng)淺支、深支,較PDWI-SPAIR序列能更清晰顯示病變與神經(jīng)的關(guān)系,有助于累及腕掌部神經(jīng)疾病的檢出及定位、定性診斷、術(shù)前及術(shù)后評(píng)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
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R445.2;R688

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