本文選題：臂叢神經(jīng) + 早期損傷��； 參考：《復(fù)旦大學(xué)》2014年博士論文

【摘要】：第一部分 臂叢神經(jīng)損傷的常規(guī)MRI及MR神經(jīng)成像序列的應(yīng)用目的 探討臂叢神經(jīng)損傷的MR表現(xiàn)特點(diǎn)及其診斷價(jià)值。 材料與方法采用3OT MRI掃描儀對(duì)43例臨床診斷為臂叢神經(jīng)損傷的患者行術(shù)前常規(guī)MRI及MR神經(jīng)成像序列掃描,常規(guī)MRI掃描序列包括橫軸位SE T1W1、FSE T2W1、TIRM, MR神經(jīng)成像序列包括冠狀位SPACE、TIRM及T1 FLASH。將手術(shù)探查、術(shù)中肌電圖及術(shù)前MRI檢查結(jié)果進(jìn)行比較,探討臂叢神經(jīng)損傷的MRI表現(xiàn)及對(duì)于早期損傷患者的診斷價(jià)值。 結(jié)果 納入統(tǒng)計(jì)的215對(duì)節(jié)前神經(jīng)中有105對(duì)損傷,MRI共檢出98對(duì),診斷的敏感度為76.2%(80/105),特異度為83.6%(92/110),準(zhǔn)確率為80.0%(172/215)。損傷間隔在1月內(nèi)的MRI診斷的準(zhǔn)確率為79.1%,1月至3月內(nèi)的準(zhǔn)確率為80.0%,兩組準(zhǔn)確率差異無統(tǒng)計(jì)學(xué)意義(P0.05)。臂叢神經(jīng)節(jié)前損傷的直接征象包括：完全性撕脫傷：(1)椎管內(nèi)神經(jīng)前后根連續(xù)性中斷或消失68對(duì),(2)神經(jīng)前后根增粗、僵硬、迂曲或無法連續(xù)追蹤至椎間孔處8對(duì)；部分性撕脫：(1)神經(jīng)前根或后根消失、連續(xù)性中斷10對(duì)；(2)冠狀面圖像示神經(jīng)前后根根絲數(shù)較對(duì)側(cè)明顯減少13對(duì)。間接征象包括：(1)椎管內(nèi)局部腦脊液聚集,椎間孔區(qū)創(chuàng)傷性脊膜囊腫(假性脊膜膨出)44對(duì),(2)神經(jīng)根袖形態(tài)異常、雙側(cè)不對(duì)稱,重建圖像可示神經(jīng)根袖影消失,根袖末端尖角變鈍、消失或延伸至椎間孔外9對(duì)；(3)相應(yīng)水平脊髓變形或移位1對(duì)；(4)脊髓損傷1例。MRI對(duì)臂叢神經(jīng)節(jié)后損傷診斷的靈敏度為74.8%,特異度為88.1%,準(zhǔn)確率為79.2%。損傷間隔在1月內(nèi)的MRI診斷的準(zhǔn)確率為81.4%,損傷間隔1月至3月內(nèi)的診斷準(zhǔn)確率為85.7%,兩組準(zhǔn)確率差異無統(tǒng)計(jì)學(xué)意義(P0.05)。臂叢神經(jīng)節(jié)后損傷的MRI表現(xiàn)包括：(1)神經(jīng)連續(xù)性中斷、消失、斷端分離12根。(2)神經(jīng)尚連續(xù),但形態(tài)增粗,走行迂曲、僵硬20例。(3)神經(jīng)連續(xù),略增粗,TIRM高信號(hào)18例。(4)神經(jīng)連續(xù)性存在,走行自然,結(jié)構(gòu)及信號(hào)與健側(cè)基本一致,3例。 結(jié)論 MRI對(duì)臂叢神經(jīng)損傷的患者可早期準(zhǔn)確的做出定位及定性診斷。第二部分臂叢神經(jīng)損傷的MR功能成像的應(yīng)用目的探討臂叢神經(jīng)損傷的MR功能成像的診斷價(jià)值。材料與方法采用3.0T MRI掃描儀對(duì)42例臨床診斷為臂叢神經(jīng)損傷的患者行術(shù)前DTI掃描。將手術(shù)探查、術(shù)中肌電圖及術(shù)前DTI成像參數(shù)進(jìn)行比較,探討臂叢神損傷的DTI參數(shù)意義及對(duì)于早期損傷患者的診斷價(jià)值。結(jié)果42例臂叢神損傷患者經(jīng)DTI參數(shù)測量得患側(cè)C5-C8神經(jīng)根部的ADC值、FA值分別1.483±0.153,0.434±0.063(×10-3mm2/s),健側(cè)C5-C8神經(jīng)根部的ADC值、F值分別為1.380±0.163,0.482±0.070(×10-3mm2/s),比較雙側(cè)ADC值、FA差異均具有統(tǒng)計(jì)學(xué)意義(P=0.001,P=0.001)。損傷1月內(nèi)的患者患側(cè)與健C5-C8神經(jīng)根部僅FA值差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。損傷3月內(nèi)的患患側(cè)與健側(cè)C5-C8神經(jīng)根部的ADC、FA值差異均具有統(tǒng)計(jì)學(xué)意義(P0.001P0.001)。結(jié)論DTI技術(shù)為早期損傷情況的判斷提供參考,有利于臨床術(shù)方案的制定和患者預(yù)后的判斷。第三部分：臂叢神經(jīng)腫瘤性病變的MR診斷及應(yīng)用目的 分析臂叢神經(jīng)腫瘤性病變的MRI特點(diǎn),探討其在診斷與鑒別診斷中的價(jià)值。 材料和方法本研究分析經(jīng)手術(shù)病理證實(shí)的13例臂叢神經(jīng)腫瘤性病變患者及經(jīng)淋巴結(jié)穿刺活檢證實(shí)的1例轉(zhuǎn)移到臂叢神經(jīng)的腫瘤的MRI表現(xiàn),其中神經(jīng)鞘瘤9例,叢狀神經(jīng)鞘瘤1例,神經(jīng)纖維瘤1例,侵襲性纖維瘤1例,滑膜肉瘤1例,乳腺癌轉(zhuǎn)移瘤1例。所有患者均行MR常規(guī)掃描、神經(jīng)成像掃描及DTI掃描。 結(jié)果9例神經(jīng)鞘瘤均位于臂叢神經(jīng)節(jié)后段,類圓形為主,邊界清晰,有包膜,與臂叢神經(jīng)走行方向一致,其中1例啞鈴狀延伸入椎間孔,2例病灶內(nèi)有囊變區(qū)；1例叢狀神經(jīng)鞘瘤為右側(cè)臂叢神經(jīng)根干部肥大增粗,呈團(tuán)塊狀,邊界清晰,T1WI等信號(hào),T2WI及TIRM序列上呈高信號(hào),內(nèi)伴小片狀低信號(hào),冠狀面TIRM圖像清晰顯示腫塊與載瘤神經(jīng)之間的關(guān)系。1例神經(jīng)纖維瘤為沿臂叢神經(jīng)生長的類圓形腫塊,T1WI等低信號(hào),T2WI及TIRM高信號(hào)。1例侵襲性纖維瘤為右側(cè)臂叢神經(jīng)根干部橢圓形巨大腫塊,T1WI等稍低信號(hào),T2WI等信號(hào),TIRM高信號(hào)伴混雜低信號(hào)影。1例滑膜肉瘤,左側(cè)鎖骨下區(qū)團(tuán)塊影,緊鄰臂叢神經(jīng)束支部,伴神經(jīng)輕度腫脹,分界不清,T1WI低信號(hào),T2WI及TIRM均呈高信號(hào)。1例乳腺癌轉(zhuǎn)移至臂叢神經(jīng)為左側(cè)臂叢神經(jīng)股部梭形腫塊,T1等稍低信號(hào),T2WI略高信號(hào),TIRM高低混雜信號(hào)。經(jīng)DTI掃描的13例患者中,8例神經(jīng)鞘瘤DTT顯示纖維受壓移位,1例侵襲性纖維瘤DTT顯示臂叢神經(jīng)與腫塊關(guān)系密切,局部受壓改變。 結(jié)論 MRI可清晰顯示常見累及臂叢神經(jīng)的腫瘤性病變,準(zhǔn)確顯示病變部位、累及范圍及與鄰近組織的關(guān)系,為臨床準(zhǔn)確診斷及治療臂叢神經(jīng)病變提供可靠信息。
[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.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.2;R688

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