本文選題：超聲檢查 + 磁共振�。� 參考：《山東大學(xué)》2014年博士論文

【摘要】：目的：探討非創(chuàng)傷性上肢神經(jīng)束扭轉(zhuǎn)的高頻超聲診斷價(jià)值。 材料與方法：收集15例上肢神經(jīng)扭轉(zhuǎn)的患者進(jìn)行檢查,所有患者均行高頻超聲檢查,5例患者同時(shí)行磁共振檢查。其中,男11例,女4例,年齡18-42歲,15例患者均無明顯外傷史,均為單側(cè)上肢發(fā)病。將高頻探頭(9-14MHz)置于上肢體表由近心側(cè)向遠(yuǎn)心側(cè)直接掃查,二維超聲連續(xù)掃查臂叢神經(jīng)、上肢的橈神經(jīng)、正中神經(jīng)及尺神經(jīng),著重觀察上臂中段以遠(yuǎn)及肘關(guān)節(jié)水平神經(jīng)束的走行,特別是橈神經(jīng)主干及橈神經(jīng)深支的近心段,觀察神經(jīng)的內(nèi)徑及其回聲改變,雙側(cè)對比觀察,測量并記錄患側(cè)神經(jīng)束及對側(cè)相應(yīng)位置正常神經(jīng)束的內(nèi)徑。同時(shí)注意神經(jīng)周圍的解剖結(jié)構(gòu),神經(jīng)有無卡壓等。當(dāng)發(fā)現(xiàn)神經(jīng)病變,均準(zhǔn)確定位病變的位置及病變累及的范圍,并體表標(biāo)記扭轉(zhuǎn)的位置,用“×”表示。其中5例患者行3.0T磁共振檢查,對患者主要采用T1加權(quán)成像、T2加權(quán)成像、T1壓脂成像、T2壓脂成像及彌散背景抑制成像等序列進(jìn)行檢查,觀察神經(jīng)束的走行、內(nèi)徑及其信號的改變,并觀察神經(jīng)束周圍有無異常解剖結(jié)構(gòu)。分析非創(chuàng)傷性上肢神經(jīng)扭轉(zhuǎn)的高頻超聲聲像圖及磁共振影像特征,并與臨床外科手術(shù)所見進(jìn)行對照。對扭轉(zhuǎn)神經(jīng)束的內(nèi)徑與對側(cè)正常肢體相應(yīng)位置神經(jīng)束內(nèi)徑進(jìn)行配對t檢驗(yàn),應(yīng)用SPSS13.0軟件進(jìn)行統(tǒng)計(jì)分析,以p0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義。 結(jié)果：高頻超聲均可清晰顯示各神經(jīng)束的走行及其內(nèi)部的束膜結(jié)構(gòu)。本組15例神經(jīng)束扭轉(zhuǎn)患者高頻超聲及5例磁共振神經(jīng)檢查均做出準(zhǔn)確診斷,診斷符合率為100%。15例非創(chuàng)傷性神經(jīng)束扭轉(zhuǎn)的患者中,13例為單純橈神經(jīng)扭轉(zhuǎn),1例尺神經(jīng)扭轉(zhuǎn),另1例為正中神經(jīng)合并橈神經(jīng)扭轉(zhuǎn)。13例單純橈神經(jīng)扭轉(zhuǎn)中僅累及橈神經(jīng)深支的有2例,余11例均累及上臂橈神經(jīng)主干。15例神經(jīng)束扭轉(zhuǎn)中單發(fā)神經(jīng)扭轉(zhuǎn)5例,多發(fā)神經(jīng)扭轉(zhuǎn)10例。上肢非創(chuàng)傷性神經(jīng)束扭轉(zhuǎn)聲像圖表現(xiàn)為單發(fā)或者多節(jié)段性沙漏樣改變,沙漏樣改變兩端神經(jīng)束增粗,回聲減低,內(nèi)部篩網(wǎng)狀束膜結(jié)構(gòu)顯示不清。扭轉(zhuǎn)的神經(jīng)束內(nèi)徑約0.284±0.05cm,而對側(cè)健康肢體相應(yīng)位置神經(jīng)束寬約0.23+0.04cm,行配對t檢驗(yàn)得出t值為9.542(p0.01)。 結(jié)論：高頻超聲可作為診斷上肢外周神經(jīng)非創(chuàng)傷性扭轉(zhuǎn)的首選影像學(xué)檢查方法,可對臨床外周神經(jīng)手術(shù)術(shù)前評估及術(shù)式的選擇具有重要的意義。 目的：探討高頻超聲對外周神經(jīng)腫瘤的診斷價(jià)值。 方法：收集46例外周神經(jīng)腫瘤患者進(jìn)行高頻超聲檢查,其中男性28例,女性18例,年齡2-76歲,平均年齡37.8歲。46例患者中36例因單一腫物就診,另10例為多發(fā)腫物。對腫物采用高頻探頭(9～14MHz)連續(xù)掃查,注意與病變部位相連的神經(jīng)形態(tài)、回聲及其內(nèi)部結(jié)構(gòu)等,并與血管、肌腱、韌帶等的回聲相鑒別。發(fā)現(xiàn)病變后,均準(zhǔn)確定位病變的位置及病變累及的范圍,并作體表標(biāo)記。其中11例患者行磁共振檢查,對患肢主要采用T1加權(quán)成像、T2加權(quán)成像、T1壓脂成像、T2壓脂成像等序列進(jìn)行檢查,觀察腫瘤的形態(tài)、內(nèi)部信號改變及其與周圍的解剖關(guān)系等。 結(jié)果：46例外周神經(jīng)腫瘤患者中,超聲及磁共振檢查均發(fā)現(xiàn)腫物并準(zhǔn)確定位,其中神經(jīng)鞘瘤29例,神經(jīng)纖維瘤8例,脂肪纖維錯(cuò)構(gòu)瘤9例。其中10例多發(fā)腫物,均為神經(jīng)鞘瘤。46例患者中,腫瘤位于正中神經(jīng)17例,尺神經(jīng)13例,橈神經(jīng)5例,腓總神經(jīng)6例,脛神經(jīng)5例,皮神經(jīng)4例,臂叢神經(jīng)2例。 正常外周神經(jīng)聲像圖在其長軸表現(xiàn)為條索狀相互平行的低回聲束,短軸表現(xiàn)為篩網(wǎng)狀結(jié)構(gòu)。實(shí)時(shí)觀察外周神經(jīng)位置相對恒定,不隨肌肉、肌腱和韌帶而運(yùn)動。 神經(jīng)鞘瘤縱切面表現(xiàn)為低回聲實(shí)性腫塊,邊界清晰,形態(tài)規(guī)則,呈紡錘形,其兩端與神經(jīng)相連,呈鼠尾樣改變,內(nèi)部回聲欠均勻,內(nèi)部多見囊變及出血等無回聲區(qū),彩色多普勒顯像顯示其內(nèi)可見較豐富的血流信號顯示,部分多發(fā)神經(jīng)鞘瘤聲像圖為沿神經(jīng)分布的串珠樣結(jié)節(jié),邊界清晰。 神經(jīng)纖維瘤聲像圖表現(xiàn)分為三型：結(jié)節(jié)型、叢狀及彌漫型,其中結(jié)節(jié)型神經(jīng)纖維瘤瘤最為常見,其聲像圖與神經(jīng)鞘瘤類似；叢狀及彌漫型神經(jīng)纖維瘤較為少見,其中叢狀表現(xiàn)為皮下多發(fā)低回聲結(jié)節(jié),呈串珠樣改變,無明顯邊界；彌漫型可見皮下淺筋膜層彌漫型增厚,結(jié)構(gòu)紊亂,彌漫分布叢狀及類圓形的低回聲結(jié)節(jié),呈類淋巴水腫樣改變。 脂肪纖維錯(cuò)構(gòu)瘤聲像圖表現(xiàn)為：神經(jīng)明顯增粗,呈膨脹性生長,縱切面神經(jīng)內(nèi)可見分布不均的條狀低回聲神經(jīng)纖維和高回聲脂肪組織相間的結(jié)構(gòu),呈“電纜狀”；橫斷面表現(xiàn)為點(diǎn)狀低回聲和強(qiáng)回聲相間,呈“蓮藕狀”。彩色多普勒顯示,增粗的神經(jīng)內(nèi)未見血流信號顯示。 結(jié)論：高頻超聲可作為診斷外周神經(jīng)腫瘤首選的影像學(xué)檢查方法,可對臨床外周神經(jīng)腫瘤術(shù)前評估及術(shù)式的選擇具有重要的意義。
[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.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R741

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