MRI在臂丛神经节前损伤诊断中的应用  

MRI diagnosis of brachial plexus preganglionic injury

作　　者：赵秋枫[1] 耿道颖[1] 杨蓊勃[2] 

机构地区：[1]复旦大学附属华山医院放射科,上海200040 [2]复旦大学附属华山医院手外科,上海200040

出　　处：《中华放射学杂志》2009年第1期60-64,共5页Chinese Journal of Radiology

摘　　要：目的探讨臂丛神经节前损伤的MRI表现及其诊断价值。方法回顾性分析20例临床诊断为臂丛神经节前损伤患者的临床和影像资料。所有患者手术前均行MR检查，后行锁骨上手术探查及术中肌电图（EMG）检查，将手术探查所见、EMG检查结果与MRI结果比较，并统计MRI诊断臂丛神经节前损伤的准确性、敏感性及特异性。结果20例患者计入统计的73对受损神经根中MRI共检出63对，诊断的准确性、敏感性及特异性分别为86．5％（83／96）、86．3％（63／73）、87．0％（20／23）。臂丛神经节前损伤的直接征象包括：（1）椎管内神经根消失或离断54对（85．7％）；（2）脊神经前后根增粗、迂曲、走行僵硬无法连续追踪至椎间孔处9对（14．3％）。间接征象包括：（1）椎管内脑脊液囊性聚集，假性脊膜膨出46对（73．0％）；（2）神经根袖形态异常13对（20．6％）；（3）脊髓变形、移位50对（79．4％）；（4）脊柱旁肌信号异常19例。结论MRI可很好地显示椎管内及椎间孔区神经根结构，对臂丛神经节前损伤可作出准确诊断，为早期诊断臂丛神经节前损伤提供可靠参考。Objective To evaluate MRI in diagnosing brachial plexus preganglionic injury. Methods Twenty cases with brachiat plexus preganglionic injury underwent MR scanning before operation. MR imaging was obtained by GE Signa EXCITE 1.5 T scanner. The scanning sequences included SE T1 WI, FSE T2WI, T2WI STIR and 3D Fast imaging employing steady state with phase cycled （3D-FIESTA-c）. All the patients had exploration of the supraclavicular plexus and electrophysiology examination. And the accuracy, sensitivity and specificity of MRI in diagnosing preganglionic brachial plexus injury were calculated with the standards of surgical and EMG results. Results Among the 73 pairs of injured roots, MR imaging detected the abnormalities in 63 pairs. The accuracy, sensitivity and specificity of MRI in diagnosing preganglionic brachial plexus injury were 86. 5% （ 83/96 ）, 86. 3% （ 63/73 ）, 87.0% （20/23）, respectively. The direct signs of brachial plexus preganglionic injury included （1） lack or mutilation of nerve root in 54 pairs （85.7%） , （2） coarsening, bending, stiff course and unable to be traced to the intervertebral foramen continuously in 9 pairs （14. 3% ）. The indirect signs included （ 1 ） cystic cerebrospinal fluid gathering in the vertebral canal, posttraumatic spinal meningocele in 46 pairs （73.0%）, （2） abnormal shape of nerve sleeve in 13 pairs （20. 6% ）, （3） displacement and deformity of spinal cord in 50 pairs （79. 4% ） , （4） abnormal signal of paravertebral muscles in 19 patients. Conclusion MRI can distinctly show the nerve rootlets within the vertebral canal, so it is helpful in making a correct diagnosis of brachial plexus preganglionic injuries.

关 键 词：臂丛神经病 诊断 磁共振成像 

分 类 号：R686[医药卫生—骨科学]