剪切波弹性成像检测正中神经病变的初步研究  

Preliminary evaluation of shear wave elastography for median nerve neuropathy

作　　者：吕秀花[1] 段云友[1] 张莉[1] 陈芬英[2] 沈金金[2] 杨勇[1] 刘禧[1] 杨一林[1] 

机构地区：[1]第四军医大学唐都医院超声科,西安710038 [2]第四军医大学唐都医院神经内科,西安710038

出　　处：《中华超声影像学杂志》2015年第2期147-150,共4页Chinese Journal of Ultrasonography

摘　　要：目的 探讨剪切波弹性成像（shear wave elastography,SWE）技术评价正中神经病变的可行性.方法 选取73例健康志愿者（146根神经）为对照组;根据临床症状及电生理结果,85例患者（115根神经）为病例组,分为糖尿病周围神经病变组（DPN组,57根神经）和腕管综合征组（CTS组,58根神经）.行SWE检测腕部、前臂中点处正中神经弹性模量均值（WEmean、FEmean）及前臂中点处同一感兴趣区内正中神经与指浅屈肌二者的弹性模量均值比（FRatio）,分别比较各组间参数的差异.绘制ROC曲线,对SWE技术的诊断效能进行评价;应用Pearson相关分析豌豆骨水平正中神经横截面积（CSA）与弹性模量之间的相关性.结果 DPN组与对照组正中神经弹性参数比较差异均无统计学意义（P＞0.05）,CTS组与对照组及DPN组比较差异均有统计学意义（P＜0.001,P＜0.05）.CTS组中WEmean、FEmean的ROC曲线下面积（AUC）较FRatio高（AUC＞0.8）,WEmean、FEmean的诊断效能比较差异无统计学意义（P＞0.05）.豌豆骨水平正中神经CSA与WEmean呈正相关（r=0.33,P＜0.05）.结论 SWE技术评估正中神经具有可行性,可用于反映神经发生病变后的硬度,为临床判断正中神经病变提供参考.Objective To explore the feasibility of real-time quantitative shear wave elastography （SWE） in median nerve （MN） lesions.Methods Seventy-three healthy volunteers （total 146 nerves） were included as control group （group A）.The neuropathic group consisted of 85 patients （total 115 nerves）,according their clinical symptoms and electrophysiological results.They were divided into two groups：diabetic peripheral neuropathy group （group B,57 nerves） and carpal tunnel syndrome group （group C,58 nerves）.The real-time quantitative SWE embedded in Supersonic AixPlorer was used to detect the MN.The mean elasticity modulus of the MN at the wrist （WEmean）,at the midpoint of the forearm （FEmean） and the mean elasticity modulus ratio of the MN and the musculus flexor digitorum superficialis in the same interest region at the midpoint of the forearm （FRatio） were calculated.Receiver-operating characteristic （ROC） curve was drawn to assess the diagnostic efficiency.Pearson rank correlation was used to analyze the correlation between the cross-sectional area （CSA） and WEmean of MN at the level of pisiform bone.Results There were significant differences of the elastic parameters between group C and A （P 〈0.001）,group C and B （P 〈0.05）.While the difference between group B and A was not statistically significant （P 〉0.05）.The area under the curve （AUC） of elastic parameters indicated that WEmean and FEmean were higher than FRatio in diagnosis of carpal tunnel syndrome（AUC〉 0.8）.No significant difference of diagnostic value was found between WEmean and FEmean （P 〉0.05）.The CSA of MN positively correlated with WEmean （r =0.33,P 〈0.05）.Conclusions SWE technology showed its feasibility in MN evaluation.It could be used to assess the stiffness of nerve neuropathy and may be a quantitative tool for clinical median neuropathy diagnostics.

关 键 词：超声检查 正中神经病 剪切波弹性成像 

分 类 号：R445.1[医药卫生—影像医学与核医学] R745[医药卫生—诊断学]