MR扩散加权神经成像技术在非创伤性上肢神经扭转中的应用  

Application of diffusion-weighted MR neurography in nontraumatic upper limb nerve torsion

作　　者：王姗姗[1] 石红岭[2] 赵连新[3] 王光彬[2] 杨丽[4] 史宏璐[2] 姚彬[1] 陈欣[1] 邵赛[1] 

机构地区：[1]山东大学医学院影像医学与核医学系,济南250012 [2]山东省医学影像学研究所 [3]山东大学齐鲁医院放射科 [4]上海市影像医学研究所复旦大学附属中山医院放射科

出　　处：《中华放射学杂志》2015年第3期209-212,共4页Chinese Journal of Radiology

基　　金：国家自然科学基金面上项目（81371534）;山东省科技发展计划项目（2010GSF10241）

摘　　要：目的 分析非创伤性上肢神经扭转的MR扩散加权神经成像（DW-MRN）影像特点,探讨DW-MRN的临床价值及优势.方法 回顾性分析6例经临床手术确诊为非创伤性上肢神经扭转患者的临床及影像资料.所有患者术前均行轴面SE序列T1WI、轴面及冠状面SE序列压脂T2WI、DW-MRN及上肢神经超声检查,由2名高年资放射科医师联合分析其DW-MRN特点,并与超声、临床手术结果进行对照.结果 DW-MRN对6例患者均做出准确诊断,DW-MRN共显示神经扭转19处,与术中所见吻合;超声显示16处,漏诊3处.上肢神经扭转处T1WI呈低信号,压脂T2WI神经中心呈低信号,周围呈高信号.其两端的神经束增粗,T1WI呈低信号,压脂T2WI呈高信号.DW-MRN显示扭转处神经变细,呈沙漏状,正常神经高信号消失,扭转部位的近端及远端均可见神经增粗.多发神经扭转时DW-MRN显示神经出现多发、节段性沙漏状改变.结论 DW-MRN显示非创伤性上肢神经扭转的特征性表现为单发或多发节段性沙漏样改变,并能准确、直观显示神经扭转的数量及位置,有助于神经扭转的诊断、鉴别诊断及指导手术,在分辨率、视野大小及图像显示方面较超声有一定优势.Objective To investigate the diffusion weighted MR neurography（DW-MRN） features of nontraumatic upper limb nerve torsion and evaluate the application value of DW-MRN.Methods Six patients （unilateral upper extremity） who underwent surgical treatment for nerve fascicle torsion were analyzed retrospectively.Spin echo T1WI,spin echo fat suppress T2WI,DW-MRN and ultrasound were performed in all 6 patients.The DW-MRN features were analyzed by two radiologists and compared with the clinical surgeries and the results of ultrasonagraphy.Results Six patients were accurately diagnosed preoperatively by using DW-MRN as having nerve fascicle torsions.Nineteen nerve torsions were found in DW-MRN and the result was consistent with the findings at surgery,sixteen nerve torsions were found in ultrasonography,but three were missed.The affected segmental nerve fascicles showed hypointensitity in T1WI and hyperintensitity in T,WI because of nerve fascicle edema.The lesion of nerve torsion was hypointense signal,and single or multi-segmental hourglass-like change was seen at DW-MRN.Conclusions The DW-MRN of nontraumatic upper limb nerve torsion has certain characteristics,and can display the location and number of nerve torsion clearly.DW-MRN features is helpful in the diagnosis,differential diagnosis of nontraumatic upper limb nerve torsion and guidethesurgery.Compared to ultrasonography,DW-MRN has certain advantages in resolution,field size and visualization of images.

关 键 词：桡神经 正中神经 磁共振成像 

分 类 号：R688[医药卫生—骨科学] R445.2[医药卫生—外科学]