3DMRI对臂丛及血管同时成像技术诊断TOS的可行性研究  

Feasibility study of 3D MRI in diagnosis of thoracic outlet syndrome with simultaneous brachial plexus and vascular imaging

作　　者：刘宗宝[1] 祁连港 钱辉[1] 陆剑锋[1] 徐正道[2] 陈建新[2] 张同华 王涛 Liu Zongbao;Qi Liangang;Qian Hui;Lu Jianfeng;Xu Zhengdao;Chen Jianxin;Zhang Tonghua;Wang Tao(Department of Hand and Foot Surgery,Zhangjiagang Hospital Affiliated to Suzhou University,Suzhou 215000,China)

机构地区：[1]苏州大学附属张家港医院手足外科,苏州215000 [2]苏州大学附属张家港医院影像科,苏州215000 [3]复旦大学附属华山医院手外科,上海

出　　处：《中华手外科杂志》2018年第5期363-366,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨3DMRI对臂丛及血管同时成像的可行性，以及对胸廓卅口综合征（thoracic outlet syndrome,TOS）的诊断价值。方法自2016年1月至2017年12月，我院收治初步诊断为TOS患者14例，手术治疗4例，保守治疗10例。术前通过3DMRI血管神经融合技术进行三维重建。根据i维解剖模型发现多列锁骨下动脉与臂丛神经异常情况，并制定治疗方案，针对手术患者对比术前、术中所见，评估这一辅助诊断技术的应用价值。结果全部患者的臂丛和锁骨下动脉以及周围重要的解剖结构均得到三维重建并数字化融合。10例保守治疗患者的症状及体征明显改善。4例手术患者：其中前斜角肌压迫1例，术中切断斜角肌；第七颈椎横突过长1例，术中切断小斜角肌腱束；神经鞘瘤1例，术中切除鞘瘤；乳腺癌转移瘤1例，考虑切除风险较大，术中活检行病理检查。前3例手术患者术后症状明显好转。重建后的模型与常规术前诊断依据、术中所见相一致。结论3DMRI对臂丛神经及血管同时显像技术能够形象、可靠地显示臂丛神经、血管位置，立体化多角度呈现血管神经与周周重要解剖结构的立体关系，为临床诊断TOS提供了影像学依据。Objective To explore the feasibility of3D MRI with the simultaneous brachial plexus and vascular imaging and its diagnostic value for thoracic outlet syndrome （TOS）. Methods From January 2016 to December 2017, 14 patients with TOS were initially diagnosed. 4 cases received surgical treatment and 10 received conservative treatment. Three-dimensional reconstruction was performed by 3D MRI neurovascular fusion technology before operation. According to the three-dimensional anatomical model, the abnormalities of multiple subclavian arteries and brachial plexus nerves were found and the treatment strategy was made. The application value of the auxiliary diagnostic technique was evaluated by the comparison of preoperative and intraoperative findings. Results The hrachial plexus, subclavian artery and the surrounding important anatomical structures were reconstructed in three dimensions and digitally fused in all the patients. The symptoms and signs of 10 patients with conservative treatment improved significantly. Among 4 patients underwent surgical treatment, 1 patient with anterior scalenus compression obtained scalenus resection intraoperatively; 1 patient with overly long seventh transverse cervical process obtained the small oblique tendon bundle resection intraoperatively; 1 patient with neurilemmoma obtained schwannoma cutting; 1 patient with metastasis of breast cancer obtained intraoperative biopsy for pathological examination considering the high risk of resection. The symptoms of the first 3 patients improved significantly after operation. The reconstructed model was consistent with the preoperative diagnostic basis and intraoperative findings. Conclusion 3D MRI with the simultaneous brachial plexus and vascular imaging can display the position of brachial plexus nerve and blood vessel visually and reliably, and show the three-dimensional relationship between blood vessel, nerve and the surrounding important anatomical structures, which provides imaging basis for clinical diagnosis of TOS.

关 键 词：磁共振成像 臂丛 锁骨下动脉 

分 类 号：R658[医药卫生—外科学]