CT周围神经重组图像在评价骨肌肿瘤与邻近神经关系中的应用价值分析  

The application of neuroimaging reconstruction technique in evaluating the relationship between skeletal musculature tumors and nerves nearby

作　　者：吕喆[1] 臧杰[2] 张滨[1] 常天静 杨帆[1] 那曼丽 LüZhe;Zang Jie;Zhang Bin;Chang Tianjing;Yang Fan;Na Manli(Department of Radiology,Peking University Shougang Hospital,Beijing 100041,China;Musculoskeletal Tumor Center,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京大学首钢医院医学影像科,北京100041 [2]北京大学人民医院骨与软组织肿瘤治疗中心,北京100044

出　　处：《中华医学杂志》2020年第5期382-386,共5页National Medical Journal of China

摘　　要：目的应用CT周围神经图像,观察骨肌系统肿瘤与邻近神经的关系,并探讨其在手术治疗中的价值。方法收集2016年5月至2019年4月在北京大学首钢医院影像科检查的27例骨肌系统肿瘤患者,男17例、女10例,年龄13~67岁,平均年龄34岁。其中15例原发软组织肿瘤、9例原发骨肿瘤、3例转移瘤,所有肿瘤均与神经关系密切。术前行CT扫描,应用曲面重组技术对周围神经进行重建,观察病灶与邻近神经关系。所有患者在检查完成后2周内行手术治疗。根据其术前影像特点判断神经是否受侵,并以术中所见为金标准,计算神经重组图像判断肿瘤侵犯(压迫)神经的敏感度、特异度、阳性预测值、阴性预测值。结果27例患者中有25例(92.6%)可以在同一层面显示肿瘤与邻近神经的关系,其中有22例术前影像判断与术中所见相符(22/25,88.0%)。在神经重组图像中,周围神经呈连续的条索状结构,并与肿瘤在同一层面上,受侵神经可显示神经局部增粗、边缘模糊,增强扫描可见强化。应用神经重组图像判断肿瘤侵犯神经的敏感度为100.0%、特异度为89.5%、阳性预测值为75.0%、阴性预测值为100.0%;判断肿瘤压迫神经的敏感度92.3%、特异度100.0%、阳性预测值100.0%、阴性预测值80.0%。结论周围神经重组图像可以帮助临床医师快速、直观地评价病灶与邻近神经的关系,指导术式的选择、减少术中神经损伤的风险,对神经是否受到侵犯有较高的敏感度和特异度。Objective To analyze the relationship between tumors of the musculoskeletal system and adjacent nerves by reconstructing images of peripheral nerves,and explore its value in surgical treatment.Methods From May 2016 to April 2019,a total of 27 patients were collected in Department of Imaging,Shougang Hospital,who were with skeletal muscle system tumors,including 15 primary soft tissue tumors,9 primary bone tumors,3 metastatic tumors,all of them were closely related to nerves.There were 17 males and 10 females,aged 13-67 years,with an average age of 34 years.Before the operation,CT volume scanning was performed,and curved planar reconstruction(CPR)was used to reconstruct the peripheral nerves.All patients were operated within 2 weeks after the examination.According to the image characteristics before the operation,the nerve invasion was judged.The sensitivity,characteristic,positive predictive value and negative predictive value of the tumor invasion(compression)nerve were calculated according to the intraoperative findings as the gold standard.Result Of the 27 cases,25 cases(25/27,92.6%)could show the relationship between the tumors and the adjacent nerves at the same level,and 22 cases(22/25,88.0%)had the same preoperative image judgments as the intraoperative findings.In the reconstructed images,the peripheral nerve was a continuous strip-like structure on the same level with the tumor.The invaded nerve became thicker and the edge was blurred.Enhanced scan showed enhancement.The sensitivity,specificity,positive predictive value and negative predictive value of neuroimaging reconstruction were 100.0%,89.5%,75.0%and 100.0%respectively.The sensitivity,specificity,positive predictive value and negative predictive value of the nerve compression were 92.3%,100.0%,100.0%and 80.0%respectively.Conclusions Neurological reconstructed images can help clinicians evaluate the relationship between lesions and adjacent nerves quickly and intuitively.They can guide the selection of surgical methods,reduce the risk of intraoperat

关 键 词：周围神经 肿瘤 体层摄影术 神经成像 

分 类 号：R730[医药卫生—肿瘤]