臂丛MRN在诊断脱髓鞘合并轴索损伤CIDP中的应用  

Brachial Plexus MRN in the Diagnosis of Demyelination Combined with Axonal Injury of CIDP

作　　者：邓燕 王卫卫 杨杨 赵彦胤 李雅洁 刘含秋 DENG Yan;WANG Weiwei;YANG Yang;ZHAO Yanyin;LI Yajie;LIU Hanqiu(Department of Radiology,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Neurology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院放射科,上海市200040 [2]复旦大学附属华山医院神经内科,上海市200040

出　　处：《中国医学计算机成像杂志》2024年第3期365-371,共7页Chinese Computed Medical Imaging

基　　金：国家自然科学基金(82371935)。

摘　　要：目的:探讨臂丛磁共振神经成像(MRN)在诊断脱髓鞘合并轴索损伤的慢性炎性脱髓性多发性神经根神经病(CIDP)中的应用价值。方法:收集2016—2021年在我院确诊的CIDP患者29例,根据神经电生理检查分为脱髓鞘组及脱髓鞘合并轴索损伤组。在臂丛MRN图像上测量所有患者臂丛神经根(C5~C8)最大直径以及神经-肌肉T2WI信号强度比,收集所有患者的临床资料,进行组间差异性分析和组内相关性分析,并绘制受试者工作特征(ROC)曲线。结果:脱髓鞘合并轴索损伤组CIDP患者臂丛神经根最大直径大于脱髓鞘组,其中C5(P=0.011)、C6(P=0.046)、C8(P=0.001)神经根的差异具有统计学意义。ROC曲线分析结果显示,C8神经根的最大直径具有较好的诊断效能,其ROC曲线下面积(AUC)为0.851,相应的阈值为4.36 mm。脱髓鞘合并轴索损伤组CIDP患者C6(r=0.634,P=0.02)、C7(r=0.605,P=0.029)神经根最大直径与脑脊液蛋白水平呈中度正相关,C7神经根最大直径(r=-0.567,P=0.043)以及C8神经根的神经-肌肉T2WI信号强度比(r=-0.598,P=0.031)与发病年龄呈中度负相关。结论:臂丛MRN有助于识别脱髓鞘合并轴索损伤的CIDP患者,C8神经根的最大直径可能具有较好的诊断效能。Purpose:To evaluate the diagnostic utility of brachial plexus magnetic resonance neurography(MRN)in chronic inflammatory demyelinating polyradiculoneuropathy(CIDP)with combined demyelination and axonal injury.Methods:We retrospectively analyzed 29 CIDP patients diagnosed from 2016 to 2021,and grouped according to neurophysiological findings into pure demyelination and combined demyelination with axonal damage categories.The maximum diameters of the C5-C8 nerve roots and their nerve-muscle T2WI signal intensity ratios were measured using MRN.Clinical data were collected for all patients.The intergroup differences and intragroup correlations were analyzed,and the receiver operating characteristic(ROC)curves were also performed.Results:Significant increases in the maximum diameters of nerve roots were observed in the combined axonal injury group compared to the pure demyelination group,notably at C5(P=0.011),C6(P=0.046),and C8(P=0.001).ROC analysis confirmed the diagnostic accuracy of the C8 nerve root diameter,demonstrating an area under the curve(AUC)of 0.851,with a diagnostic threshold set at 4.36 mm.Additionally,there were moderate positive correlations between the maximum diameters of the C6(r=0.634,P=0.02)and C7(r=0.605,P=0.029)nerve roots and cerebrospinal fluid protein levels.The diameter of the C7 nerve root(r=-0.567,P=0.043)and the nerve-muscle T2WI signal intensity ratio of the C8 nerve root(r=-0.598,P=0.031)exhibited moderate negative correlations with the age of onset.Conclusion:Brachial plexus MRN proves to be an effective diagnostic tool in identifying CIDP patients with combined demyelination and axonal injury,where the diameter of the C8 nerve root emerges as a particularly reliable diagnostic marker.

关 键 词：磁共振神经成像 慢性炎性脱髓鞘性多发性神经根神经病 臂丛神经 轴索损伤 

分 类 号：R445.2[医药卫生—影像医学与核医学] R745[医药卫生—诊断学]