3D-FIESTA-c与STIR脉冲序列结合MRI评价臂丛神经损伤

There is a large amount of fat in the postganglionic segment of the brachial plexus nerve.The use of short T1 inversion recovery pulse sequence may improve signal strength of the brachial plexus postganglionic segment.The present study revealed that the combination of three-dimensional fast imaging employing steady-state acquisition with phase-cycled and short T1 inversion recovery pulse sequence clearly displayed the anatomical morphology and structure of the brachial plexus nerve,together with maximum intensity projection,volume rendering and other three-dimensional reconstruction techniques.Our results suggested that this method is also suitable for providing accurate assessment and diagnosis of the site,severity and scope of brachial plexus injury.     

Supplementary motor area deactivation impacts the recovery of hand function from severe peripheral nerve injury

Although some patients have successful peripheral nerve regeneration, a poor recovery of hand function often occurs after peripheral nerve injury. It is believed that the capability of brain plasticity is crucial for the recovery of hand function. The supplementary motor area may play a key role in brain remodeling after peripheral nerve injury. In this study, we explored the activation mode of the supplementary motor area during a motor imagery task. We investigated the plasticity of the central nervous system after brachial plexus injury, using the motor imagery task. Results from functional magnetic resonance imaging showed that after brachial plexus injury, the motor imagery task for the affected limbs of the patients triggered no obvious activation of bilateral supplementary motor areas. This result indicates that it is dififcult to excite the supplementary motor areas of brachial plexus injury patients during a motor imagery task, thereby impacting brain remodeling. Deactivation of the supplementary motor area is likely to be a serious problem for brachial plexus injury patients in terms of preparing, initiating and executing certain movements, which may be partly responsible for the unsatisfactory clinical recovery of hand function.     

空蝶鞍综合征与正常人在鞍区不同位点脑脊液流动磁共振定量对比研究

We used MRI to examine 38 healthy females and 38 female patients with empty sella syndrome. Cerebrospinal fluid flow was examined in six regions of interest, including the anterior clinoid processes, posterior clinoid processes, and 1.0 mm, -1.0 mm, 2.0 mm, -2.0 mm from the midpoint of the line between the anterior and posterior clinoid processes. The results revealed no significant differences in cerebrospinal fluid flow velocity and discharge in a single cardiac cycle, or indicators of cardiac cycles in the control group, indicating that the cerebrospinal fluid flow was relatively steady in the saddle area of the normal brain. In the empty sella syndrome group, cerebrospinal fluid hernia into the saddle area triggered a fluctuation of the anterior and posterior clinoid processes in the saddle area, while the flow in other regions in the saddle area was relatively steady; this resulted in significant differences in cerebrospinal fluid flow velocity and discharge, as well as the cardiac cycle.     

磁共振神经成像序列在臂丛神经损伤中的应用

目的探讨磁共振神经成像(MRN)序列对臂丛神经损伤的诊断价值。方法采用3.0T MRI对43例临床诊断为臂丛神经损伤患者行术前常规MRI及MRN序列扫描,对手术探查、术中肌电图及术前MRI/MRN检查结果进行比较分析。结果 MRN对节前神经损伤诊断的敏感度为76.2%,特异度为83.6%,准确率为80.0%。MRN对臂丛神经节后损伤诊断的敏感度为74.8%,特异度为88.1%,准确率为79.2%。结论 MRN可作为早期臂丛神经损伤定性及定位诊断的影像学检查方法之一。     

磁共振神经成像在周围神经疾病的临床应用

磁共振成像技术的进展已经使周围神经疾病的诊断从传统的临床和电生理检查向解剖学研究转化。磁共振神经成像能够获取周围神经纵切面和横切面的影像,来直接观察神经内外的病灶。磁共振神经成像作为一种敏感的非侵入性技术,可用于诊断周围神经的神经压迫症、炎症、创伤、康复和系统性神经疾病。这就要求神经科医生与放射科医生一样,也要熟识该领域各种新技术的影像表现。本文将对磁共振神经成像在周围神经疾病的临床应用以及目前存在的问题和磁共振实验研究作一综述,包括相应的技术介绍。     

磁共振断层血管成像及神经内镜在判断原发性三叉神经痛病因中的作用

目的 探讨磁共振断层血管成像(MRTA)及神经内镜在判断原发性三叉神经痛病因中所起的作用. 方法 回顾性分析行微血管减压术治疗的49例原发性三叉神经痛患者的临床资料、影像学资料及手术资料.所有患者术前均行MRTA检查,术中垫入隔片前置入30°神经内镜行多角度观察. 结果 本组患者MRTA阳性率为77.6%(38/49),MRTA检测为阳性者在术中均得到证实,无一例假阳性.4例术中无法判别可疑血管是否为责任血管者应用神经内镜予以了明确.49例患者中术后47例(95.9%)疼痛消失,1例(2.0%)疼痛减轻,总有效率为97.9%. 结论 MRTA及神经内镜技术有助于判断原发性三叉神经痛的病因,提高手术的安全性和有效性.

Abstract：

Objective To explore the role of magnetic resonance tomographic angiography (MRTA) and neuroendoscope in determining the etiology of idiopathic trigeminal neuralgia. Methods Forty-nine patients with idiopathic trigeminal neuralgia, performed microvascular decompression were chosen; their clinical data, imaging data and operative data were retrospectively analyzed. All patients underwent preoperative MRTA; and before placing intraoperative Teflon, 30° neuroendoscope was applied for multi-angle exploration. Results Positive rate reached 77.6% under MRTA. All patients with positive results under MRTA were confirmed, without a false-positive. Neuroendoscope helped to determine whether the suspect vessels were the offending vessels in 4 patients. The total effective rate in 49 patients was 97.9%; pain disappeared in 47 patients (95.9%) and pain relieved in 1 (2.0%).Conclusion MRTA and neuroendoscope can help to determine the etiology of idiopathic trigeminal neuralgia, and improve the safety and effectiveness of MVD.     

磁共振弥散张量成像在腰骶丛神经急性损伤诊断中应用价值

目的 探讨磁共振弥散张量成像（DTI）在腰骶丛神经急性损伤诊断中的临床价值。方法 选取经影像学和临床诊断为腰骶丛神经急性损伤60例为研究对象，均采用磁共振进行扫描检查，分析图像并记录相关数据。测量受损和正常L4~S1神经根各向异性分数（FA）与表观扩散系数（ADC）值。利用ROC曲线分析诊断敏感性和特异性。结果 与正常神经相比，受损神经FA值明显降低（P<0.05），而ADC值明显增高（P<0.05）。ROC曲线结果显示FA值曲线下面积为0.887，阈值为0.198时，诊断腰骶丛神经损伤的敏感度为71.7%、特异度为91.7%；当FA值≤0.188时，诊断特异度为100.0%。FA值与腰骶丛神经急性损伤呈明显负相关（r=-0.647，P<0.001）。结论 DTI技术应用于腰骶丛神经急性损伤诊断，具有显著效果，可较为直观地显示神经束走向和损伤具体位置，从而指导临床诊断     

磁共振断层血管成像在颅神经血管压迫综合征的应用

目的 探讨磁共振断层血管成像(MRTA)对颅神经血管压迫综合征病因诊断的临床应用价值,评价3D-FIESTA及3D-TOF-SPGR序列显示颅神经与血管的三维空间关系的能力.方法 湖北省恩施自治州中心医院神经外科白2007年5月至2009年5月共收治行微血管减压术(MVD)治疗的颅神经血管压迫综合征患者41例,术前行MRTA及其3D-FIESTA和3D-TOF-SPGR 序列扫描,观察颅神经与周围血管的空间关系,并与术中探查结果进行对照,评价MRTA及其3D-FIESTA和3D-TOF-SPGR序列在术前评估颅神经与周围血管关系的能力.结果MRTA能清晰且同时显示三叉神经、面神经、舌咽神经等颅神经和责任血管,在3D-FIESTA图像上,脑脊液呈高信号,神经与血管呈中等信号,对比良好;在3D-TOF-SPGR图像上,脑脊液为低信号,脑实质和颅神经为等信号,血管为高信号;3D-FIESTA序列扫描显示病变侧神经与血管有密切关系34例(82.9%),3D-TOF-SPGR序列扫描显示病变侧神经与血管有密切关系35例(85.4%),二者差异无统计学意义(χ2=0.091.P=0.762).结论 MRTA技术能清楚显示颅神经及责任血管,3D-FIESTA结合3D-TOF-SPGR对颅神经血管压迫综合征的术前病因诊断及手术适应证的选择具有重要价值.     

磁共振断层血管成像在颅神经血管压迫综合征的应用

目的 探讨磁共振断层血管成像(MRTA)对颅神经血管压迫综合征病因诊断的临床应用价值,评价3D-FIESTA及3D-TOF-SPGR序列显示颅神经与血管的三维空间关系的能力.方法 湖北省恩施自治州中心医院神经外科白2007年5月至2009年5月共收治行微血管减压术(MVD)治疗的颅神经血管压迫综合征患者41例,术前行MRTA及其3D-FIESTA和3D-TOF-SPGR 序列扫描,观察颅神经与周围血管的空间关系,并与术中探查结果进行对照,评价MRTA及其3D-FIESTA和3D-TOF-SPGR序列在术前评估颅神经与周围血管关系的能力.结果MRTA能清晰且同时显示三叉神经、面神经、舌咽神经等颅神经和责任血管,在3D-FIESTA图像上,脑脊液呈高信号,神经与血管呈中等信号,对比良好;在3D-TOF-SPGR图像上,脑脊液为低信号,脑实质和颅神经为等信号,血管为高信号;3D-FIESTA序列扫描显示病变侧神经与血管有密切关系34例(82.9%),3D-TOF-SPGR序列扫描显示病变侧神经与血管有密切关系35例(85.4%),二者差异无统计学意义(χ2=0.091.P=0.762).结论 MRTA技术能清楚显示颅神经及责任血管,3D-FIESTA结合3D-TOF-SPGR对颅神经血管压迫综合征的术前病因诊断及手术适应证的选择具有重要价值.     

磁共振断层血管成像在颅神经血管压迫综合征的应用

目的 探讨磁共振断层血管成像(MRTA)对颅神经血管压迫综合征病因诊断的临床应用价值,评价3D-FIESTA及3D-TOF-SPGR序列显示颅神经与血管的三维空间关系的能力.方法 湖北省恩施自治州中心医院神经外科白2007年5月至2009年5月共收治行微血管减压术(MVD)治疗的颅神经血管压迫综合征患者41例,术前行MRTA及其3D-FIESTA和3D-TOF-SPGR 序列扫描,观察颅神经与周围血管的空间关系,并与术中探查结果进行对照,评价MRTA及其3D-FIESTA和3D-TOF-SPGR序列在术前评估颅神经与周围血管关系的能力.结果MRTA能清晰且同时显示三叉神经、面神经、舌咽神经等颅神经和责任血管,在3D-FIESTA图像上,脑脊液呈高信号,神经与血管呈中等信号,对比良好;在3D-TOF-SPGR图像上,脑脊液为低信号,脑实质和颅神经为等信号,血管为高信号;3D-FIESTA序列扫描显示病变侧神经与血管有密切关系34例(82.9%),3D-TOF-SPGR序列扫描显示病变侧神经与血管有密切关系35例(85.4%),二者差异无统计学意义(χ2=0.091.P=0.762).结论 MRTA技术能清楚显示颅神经及责任血管,3D-FIESTA结合3D-TOF-SPGR对颅神经血管压迫综合征的术前病因诊断及手术适应证的选择具有重要价值.     

Assessment of obstetric brachial plexus injury with preoperative ultrasound

Introduction: Tools used in the assessment of obstetric brachial plexus injuries (OBPIs) have traditionally included electrodiagnostic studies, computerized tomography with myelography, and MRI. However, the utility of ultrasound (US) in infants for such assessment has not been extensively examined. Methods: This retrospective case series reports the preoperative brachial plexus US findings in 8 patients with OBPI and compares US with intraoperative findings. When available, the preoperative US was compared with the preoperative MRI. Results: US revealed abnormalities in all 8 patients. Although MRI detected abnormalities in the majority of patients, US provided accurate information regarding severity and anatomic location of injury in some patients. Conclusions: US is a relatively inexpensive, noninvasive, painless diagnostic modality that can be used to assess OBPI. This case series suggests that US is a valuable adjunct to current diagnostic modalities. Muscle Nerve 53 : 946–950, 2016     

Role of magnetic resonance neurography in brachial plexus lesions

Magnetic resonance neurography (MRN) is a relatively new imaging technique that is highly sensitive in detecting lesions in the peripheral nerves. We studied six cases of brachial plexopathies in which MRN played a pivotal role in making the correct diagnoses. All patients had clinical, nerve conduction, and electromyographic findings consistent with brachial plexus lesions. Four patients had brachial plexitis and two had multifocal demyelinating neuropathy presenting as brachial plexopathies. MRN in all patients showed edema, thickening, and T2 hyperintensities localized to the brachial plexus region. We conclude that MRN is a useful technique in evaluating patients with brachial plexus lesions, particularly in cases of brachial plexitis, where conventional magnetic resonance imaging is generally normal.     

MRI of the brachial plexus in polyneuropathy associated with monoclonal gammopathy

On magnetic resonance (MR) imaging of the brachial plexus increased signal intensity and swelling of the brachial plexus has been found in chronic inflammatory demyelinating polyneuropathy (CIDP). Whether these proximal abnormalities are also present in the distal polyneuropathy associated with monoclonal gammopathy is unknown. Therefore, we performed MR imaging of the brachial plexus in 21 patients with polyneuropathy associated with IgM monoclonal gammopathy (11 IgM with anti-MAG antibodies, 10 IgM without anti-MAG antibodies). For comparison we studied 9 patients with polyneuropathy associated with IgG monoclonal gammopathy and 8 patients with CIDP. Among the 30 patients with monoclonal gammopathy, 24 patients had demyelinating polyneuropathy. Among these 24 patients, there was increased signal intensity of the brachial plexus on the T2-weighted images regardless of whether clinical deficits were generalized or purely distal in location. No association was found with the isotype of the monoclonal gammopathy. Of the 8 patients with CIDP, 5 had brachial plexus abnormalities. None of the 6 patients with axonal polyneuropathy associated with monoclonal gammopathy had such abnormalities. Thus, MR imaging of the brachial plexus shows that the distal demyelinating polyneuropathy associated with monoclonal gammopathy is more generalized than presumed.     

Electroacupuncture attenuates neuropathic pain after brachial plexus injury

Electroacupuncture has traditionally been used to treat pain, but its effect on pain following brachial plexus injury is still unknown. In this study, rat models of an avulsion injury to the left brachial plexus root(associated with upper-limb chronic neuropathic pain) were given electroacupuncture stimulation at bilateral Quchi(LI11), Hegu(LI04), Zusanli(ST36) and Yanglingquan(GB34). After electroacupuncture therapy, chronic neuropathic pain in the rats' upper limbs was significantly attenuated. Immunofluorescence staining showed that the expression of β-endorphins in the arcuate nucleus was significantly increased after therapy. Thus, experimental findings indicate that electroacupuncture can attenuate neuropathic pain after brachial plexus injury through upregulating β-endorphin expression.     

Histopathological basis of Horner's syndrome in obstetric brachial plexus palsy differs from that in adult brachial plexus injury

Although Horner's syndrome is usually taken as an absolute indicator of avulsions of the C8 and T1 ventral roots in adult brachial plexus injury, its pathological basis in obstetric brachial plexus palsy (OBPP) is unclear. We therefore examined the morphological mechanism for the presence of Horner's syndrome in brachial plexus injury in infants and adults. Some axons of sympathetic preganglionic neurons in T1 innervate the superior cervical ganglion via the C7 ventral root in infants but not in adults. Therefore, the presence of Horner's syndrome may relate in part to avulsion of the C7 root in OBPP. These findings suggest that Horner's syndrome in OBPP is not necessarily indicative of avulsions of the C8 and T1 roots, as it can occur with avulsion of the C7 root.     

Infraclavicular brachial plexus injury following axillary regional block

Infraclavicular brachial plexopathy is a potential complication of axillary regional block. We retrospectively reviewed 13 such injuries and found the median nerve most often affected, followed by combined median and ulnar neuropathies, and then by various combinations involving the median, ulnar, radial, and musculocutaneous nerves. All were axon-loss in type and most were severe in degree electrophysiologically. The clinical and electrodiagnostic features of these injuries are strikingly similar to those sustained after axillary arteriography, which has been associated with the medial brachial fascial compartment (MBFC) syndrome. This syndrome is characterized by the evolution of neurologic deficits and pain following hematoma formation within a compartment of the upper arm. Thus, we believe that this mechanism underlies most nerve injuries that result from axillary angiography or axillary regional block. This has important treatment implications, as timely surgical intervention may lead to improved outcome.