磁共振对臂丛神经损伤诊断准确率的分析

目的 探讨磁共振(magnetic resonance imaging,MRI)对臂丛神经节前损伤诊断的准确率及影响因素.方法 运用MRI对27例臂丛神经损伤的患者进行多序列扫描,将影像学诊断与手术所见及术中神经电生理检测结果进行比较,统计各神经根损伤诊断的准确率.结果 臂丛神经节前损伤MRI表现的直接征象:冠状面、横断面或多平面重建均见脊神经前后根消失或连续性的中断,脊髓移位(中心点偏移＞1.5mm);间接征象:创伤性脊膜囊肿,椎管内囊状脑脊液积聚,脊髓变形或移位,"黑线征",脊柱旁肌肉信号异常、强化.臂丛神经节后损伤MRI表现的直接征象:神经增粗或离断、扭曲,伴或不伴T2WI信号增高,创伤性神经瘤形成;间接征象:去神经化肌肉的显示.MRI对臂丛C5～T1各神经根撕脱损伤诊断的准确率分别是59.3%、85.2%、100%、88.9%和92.6%.结论 MRI对臂丛各神经根节前损伤的诊断效能不同,影像诊断应与临床及神经电生理检测相结合.

Abstract：

Objective To analyze the diagnostic accuracy of MRI in determining brachial plexus preganglionic injury and the factors that affect the accuracy. Methods Twenty-seven patients who presented with brachial plexus root avulsion injuries underwent MRI scanning with multiple sequences before the operation.Images of MRI were reviewed for features that would lead to the diagnosis of a preganglionic injury. MRI diagnosis was then verified and compared with surgical findings and electrophysiological diagnosis. The accuracy rate for individual nerve root avulsion was calculated. Results There were direct signs and indirect signs of MRI features that indicated preganglionic injuries. The direct signs included disappearance or loss of continuity of the ventral and dorsal rootlets of the spinal nerve on coronal plane, axial plane or multiplanal reconstruction, and spinal cord shift (midline shift ＞ 1.5 mm). The indirect signs included traumatic pseudomeningocele, CSF collection in the vertebral canal, spinal cord deformation or shift, "black line" sign, and abnormal signals in the paraspinal muscles. Direct MRI signs of postganglionic injuries included thickening, rupture or distortion of the nerve root, with or without increase signal in T2 weighted images, and neuroma formation. Muscle denervation was also an indirect sign for postganglionic injury. The diagnostic accuracy by MRI of C5 to T1 avualsion was 59.3%,85.2%,100%,88.9% and 92.6% respectively. Conclusion The capability of MRl to evaluate lesions of each nerve root is different. A diagnosis should be made combining MRI, electrophysiological and clinical findings.     

Application of MRI in indirect temporomandibular joint injury without condylar fracture

Objective： To discuss the application of MRI in indirect temporomandibular joint injury without condylar fracture. Methods： MRI examination on temporomandibular joint was conducted in 28 patients with indirect injury to temporomandibular joint without condylar fracture. The scanning sequence included TIWI, PDWI on oblique sagittal section at both open and closed mouth positions, and T1WI, T2WI on oblique coronal section. The MRI appearance was analyzed by 2 senior radiologists. Results： Among the 56 temporomandibular joints of28 patients, 35 joints exhibited pathological changes on MRI, in which there were 9 bone injuries, 21 articular disc dislocation, 24 intracapsular hematocele and hydrops. Conclusions： MRI can clearly reveal bone injury, articular disc dislocation as well as articular capsule abnormality in the indirect injury of temporomandibular joint without condylar fracture. It is highly advocated in clinical use.     

3.0T术中磁共振成像导航在神经外科手术应用的初步经验

目的 探讨3.0 T术中磁共振成像(iMRI)导航在神经外科手术应用的临床价值.方法 回顾性分析2010年9月至2011年3月,在具备诊断和手术功能的"3.0 T iMRI数字一体化神经外科手术中心"施行的各类颅脑手术122例,包括临床资料、iMRI实时影像导航对手术进程和手术结果的影响等.结果 122例患者手术室内扫描2～4次,平均2.6次.各种扫描图像质量皆优良.iMRI技术使脑胶质瘤(60例)手术全切除率从71.7%提高到90.0%,患者的近期致残率为6.7%,远期致残率3.3%.iMRI技术使垂体大腺瘤(29例)手术全切除率从75.9%提高到93.1%.未发生与应用iMRI数字一体化神经外科手术有关的并发症(如感染等).同期完成2500余人次MRI诊断性检查.结论 3.0 T iMRI神经导航的应用,为脑胶质瘤与垂体大腺瘤手术进程的实时引导、切除范围的精确判断以及脑功能与代谢信息的定量分析提供了客观依据,真正实现了脑肿瘤的最大程度安全切除.

Abstract：

Objective To report the preliminary experience in clinical application of 3.0 T intraoperative magnetic resonance imaging (iMRI) neuronavigation system in China. Methods From September 2010 to March 2011, a consecutive series of 122 patients with intracranial lesions underwent operations in guidance with 3.0 T iMRI. A retrospective analysis was conducted regarding clinical efficiency.Results Among 122 procedures, the numbers of intraoperative scanning were 2-4 times with an average of 2.6.The qualities of images were excellent. Due to the discovery and further possibility of resection of residual tumors, the ratio of gross total resection was increased from 71.7% to 90.0% in cerebral gliomas(n =60), while from 75.9% to 93.1% in macroadenomas (n =29).There were 6.7% of all patients occurred postoperative paralysis, but only 3.3% of patients had persistent paralysis at 1-2months follow-up.There was no iMRI-related adverse event occurred. During the same period, more than 2500 patients underwent diagnostic MRI scanning. Conclusions 3.0 T iMRI neuronavigation system provides high-quality intraoperative structural, functional and metabolic images for real time tumor resection control and accurate functional preservation, resulting in an improvement in maximal safe brain surgery.The system is cost-effective.     

超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度

目的 超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度.方法 择期上肢手术患者50例,年龄19～72岁,体重45～83 ks,身高150～181 cm,ASA分级Ⅰ或Ⅱ级.超声引导下行臂丛神经阻滞,定位成功后注入罗哌卡因30 ml,初始浓度0.50%,浓度变化梯度为O.05%,阻滞有效则下一例采用低一级浓度,阻滞无效,则下一例采用高一级浓度.采用Prebit法计算超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度及其95%可信区间.结果 超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度为0.436%,95%可信区间为0.393%～0.477%.结论 超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度为0.436%.

Abstract：

Objective To determine the median effective concentration (EC50) of ropivacaine for ultrasound-guided brachial plexus block.Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes, aged 19-72 yr, weighing 45-83 kg, scheduled for upper extremity surgery under brachial plexus block guided by ultrasound, were enrolled in this study. Brachial plexus block was performed under the guidance of ultrasound. After successful location, ropivacaine 30 ml was injected. EC50 of ropivacaine was determined by up-and-down sequential method. The initial concentration was 0.50% . Each time the concentration increased/decreased by 0.05% . EC50 of ropivacaine required for ultrasound-guided brachial plexus block and 95% confidence interval were calculated using Probit analysis.Results The EC50 of ropivacaine resulting in complete block of the brachial plexus nerve was 0.436%(95% confidence interval 0.393%-0.477% ). Conclusion The EC50 of ropivacaine is 0.436% for ultrasoundguided brachial plexus block.     

右美托咪啶对上肢手术患者罗哌卡因臂丛神经阻滞效果及上肢缺血再灌注损伤的影响

目的 探讨右美托咪啶对上肢手术患者臂丛神经阻滞及上肢缺血再灌注损伤的影响.方法 拟行腋路臂丛神经阻滞的上肢手术患者40例,性别不限,年龄18～55岁,体重45～80kg,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将患者随机分为2组(n=20),对照组(C组):神经阻滞用药为0.5%罗哌卡因30 ml;右美托咪啶组(D组):神经阻滞用药为0.5%罗哌卡因+右美托咪啶8 mg混合液30 ml.评价感觉阻滞和运动阻滞的效果,记录感觉阻滞和运动阻滞的起效时间和维持时间,于麻醉诱导前(T0)、松止血带后1、5和30 min(T1-3)时抽取术侧肘部静脉血样,测定血浆MDA和缺血修饰蛋白(IMA)的浓度,同时取术侧肘部动脉血样,行血气分析.记录术中恶心呕吐、呼吸抑制、头晕、心动过缓等并发症的发生情况.术中主诉疼痛的患者静脉注射舒芬太尼0.2μg/kg,仍因疼痛无法完成手术的患者则改为全身麻醉.结果 无一例患者使用补救用药,无一例患者更改麻醉方式,所有患者均未发生恶心呕吐、呼吸抑制、头晕、心动过缓等并发症.与C组比较,D组感觉阻滞、运动阻滞维持时间明显延长,血浆MDA和IMA的浓度明显降低,PaO2和BE升高(P＜0.05),感觉阻滞和运动阻滞的起效时间差异无统计学意义(P＞0.05);与T0时比较,两组T2、T3时血浆MDA和IMA的浓度升高,C组T1时pH值降低,两组T1时PaO2降低,T1、T2时BE降低(P＜0.05).结论 右美托咪啶不仅可增强上肢手术患者罗哌卡因臂丛神经阻滞效果,还可减轻止血带诱发的上肢缺血再灌注损伤.

Abstract：

Objective To investigate the effect of dexmedetomidine on brachial plexus block with ropivacaine and upper extremity ischemia-reperfusion (I/R) injury in patients undergoing upper extremity surgery. Methods Forty ASA Ⅰ or Ⅱ patients of both sexes, aged 18-55 yr, weighing 45-80 kg, scheduled forupper extremity surgery under brachial plexus block, were randomly divided into 2 groups ( n = 20 each): control group ( group C )and dexmedtomidine group (group D). In group C, brachial plexus block was performed using 0.5% ropivacaine 30 ml. In group D, brachial plexus block was performed with a mixture (30 ml) of 0.5% ropivacaine and 8 mg dexmedetomidine. The efficacy of motor and sensory block was evaluated and the onset time and duration of motor and sensory block were recorded. Venous blood samples were obtained from peripheral vein on the operated side before anesthesia induction (T0), and at 1, 5 and 30 min after tourniquet release (T1-3) to detect the plasma concentrations of MDA and ischemia-modified albumi (IMA). Arterial blood samples were also obtained at the same time points for blood gas analysis. The complications such as nausea and vomiting, respiratory depression, bradycardia and dizziness were recorded. Sufentanil 0.2 μg/kg was given as rescue medication. If the operation could not be completed, general anesthesia was used. Results There was no requirement for rescue analgesics and general anesthesia, and no complications occurred in all the patients. The duration of sensory and motor block was significantly longer, the plasma concentrations of MDA and IMA were significantly lower, and PaO2 and BE were significantly higher in group D than in group C ( P ＜ 0.05). The plasma concentrations of MDA and IMA were significantly higher at T2 and T3 in both groups, the pH value was significantly lower at T1 in group C, PaO2 at T1 and BE at T1 and T2 were significantly lower in both groups than those at T0 ( P ＜ 0.05). Conclusion Dexmedetomidine can not only enhance the efficacy of brachial plexus block with ropivacaine, but also reduce the upper extremity I/R injury caused by tourniquet in patients undergoing upper extremity surgery.     

超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度

Objective To determine the median effective concentration (EC50) of ropivacaine for ultrasound-guided brachial plexus block.Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes, aged 19-72 yr, weighing 45-83 kg, scheduled for upper extremity surgery under brachial plexus block guided by ultrasound, were enrolled in this study. Brachial plexus block was performed under the guidance of ultrasound. After successful location, ropivacaine 30 ml was injected. EC50 of ropivacaine was determined by up-and-down sequential method. The initial concentration was 0.50% . Each time the concentration increased/decreased by 0.05% . EC50 of ropivacaine required for ultrasound-guided brachial plexus block and 95% confidence interval were calculated using Probit analysis.Results The EC50 of ropivacaine resulting in complete block of the brachial plexus nerve was 0.436%(95% confidence interval 0.393%-0.477% ). Conclusion The EC50 of ropivacaine is 0.436% for ultrasoundguided brachial plexus block.     

超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度

Objective To determine the median effective concentration (EC50) of ropivacaine for ultrasound-guided brachial plexus block.Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes, aged 19-72 yr, weighing 45-83 kg, scheduled for upper extremity surgery under brachial plexus block guided by ultrasound, were enrolled in this study. Brachial plexus block was performed under the guidance of ultrasound. After successful location, ropivacaine 30 ml was injected. EC50 of ropivacaine was determined by up-and-down sequential method. The initial concentration was 0.50% . Each time the concentration increased/decreased by 0.05% . EC50 of ropivacaine required for ultrasound-guided brachial plexus block and 95% confidence interval were calculated using Probit analysis.Results The EC50 of ropivacaine resulting in complete block of the brachial plexus nerve was 0.436%(95% confidence interval 0.393%-0.477% ). Conclusion The EC50 of ropivacaine is 0.436% for ultrasoundguided brachial plexus block.     

高场强术中磁共振成像系统在内镜脊索瘤手术中的初步应用

目的 总结高场强术中磁共振成像(iMRI)系统在内镜经口或经鼻脊索瘤手术中应用的初步经验.方法 自2009年1月至2010年12月,共有23例脊索瘤患者进行了内镜经口或鼻iMRI辅助下的手术.男性12例,女性11例,年龄29～64岁,平均(42±3)岁.肿瘤最大径2.0～5.7 cm,平均(3.5±0.8)cm.术中应用1.5 T移动磁体双室设计的iMRI系统,其中20例联合使用了神经导航系统.结果 23例内镜经口或鼻脊索瘤手术中,扫描次数1～5次,平均2.5次,20例应用了导航技术,12例根据术中扫描更新了导航的资料.15例iMRI扫描发现了肿瘤残留.其中12例进一步手术切除,并最终经iMRI扫描证实9例得到全切除,3例残留肿瘤得到进一步切除.肿瘤全切除率由34.8%(8/23)提高到73.9%(17/23).在15例术中扫描发现肿瘤残留的脊索瘤中,巨大脊索瘤占9例.巨大脊索瘤术中扫描残留检出率为9/11,其他脊索瘤术中扫描残留检出率为6/12.未发生与iMRI相关的并发症或安全事故.结论 高场强iMRI系统能够在术中获得高质量的影像,为手术中实时判断肿瘤切除程度提供了客观依据,提高了内镜经口或鼻脊索瘤的肿瘤切除程度和手术安全性.

Abstract：

Objective To review the preliminary clinical experience with high-field-strength intraoperative magnetic resonance imaging (iMRI) in the endoscopic chordoma operation with transsphenoidal or transoral approach.Methods From Janury 2009 to December 2010, 23 patients [range, 29-64 years, mean age (42 ± 3) years] of chordoma were operated with endoscopic transsphenoidal or transoral approach and examined intraoperatively with a movable 1.5 T iMRI magnet.Tumor size range was 2.0-5.7 cm, mean (3.5 ±0.8)cm.A navigation system based on iMRI was used in 20 cases. Results iMRI scan were performed in each operation from 1 time to 5 times.Neuronavigation system were used in 20 operations and the data renewed in 12 cases by the information from iMRI.In 15 of 23 patients, iMRI had revealed residual lesions and resulted in 12 cases further treatment, eventually, 9 tumors were totally removed and 3 tumors were further removed.The ratio of total removal tumor was enhanced to 73.9% ( 17/23 ) from 34.8%(8/23).Among 15 cases of paitial chordoma removal detected by scanning in operation, 9 were huge chordoma The residual of huge chordoma detected by scanning in operation was 9/11, and other chordoma contributed to 6/12.There were no iMRI related safety issue or accident recorded in this study.Conclusions High-field-strength iMRI provids high-quality images of tumor resection that allows intraoperative modification of the surgical strategy.Combined with the navigation system, iMRI is helpful to maximize the resection of the chordoma and benefit for the safety of endoscopic operation.     

创伤性胸腰椎骨折时后方韧带复合体的状态评估及其作用分析

目的 评估创伤性胸腰椎骨折时后方韧带复合体(PLC)的状态及分析其对确立诊治原则的作用.方法 选取2005年8月至2008年5月采用后路手术治疗的60例创伤性胸腰椎骨折患者,男性38例,女性22例,年龄21～65岁,平均34岁.根据AO胸腰椎骨折分类法,将其分为压缩或爆裂型骨折(A型)42例、屈曲牵张型损伤(B型)5例、骨折脱位型(C型)13例.采用磁共振成像(MRI)作为手术前PLC状态评估的主要方法,进行T1WI、T2WI、脂肪抑制序列扫描,并进行负片阅读.根据术前损伤节段处有无皮肤严重挫伤及凹陷、棘突间隙增宽及压痛,有无神经功能受累,X线或CT重建扫描有无椎体后凸或滑移的增加、关节突骨折或(半)脱位、棘突或椎板的横形骨折等进一步进行综合评估.与术中探查结果进行比较进行参数计算.结果 术前60例患者PLC状态评估的灵敏度、特异度、准确度、阳性预测值、阴性预测值、误诊率、漏诊率分别为85.3%、80.8%、83.3%、85.3%、80.8%、19.2%、14.7%.在剔除了13例骨折脱位型病例后,47例患者PLC状态评估的灵敏度、特异度、准确度、阳性预测值、阴性预测值、误诊率、漏诊率分别为81.0%、80.8%、80.9%、77.3%、84.0%、19.2%、19.0%.术前MRI诊断的假阴性及假阳性各有5例.结论 MRI是评估PLC状态的主要手段,尽管增加了脂肪抑制序列和负片阅读,目前仍不能完全准确地在术前判断PLC状态,必须结合相关的局部体检、其他影像学技术以及MRI图像上异常信号所出现的部位和损伤时间加以综合判断和分析.

Abstract：

Objectives To evaluate and analyze the role of posterior ligment complex (PLC) in determining therapeutic principle for traumatic thorac-lumbar fracture.Methods From August 2005 to May 2008,60 patients (38 male, 22 female) who suffered from the traumatic thoracic-lumbar fracture were carried out posterior operations.According to the Magerl traumatic thorac-lumbar fracture classification system, these cases were classified to subtype A, B and C.The average age was 34 years (21-65 years).Magnetic resonance imaging (MRI) scan, which including both T1/T2 weight and fat-stir sequence, as well as the MRI negative film reading technique were used to evaluate the state of PLC. Furthermore, related physical or neurological examinations( such as severe skin bruising and sinking, broadening spinous process gap and tenderness, spinal cord or nerve root injury ) and another X-ray or CT reconstruction films were taken to evaluate the the state of PLC synthetically.Above-mentioned results were compared with the final exploration results during operation and some parameters were analyzed. Results The sensitivity,specificity, accuracy, positive predictive value( PPV ), negative predictive value ( NPV ), misdiagnosis rate and rate of missed diagnosis of these sixty patients were 85.3%, 80.8%, 83.3%, 85.3% , 80.8%,19.2% , 14.7% respectively. After 13 cases of thoracic-lumbar fracture-dislocation were eliminated, the sensitivity, specificity, accuracy, PPV, NPV, misdiagnosis rate and rate of missed diagnosis of remaining 47 cases were 81.0% , 80.8% , 80.9% , 77.3% , 84.0% , 19.2%, 19.0% respectively. There were 5 cases with MRI negative results before operation but positive results during operation Contrarily, 5 cases with MRI positive results before operation but negative results during operation occurred. Conclusions MRI is a main means for evaluating the state of PLC. Although the MRI fat-stir sequence as well as the MRI negative film reading technique are adopted, the state of PLC can not be estimated exactly before operation (especially for those unfracture dislocation cases). In order to estimate the state of PLC exactly, the related local physical examination and image technology as well as the location of the abnormal image signal in MRI film and time of injury must be analyzed synthetically.     

节后段臂丛损伤磁共振成像IDEAL与STIR序列的比较

目的比较迭代最小二乘估算法水脂分离(IDEAL)序列与短反转时间的反转恢复(STIR)序列在创伤患者臂丛神经节后段的成像表现。方法 26例有颈肩部外伤病史且临床怀疑臂丛节后段损伤患者,随机分为两组,每组13例。使用GE Signa HDxt 1.5T磁共振机,一组行冠状位薄层IDEAL T2臂丛神经成像,另一组行STIR序列臂丛神经成像。对两种序列所得图像进行主观观察评分及客观测量SNR、CNR。结果 IDEAL序列成像质量好,主、客观评价都表明在节后段臂丛神经的显示能力上优于STIR序列。结论 IDEAL序列可代替STIR序列作为臂丛神经节后段损伤患者的常规扫描序列。     

薄层连续MRI扫描描记臂丛神经

目的 通过薄层连续MRI扫描显示臂丛神经形态。方法 采用1．5-T MRI(GE，Signa)对6例健康志愿者行双侧臂丛神经斜矢状位和冠状位扫描，确认其与周围组织解剖定位关系，并观察其走行和分支情况。结果 所有志愿者的臂丛神经均得到了较好的显示，斜矢状位T2加权压脂可明显显示臂丛神经及部分神经束，特别是神经根出口处可以得到很好的显示。结论 薄层连续MRI扫描可以显示臂丛神经的形态，可以提高其对臂丛损伤的诊断。     

MRI诊断臂丛神经及其疾病的研究进展

臂丛神经解剖关系复杂,而累及臂丛神经的疾病却属常见病,如何清晰、完全、直观、无创地显示臂丛神经及其病变,一直是医学影像学的难题。近年来,MRI技术的迅速发展,使清晰显示臂丛神经根束成为可能。本文围绕正常臂丛神经及臂丛疾病的MRI征象进行综述。     

薄层增强MRI多期扫描技术诊断功能性胰岛细胞瘤(附3例报告)

目的探讨薄层增强MRI多期扫描技术即探讨梯度回波MRI三维容积插入法屏气检查（volumetric interpolated breath-hold examination,3D-VIBE）序列对功能性胰岛细胞瘤的诊断价值。方法对3例临床以及实验室检查怀疑为功能性胰岛细胞瘤的患者，按以下顺序分别进行MRI常规轴位的T2W和T1W平扫、冠状位的真实稳态旋进快速成像（true fast imaging with steady state procession, True-FISP）、磁共振胆胰管成像（magnetic resonance cholangiopancreatography, MRCP）、轴位钆剂增强的3D-VIBE三期动态扫描和2DGRE T1W增强扫描。3D-VIBE三期扫描数据采集分别于注射对比剂后15、40及65s进行。将影像资料与手术和病理发现作对比分析。结果3D-VIBE序列的动脉早期、动脉晚期和门静脉期图像能准确显示功能性胰岛细胞瘤的微小病灶，并能反映病灶的血供特征，而其它常规MRI序列可能漏诊该病灶。结论薄层动态增强的MRI序列在功能性胰岛细胞瘤的显示和定性诊断中具有重要作用。     

臂丛MRI在臂丛神经节前损伤诊断中的临床效能分析

目的：探讨臂丛MRI在臂丛神经节前损伤诊断中的临床价值。方法45例临床诊断为臂丛神经损伤的患者,术前均采用1.5 T GE Signa EXCITE MRI扫描仪行双侧臂丛MRI扫描,同时所有患者均行锁骨上臂丛神经探查以及术中肌电图检查,将MRI扫描结果与手术所见及术中肌电图进行比较,分析臂丛MRI在节前损伤诊断中的准确率。结果45例共225根神经根,169根节前损伤,MRI共检出147根,MRI诊断总体准确率为86.2%,并且MRI检查距受伤时间与诊断准确率无明显相关性（P〉0.05）。结论臂丛MRI可以清晰地显示臂丛神经椎管内外的结构,对臂丛神经节前损伤可以提供准确而清晰的定位定性诊断,具有非常高的准确率,可以为临床诊断提供可靠参考,指导临床早期制定手术方案,有益于患者的预后。     

3.0T磁共振弥散张量成像技术对轻度脊髓型颈椎病的诊断价值

目的:评价3.0T磁共振弥散张量成像技术(diffusion tensor imaging,DTI)对轻度脊髓型颈椎病的诊断价值及可行性。方法:应用3.0T高场强磁共振DTI成像序列,观察22例健康志愿者88个节段(A组)和69例轻度脊髓型颈椎病患者(依据颈髓MRI平扫结果分B、C两组,B组39例患者,硬膜囊98个节段受压、颈髓信号正常;C组30例患者,颈髓65个节段受压、颈髓信号正常)颈髓的表观扩散系数(apparentdiffusioncoefficient,ADC)及分数各向异性值(fractional anisotropy,FA),分析3组颈髓ADC值、FA值之间差异。结果:A组(C3/C4、C4/C5、C5/C6、C6/C7)共88个节段之间ADC值及FA值差异无显著性(P>0.05),故合并88个椎体数据;A、B及C组ADC值分别为0.91±0.34、1.17±0.35及1.32±0.36,组间比较,ADC值A组最低,B组次之,C组最高(P值均<0.05);三组平均FA值分别为0.71±0.16、0.62±0.15及0.54±0.14,A组最高,B组次之,C组最低(P值均<0.05)。结论:颈髓DTI较常规MRI能够早期、准确地量化轻度脊髓型颈椎病的颈髓微结构改变,可以为临床医生更早诊断治疗轻度脊髓型颈椎病提供有利的影像学依据。     

肝脏炎性肌纤维母细胞瘤的多层螺旋CT及MRI表现

目的探讨肝脏炎性肌纤维母细胞瘤（HIMT）的多层螺旋CT（MSCT）及MRI影像特点。 方法回顾性分析2015年2月至2017年11月乐山市人民医院经手术病理证实的6例HIMT,术前2例行MSCT平扫,4例行MSCT平扫+增强扫描,4例行MRI平扫+增强扫描,CT未增强者均行MRI平扫+增强扫描,对患者肿瘤的部位、大小、密度/信号、形态、囊变、强化程度和方式进行评估。 结果6例HIMT患者MSCT显示均为稍低密度,MRI信号不均匀;5例动脉期边缘模糊强化,1例无明显强化,6例门脉期及延迟扫描期均有明显强化。 结论MSCT及MRI成像均能够明确显示HIMT的形态学改变、强化程度及方式,MRI多序列成像更能初步判断肿瘤内部的可能构成成分,尤其是病灶内部坏死区在T2WI压脂序列呈低信号对诊断更有重要参考价值。     

3.0 T MR弥散加权成像对鉴别胰腺癌与慢性肿块型胰腺炎的价值

目的探讨在3．0T磁共振（MR）平台上应用弥散加权成像（diffusion—weighted imaging，DWI）鉴别诊断胰腺癌与慢性肿块型胰腺炎的价值。方法纳入经手术病理和临床随访证实的胰腺癌患者13例、慢性肿块型胰腺炎患者7例和健康志愿者14例，在行上腹部常规MR扫描后进行胰腺DWI检查。采用自旋回波回波平面成像技术和空间敏感性编码技术，分别取弥散梯度b值=400、600、800和1000s／mm^2获得相应的DWI图像，测量感兴趣区（ROI）的ADC值，并进行统计学分析。结果①健康志愿者胰腺DWI呈中等信号。②胰腺癌患者癌组织在DWI上呈均匀高信号，边界较清楚；各b值（400、600、800和1000s／mm^2）下，测得ADC值分别为（1．63&#177;0．235）、（1．42&#177;0．126）、（1．36&#177;0．170）及（1．26&#177;0．178）&#215;10^-3mm^2／s，明显低于癌周胰腺组织[（2．11&#177;0．444）、（1．83&#177;0．230）、（1．81&#177;0．426）及（1．60&#177;0．230）&#215;10^-3mm^2／s]及健康志愿者胰腺的ADC值[（1．85&#177;0．350）、（1．69&#177;0．290）、（1．67&#177;0．268）及（1．42&#177;0．221）&#215;10^-3mm^2／s]，P〈0．05。③慢性肿块型胰腺炎在DWI上呈不均匀稍高信号，边界不清；各b值下测得ADC值分别为（1．69&#177;0．150）、（1．56&#177;0．119）、（1．59&#177;0．172）及（1．35&#177;0．080）&#215;10^-3mm^2／s，均高于胰腺癌组织的ADC值，但仅当b值-800s／mm^2时，与胰腺癌组织间差异有统计学意义（P〈0．05）。结论DWI可以清楚显示胰腺肿瘤病灶及范围，结合ADC的测量值能够为鉴别胰腺癌与慢性肿块型胰腺炎提供一定的信息。     

三维高时间分辨率MR血管减影成像诊断四肢软组织血管瘤

目的探讨四肢软组织血管瘤的常规MRI表现,评价三维高时间分辨率磁共振血管减影成像（3D-HR-MRI-SA）诊断该病的价值。方法对18例临床证实的四肢软组织血管瘤患者,采用3．0TMR机行常规MR平扫和增强扫描以及3D-HR-MRISA,观察3D-HR-MRISA显示供血动脉和引流静脉的能力。以4分法（0-3分）评价各序列对瘤灶的辨认能力。结果18例中,16例单发,2例多发,共20个病灶。17个瘤灶可见供血动脉,13个瘤灶可见引流静脉。脂肪抑制T2W1辨认瘤灶范围的累积评分（2．78±0．44）优于T1wI（1．67±1．00,P=0．013）、T2w1（2．33±0．50,P=0．035）及3I）-HR_MRIsA原始图像（1．89±0．60,P=0．009）,与脂肪抑制增强T1WI差异无统计学意义（2．33士0．71,P=0．169）,而脂肪抑制增强T1WI辨认瘤灶范围的能力优于3D-HR-MRISA原始图像（P=0．035）。结论3D-HR—MRISA可初步评估血管瘤的血流动力学状态,有利于临床制定诊疗方案,但在显示瘤灶范围及其与周围结构的关系方面不可替代常规序列MRI。     

三维颅脑容积成像增强扫描显示颈静脉孔区脑神经病变

目的 观察三维颅脑容积成像（3D-BRAVO）增强序列显示颈静脉孔区脑神经病变的价值。方法 纳入22例静脉孔区脑神经病变患者,包括脑膜癌病10例、神经鞘瘤6例、神经纤维瘤2例,梅毒、脑膜瘤、脊索瘤及甲状腺乳头状癌转移癌各1例,分析其常规平扫序列、增强扫描及3D-BRAVO增强序列图像,对薄层图像行多平面重建,对比观察各序列显示静脉孔区脑神经病变的效果。结果 常规平扫及增强MRI仅能显示低位脑神经的脑池段。颈静脉孔内静脉丛在增强序列3D-BRAVO中强化明显,其内走行的神经呈线状低信号,与静脉丛形成鲜明对比,利于评估病变对神经的压迫和浸润程度。结论 增强序列3D-BRAVO可清晰显示颈静脉孔区病变压迫、浸润和累及神经情况。     

前交叉韧带损伤:3.0TMR影像与关节镜对照分析

目的分析膝关节前交叉韧带损伤的3．0TMRI特征,并与关节镜手术结果对照。方法回顾性分析来我院行3．0T MR膝关节检查的36例前交叉韧带损伤患者的40个膝关节,全部病例经关节镜检查确诊。应用3．0T MR机（Philips Achieva型）,膝关节专用线圈,进行斜矢状位TSE T1WI、TSE T2WI、PD-SPIR和冠状位、轴位TSE T2WI扫描。前交叉韧带损伤分为完全断裂、撕裂（部分断裂）及胫骨端撕脱。将膝关节前交叉韧带损伤的3．0T MR影像特征与关节镜手术结果进行对照分析。结果前交叉韧带完全断裂MRI直接征象表现为韧带连续性中断,断端肿胀（21／25）,间接征象为交叉韧带过度弯曲、T2WI和PD-SPIR股骨髁间窝外侧骨挫伤;MRI与关节镜诊断完全符合率为84．00％。前交叉韧带撕裂（部分断裂）MRI直接征象为ACL矢状T2WI和PD-SPIR显示形态不规则、部分撕裂,ACL局部肿胀增粗,信号增高,仍可见连续存在的纤维低信号;MRI与关节镜诊断完全符合率为66．67％。前交叉韧带胫骨端撕脱MR检查直接征像为胫骨近端可见T1WI、T2WI低信号撕脱骨片（3／3）,ACL水肿、形态不规则,周围可见出血、积液,MRI与关节镜诊断符合率为100％。结论高场强3．0TMR膝关节诊断的多平面、多序列影像相结合可形成ACL立体影像观,结合临床能够有效诊断ACL损伤。