磁共振臂丛神经成像在神经型胸廓出口综合征诊断与治疗中的应用评价

关键词：神经型胸廓出口综合征  磁共振神经成像  臂丛神经卡压

Keywords:neurogenic thoracic outlet syndrome  magnetic resonance neurography  brachial plexus compression

摘要：

      摘要 目的：评价磁共振臂丛神经成像在神经型胸廓出口综合征的应用价值。 方法：将30例拟诊为神经型胸廓出口综合征患者设为观察组，于治疗前、治疗后1个月分别行3.0T磁共振臂丛神经成像（MRN）的3D-STIR序列平扫+增强扫描检查，前后进行图像配准分析；对照组为20例非颈肩部疼痛的同龄段健康人，行3.0T磁共振臂丛MRN的3D-STIR序列平扫和增强检查，与观察组治疗前进行图像比对分析；观察臂丛神经及其周围斜角肌组织情况。 结果：治疗前的30例患者臂丛神经MRN平扫检查，其中有27例臂丛神经走形正常，2例提示臂丛神经根有神经鞘囊肿，1例臂丛神经存在压迫，增强扫描臂丛神经和周围斜角肌组织未见异常强化；治疗1个月后复查臂丛神经MRN平扫和增强图像，与治疗前图像对比观察，臂丛神经和周围斜角肌组织未见明显异常变化。20例同龄段非颈肩上臂疼痛体检者，17例臂丛神经MRN正常，3例提示臂丛神经根有神经根鞘囊肿，增强后扫描臂丛神经和周围斜角肌组织未见异常强化，与患者治疗前图像对比未见异常变化。 结论：高分辨率3.0T臂丛MRN平扫和增强可以检查出神经型胸廓出口综合征臂丛神经卡压部位。

Abstract:

      Abstract Objective：To observe the examination value of brachial plexus magnetic resonance neurography in diagnosis and treatment of neurogenic thoracic outlet syndrome. Method：Thirty patients with neurogenic thoracic outlet syndrome（NTOS） were selected as the observation group. Before and one month after treatment， brachial plexus 3.0Tmagnetic resonance neurography (MRN) 3D-STIR (short tau inversion recovery) sequence plain scan and enhanced scan were performed respectively，and image registration analysis was performed before and after treatment. In the control group， twenty healthy people of the same age were examined with 3.0T MR brachial plexus MRN in 3D-STIR sequence， and compared with the images of the observation group before treatment to observe the brachial plexus nerve and its surrounding scalenus. Result：Before treatment， MRN plain scan of brachial plexus was performed in 30 patients， including 27 patients with normal shape of brachial plexus， 2 patients with cyst of nerve sheath in brachial plexus nerve root， 1 patient with compression of brachial plexus nerve， and no abnormal enhancement of brachial plexus nerve and peripheral scalenus muscle tissue was found by enhanced scan. After treatment，no obvious abnormal changes were found in brachial plexus nerve and periscalene muscle in MRN plain scan and enhanced images. The MRN of the brachial plexus was normal in 17 of the 20 control patients at the same age with non neck shoulder and upper arm pain. The MRN of the brachial plexus indicated a cyst of nerve root sheath in the brachial plexus nerve root in 3 of the 20 controls. After enhancement， the scanning of the brachial plexus and the surrounding scalenus muscle tissue did not show abnormal enhancement，and no abnormal change was found compared with the image before treatment. Conclusion：High resolution 3.0T MRN of brachial plexus can detect the entrapment site of brachial plexus in neurothoracic outlet syndrome.