脊髓造影后64排螺旋CT诊断臂丛神经节前损伤

Diagnosis of brachial plexus injury by 64-slice CT-myelography

目的探讨脊髓造影后64排螺旋CT扫描对臂丛神经节前损伤的诊断价值。方法22例臂丛神经损伤患者行脊髓造影后,采用东芝Aquilin64排CT扫描机薄层螺旋扫描。分析CTM图像,以手术探查结果为金标准。结果臂丛神经节前损伤的直接征象包括神经根缺失、神经根断裂、神经根部分根丝断裂;间接征象包括创伤性脊膜囊肿、硬膜囊变形、脊髓表面部分裸露等。本组患者CTM检查共检出异常神经根73个。计算CTM诊断的灵敏度、特异度和准确度分别为93.4%、93.3%和93.4%;阳性预测值和阴性预测值分别为97.3%和84.8%。结论64排螺旋CT在扫描层厚与曲面重建等方面的优势进一步提高了诊断的特异度,但仍存在一定的假阴性率。

Objective To evaluate 64-slice CT-myelography（CTM）in diagnosing brachial plexus pre-ganglionic injury.Methods Twenty-two cases with brachial plexus injury underwent 64-slice CT scanning after myelography.Images of CTM were reviewed with surgical findings as gold standard.Results Direct signs of brachial plexus pre-ganglionic injury included lack of nerve root,rupture of nerve root,and rupture of partial cercical rootlets.Indirect signs included post-traumatic spinal meningocele,deformity of dural capsule,exposure of part of the surface of spinal cord,et al.CTM detected 73 injured nerve root.The sensitivity,specificity and accuracy were 93.4%,93.3% and 93.4%,respectively.The positive predictive value and negtive predictive value were 97.3% and 84.8%,respectively.Conclusion The thin thikness and curvical planar reconstruction function of 64-slice CT may improve the specificity of diagnosis of brachial plexus pre-ganglionic injuries.But there is probability of false negative.