MR扩散加权神经成像技术在非创伤性上肢神经扭转中的应用分析

The Application of MR Diffusion Weighted Imaging Technique in Non-traumatic Upper Limb Nerve Torsion

目的:研究并探讨磁共振(magnetic resonance,MR)扩散加权神经成像(Diffusion weighted imaging,DWI)技术在非创伤性上肢神经扭转诊断中的应用效果。方法:选择2015年1月-2017年12月本院共接收的75例疑似非创伤性上肢神经扭转患者为研究对象,所有患者均接受手术治疗,术前均接受上肢神经超声检查、磁共振扩散加权神经成像检查,由2名高年资诊断医师对超声图像、磁共振扩散加权图像进行分析,做出诊断,分析上肢神经超声检查、磁共振扩散加权神经成像检查的诊断结果,以手术确诊结果为参照,计算上肢神经超声检查、磁共振扩散加权神经成像检查对非创伤性上肢神经扭转的诊断灵敏度、特异度、准确性,再采用Kappa一致性检验,分析上肢神经超声、磁共振扩散加权神经成像诊断结果与手术确诊结果之间的一致性。根据手术确诊结果,将75例疑似非创伤性上肢神经扭转患者分为上肢神经扭转组、无上肢神经扭转组,比较两组患者在不同b值下的表观扩散系数(Apparent diffusion coefficient,ADC),并采用皮尔逊相关系数分析法,分析ADC值与上肢神经扭转的相关性。结果:上肢神经超声检查对非创伤性上肢神经扭转的诊断灵敏度、特异度、准确性分别为86.21%、64.71%、81.33%,磁共振扩散加权神经成像分别为96.55%、94.12%、96.00%,两者比较差异均有统计学意义(P<0.05)。经Kappa一致性检验,磁共振扩散加权神经成像诊断结果与手术确诊结果之间的一致性良好,而上肢神经超声诊断结果与手术确诊结果之间的一致性仅为中等。在b值分别为600、800、1 000 s/mm^2时,上肢神经扭转组患者的ADC值均低于无上肢神经扭转组(P<0.05)。经相关性分析,ADC值与非创伤性上肢神经扭转呈负相关(r=-0.731,P<0.05)。结论:磁共振扩散加权神经成像对非创伤性上肢神经扭转具有显著的诊断价值,可对非创伤性上肢神经扭转予以准确检出,其诊断准确性优于上肢神经超声检查。

Objective：To study and explore the application effect of magnetic resonance（MR） diffusion weighted imaging（DWI） technique in non-traumatic upper limb nerve torsion diagnosis.Method：From January 2015 to December 2017,75 patients with suspected non-traumatic upper limb nerve torsion received by our hospital were selected as the study subjects,all the patients were treated by surgery,the upper limb nerve was examined by ultrasound and MR diffusion weighted imaging before operation,two senior diagnostic physicians analyzed and diagnosed the ultrasound images and the diffusion weighted images of MRI,and analyzed the diagnostic results of the upper limb nerve ultrasound examination and the magnetic resonance diffusion weighted imaging,according to the results of surgical diagnosis,the sensitivity,specificity and accuracy of ultrasonic examination of upper limb nerve and magnetic resonance diffusion weighted imaging in the diagnosis of nontraumatic upper limb nerve torsion were calculated.Then Kappa consistency test was used to analyze the consistency between the diagnostic results of upper limb nerve ultrasound,MR diffusion weighted imaging and surgical diagnosis.According to the results of surgical diagnosis,75 cases of suspected non-traumatic upper limb nerve torsion were divided into upper limb torsion group and no upper limb nerve torsion group,comparison of apparent diffusivity coefficient（ADC）between two groups of patients at different b values,Pearson correlation coefficient analysis was used to analyze the correlation between ADC value and upper limb nerve torsion.Result：The diagnostic sensitivity,specificity and accuracy of ultrasonic examination of upper limb nerve torsion were 86.21%,64.71% and 81.33%,respectively,the MR diffusion weighted imaging were 96.55%,94.12% and 96.00% respectively,there were significant differences between the two groups（P〈0.05）.By Kappa consistency test,the results of MR diffusion weighted imaging and surgical diagnosis were in good agreement,while the results of upper extremity ultrasound diagnosis and surgical diagnosis were only moderate.When the b values were 600,800,1 000 s/mm^2,the ADC values of patients with upper limb nerve torsion were lower than those without upper limb torsion（P〈0.05）.There was a negative correlation between ADC value and non-traumatic upper limb torsion（r=-0.731,P〈0.05）.Conclusion：MR diffusion weighted imaging has significant diagnostic value for non-traumatic upper limb nerve torsion and can be accurately detected,the diagnostic accuracy of MR diffusion weighted imaging is better than that of ultrasonic examination of upper limb nerve.