增强磁共振神经成像(ceMRN)在成人臂丛神经损伤术前评估中的价值

The Value of Contrast Enhanced Magnetic Resonance Neurography(ceMRN)in Preoperative Evaluation of Brachial Plexus Injury in Adults

目的探讨增强磁共振神经成像(ceMRN)在成人臂丛神经损伤(BPI)术前评估中的价值。方法回顾性分析2016年8月至2019年7月华中科技大学同济医学院附属协和医院收治的28例BPI患者的影像学资料和手术记录,建立基于ceMRN的BPI分类方法,比较ceMRN分类和术中探查结果的一致性。结果ceMRN分类方法将BPI分为4类:0类,无神经损伤征象;1类,神经连续性存在,信号和(或)形态异常;2类,神经连续性中断,脊髓侧有神经根残留;3类,神经连续性中断,脊髓侧无神经根残留。基于ceMRN对损伤神经的定位与手术分型具有很高的符合率(93.3%),ceMRN分类与术中探查病理分类具有良好的一致性(Kappa=0.882),ceMRN分类中1~3类神经损伤与术中探查结果具有很高的符合率(分别为94.1%、90.9%和98.0%)。结论BPI的ceMRN分类方法与手术发现具有高度一致性,ceMRN对BPI的术前评估具有重要价值。

Objective To evaluate the value of contrast enhanced magnetic resonance neurography(ceMRN)in preoperative evaluation of brachial plexus injury(BPI)in adults.Methods The imaging data and surgical records of 28 BPI patients admitted to our hospital from August 2016 to July 2019 were retrospectively analyzed.A classification method of brachial plexus nerve injury based on ceMRN was established to compare the consistency of ceMRN classification and intraoperative exploration results.Results The BPI was divided into four categories by ceMRN classification method:Type 0,no sign of neural injury;Type 1,continuous nerve with signal and/or morphological abnormalities;Type 2,nerve continuity was interrupted with nerve signal residue on the spinal cord;Type 3,Nerve continuity was interrupted without nerve signal residue on the spinal cord side.The ceMRN classification had a high coincidence rate(93.3%)in the localization and surgical classification of injured nerves;the ceMRN classification had a good consistency with the intraoperative exploration pathological classification(Kappa=0.882);the ceMRN classification had high coincidence rates(94.1%,90.9%and 98.0%,respectively)in the type 1 to 3 nerve injuries with intraoperative exploration results.Conclusion The ceMRN classification method of BPI is highly consistent with the surgical findings,which is of great value to the preoperative evaluation of BPI.