磁共振成像对创伤性臂丛神经损伤的诊断价值

Diagnostic Value of Magnetic Resonance Imaging in Traumatic Brachial Plexus Injury

目的:探究磁共振成像在创伤性臂丛神经损伤中的诊断价值。方法:回顾性分析41例创伤性臂丛神经损伤的磁共振表现,并与手术探查结果作对比。结果:MRI诊断与手术探查在诊断神经周围水肿、瘢痕、神经瘤、根性撕脱伤、节后神经断裂以及创伤性脊膜囊肿方面差异均不具有统计学意义(P>0.05)。MRI诊断神经周围水肿、瘢痕、神经瘤、根性撕脱伤、节后神经断裂以及创伤性脊膜囊肿的敏感性分别为86.8%、65.4%、57.1%、78.6%、66.7%、78.2%;特异性分别为66.7%、86.7%、100.0%、92.3%、82.3%、94.4%;准确度分别为82.9%、73.2%、92.7%、80.5%、73.2%、85.4%;阳性预测值分别为97.1%、89.5、100.0%、91.7%、84.2%、94.7%;阴性预测值分别为28.6%、59.1%、91.9%、64.7%、63.6%、77.3%。若将创伤性脊膜囊肿作为诊断根性撕脱伤的依据,其敏感性、特异性及准确度均较低,分别为57.1%、45.5%、63.4%。结论:MRI在臂丛神经诊断时存在对神经周围水肿、瘢痕、神经瘤及部分节后神经断裂等误诊或过度诊断的情况,但仍可作为首选的诊断方式;创伤性脊膜囊肿对诊断根性撕脱伤有提示意义,但不能作为诊断臂丛神经根性撕脱伤的标准。

Objective:To explore the diagnostic value of magnetic resonance imaging in traumatic brachial plexus injury.Methods:the MRI findings of 41 cases of traumatic brachial plexus injury were analyzed retrospectively and compared with the results of surgical exploration.Results:there was no significant difference between MRI diagnosis and surgical exploration in the diagnosis of peripheral edema,scar,neuroma,root avulsion injury,postganglionic nerve rupture and traumatic meningeal cyst(P>0.05).The sensitivity of MRI in the diagnosis of peripheral edema,scar,neuroma,root avulsion injury,postganglionic nerve rupture and traumatic meningeal cyst were 86.8%,65.4%,57.1%,78.6%,66.7%and 78.2%,respectively;The specificity was 66.7%,86.7%,100.0%,92.3%,82.3%and 94.4%,respectively;The accuracy was 82.9%,73.2%,92.7%,80.5%,73.2%and 85.4%respectively;The positive predictive values were 97.1%,89.5%,100.0%,91.7%,84.2%and 94.7%,respectively;The negative predictive values were 28.6%,59.1%,91.9%,64.7%,63.6%and 77.3%respectively.If the traumatic meningeal cyst is used as the basis for the diagnosis of root avulsion injury,its sensitivity,specificity and accuracy are low,57.1%,45.5%and63.4%respectively.Conclusion:MRI has misdiagnosis or over diagnosis of peripheral edema,scar,neuroma and partial postganglionic nerve rupture in the diagnosis of brachial plexus;Traumatic meningeal cyst has suggestive significance in the diagnosis of root avulsion injury,but it can not be used as the standard for the diagnosis of brachial plexus root avulsion injury.