神經節前臂神經叢撕脫損傷的磁振造影評估

MR Image Evaluation of Pre-Ganglionic Brachial Plexus Avulsion Injury

張見仲(Chien-Chung Chang) ； 饒啟明(Kee-Min Yeow) ； 吳政賢(Cheng-Hsien Wu) ； 趙文淵(Wen-Yuen Chao) ； 李朝卿(Chao-Chin Lee) ； 劉聖山(Sheng-Shan Liu) ； 陳芊曄(Chien-Yeh Chen) ； 曾振輝(Jeng-Hwei Tseng)

《中華放射線技術學雜誌》 34卷1期 (2010/03) Pp. 1-8

https://doi.org/10.30045/CJRT.201003.0001

摘要

在我們的研究中，使用了核磁共振(magnetic resonance, MR)的三維(three dimensional, 3D)運用穩定態取像之快速造影(fast imaging employing steady-state acquisition, FIESTA)序列來檢查單側神經節前臂神經叢撕脫損傷(pre-ganglionic brachial plexus avulsion injury)的30位病患，此研究共為患者以曲面重建(curved planar reformation, CPR)技術取得300束患側及300束健側在第五頸椎神經根至第一胸椎神經根(C5-T1)正常與損傷的腹面(ventral)、背面(dorsal)頸椎神經節前神經叢影像，目的是評估CPR技術在神經節前臂神經叢損傷的影像效果。影像可以顯示：部分中斷的撕脫損傷神經叢、神經叢袖處(sleeve)完全空的神經根、呈現撕脫性的水囊，以及完整的神經叢。結果可呈現患側95.3%(286/300)的神經叢影像，但是仍有4.7%(14/300)的神經叢影像無法診斷，原因是損傷導致的沾黏(adhesion)和造成影像底部的FIESTA序列固有假影。研究證實CPR重組原始MR 3D FIESTA之影像可成功完成每一節頸椎神經叢的定位並區別腹面及背面神經叢。此方法所得到完整清晰的神經叢解剖外型也令人更有自信的判讀。相信這個MR 3D FIESTA附加使用CPR技術，是可以滿足放射科醫師的影像診斷需求及降低判讀時間；以及提供整形外科醫師術前評估手術修復或重建神經的依據。

關鍵字

運用穩定態取像之快速造影 ； 神經節前臂神經叢撕脫損傷 ； 曲面重建

並列摘要

In our study, 30 unilateral brachial plexus injury patients were evaluated using MR 3D fast imaging employing steady-state acquisition (FIESTA). For each normal and injured side of C5 to T1 ventral and dorsal nerve rootlets, 300 levels of curve planar reformat (CPR) images of the normal and injured intraspinal pre-ganglionic segments were obtained. Our purpose was to evaluate the efficacy of CPR for the demonstration of injury to the pre-ganglionic segments of brachial plexus. Imaging findings were interruption of any nerve rootlets, no demonstrable nerve rootlets with an empty nerve root sleeve, presence of an avulsion cyst, and normal nerve rootlets. Our results disclosed that the injured as well normal nerve rootlets were demonstrated in 95.3% (286/300) of instance. There is a failure rate of 4.7% (14/300), which were accounted by severe adhesion at site of injury, and artifact at the bottom of the image caused by signal dropout inherent to the FIESTA technique. The good image quality, side-by-side comparison of normal and injured nerve rootlets permitted by the CPR images, have expedited and increased the confidence of our radiologist in arriving at an image diagnosis. We conclude that imaging of pre-ganglionic brachial plexus avulsion injury using FIESTA accompanied by CPR was well accepted by our radiologist and provided valuable data for helping plastic surgeon to proceed with exploration, nerve repair, primary reconstruction.

並列關鍵字

fast imaging employing steady-state acquisition ； pre-ganglionic brachial plexus avulsion injury ； curved planar reformation