摘要
目的评价脊髓造影后CT扫描(CTM)诊断臂丛神经节前损伤的临床应用。方法27例臂丛神经损伤患者术前做脊髓造影后,使用GECT/e单排螺旋CT机薄层螺旋扫描,骨重建获取影像。由高年资医生阅片做CTM影像诊断,临床臂丛神经探查术及术后随访结果作为金标准计算CTM诊断的准确性。结果臂丛神经节前损伤CTM的直接征象是椎管内不同节段患侧颈神经根充盈缺损连续性消失,共91个。间接征象为(1)假性脊膜膨出患侧硬膜囊失去正常形态,为片状高密度影替代,并可沿椎间孔向外延伸,形成神经根鞘膜囊肿,与蛛网膜下腔间有细线状分隔44个。(2)蛛网膜囊肿硬膜囊一侧膨大变形呈囊样扩张,与蛛网膜下腔间无细线状分隔17个。(3)蛛网膜下腔不对称一侧腔变窄,脊髓有或无移位27个。(4)硬膜囊壁不完整一侧囊腔闭锁,脊髓表面部分裸露3个。直接征象阳性,加上间接征象之一,则诊断为臂丛神经节前损伤。27例患者CTM共检出神经根128个,诊断神经根损伤91个,正常37个。手术及随访证实真阳性84个,假阳性7个,真阴性34个,假阴性3个。CTM检查的敏感度、特异度及准确度分别为966%、829%及922%。结论CTM可以清楚显示臂丛神经节前段并准确诊断其损伤和部位。
Objective To evaluate the diagnostic value of CT myelography (CTM) in brachial plexus injury. Methods Twenty-seven patients with brachial plexus injury were examined by using cervical CTM with spiral scan and bone reconstruction algorithm. CT images were reviewed by the senior radiologists, who determined if the nerve root avulsion was presented. The criteria of diagnosing nerve root avulsion were loss of normal nerve root appearance in the Isovist filled thecal sac in consecutive CTM slices plus companion signs. The sensitivity, specificity, and accuracy of CTM in diagnosing nerve root injuries were calculated with operation findings and follow-up results as gold standard. Results Direct sign of nerve root avulsion was the loss of normal nerve root defect seen in the Isovist filled thecal sac in consecutive CTM slices. Indirect signs included: (1) Pseudomeningocele bulge: The leak of Isovist into nerve root sheath, and extended into foramina; (2) Arachnoid cyst: displacement of spinal cord; (3) Dissymmetry of subarachnoid cavity: deformity of thecal sac, partially lack of Isovist into arachnoid space; (4) Non-integrity of dural capsule wall: one side of capsule cavity was obstructed. Part of the surface of spinal cord was exposed. Brachial plexus injury could be diagnosed by direct sign with one of the indirect signs. Of the 27 patients (128 nerve roots), 91 nerve root avulsions were found on CTM, and 37 was found normal. Compared with operation findings, 84 were true positive, 7 false positive, 34 true negative, and 3 false negative. Based on these results, the sensitivity, specificity, and accuracy were 96.6%, 82.9%, and 92.2%, respectively. Conclusion CTM is accurate in detecting nerve root avulsion of brachial plexus.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2005年第2期144-148,共5页
Chinese Journal of Radiology
