CAJ | 학술논문

目的探讨MR扩散加权神经成像技术(DW-MRN)显示腕掌部正中神经、尺神经及其分支的价值.方法前瞻性收集42名志愿者和7例可疑腕掌部神经病变的患者,行腕掌部DW-MRN序列和脂肪抑制质子加权成像(FS-PDWI)序列扫描.先由2名医师采用双盲法分别阅片,对DW-MRN序列腕掌部正中神经及尺神经的显示情况进行评分,再共同对DW-MRN及FS-PDWI图像进行分析,计算不同序列图像中可清晰显示的正中神经主干,尺神经主干,第一、二、三指掌侧总神经及尺神经深支、浅支的数目,并观察7例腕掌部神经病变患者DW-MRN序列图像上神经与病变关系的显示情况.2名阅片者评分结果进行一致性检验,2种成像序列对志愿者腕掌部神经显示情况的比较采用配对资料x2检验.结果 2名阅片者对正中神经显示的评分均为(4.0±0.0)分,阅片者间的一致性好(Kappa值=1.000);对尺神经显示的评分分别为(3.45 ±0.74)和(3.43±0.67)分,阅片者间的一致性良好(Kappa值=0.793).42名志愿者中,DW-MRN图像上能清晰显示正中神经主干、尺神经主干、第一指掌侧总神经、第二指掌侧总神经、第三指掌侧总神经、尺神经深支、尺神经浅支者分别42、42、42、42、42、38和37名,FS-PDWI图像上分别为42、39、27、28、25、17和21名,DW-MRN图像对第一、二、三指掌侧总神经及尺神经深支、浅支的显示优于FS-PDWI图像,差异有统计学意义(x2值分别为18.26、16.80、21.31、23.23和14.26,P均＜0.01),对正中神经主干和尺神经主干的显示2种序列差异无统计学意义(P＞0.05).7例腕掌部神经病变患者DW-MRN序列均能明确显示病变范围及其与神经的关系.结论 DW-MRN技术能清晰显示腕部正中神经及尺神经主干,第一、二、三指掌侧总神经,尺神经浅支、深支,并能清晰显示病变范围及其与神经的关系.
목적 탐토MR확산가권신경성상기술(DW-MRN)현시완장부정중신경、척신경급기분지적개치.방법 전첨성수집42명지원자화7례가의완장부신경병변적환자,행완장부DW-MRN서렬화지방억제질자가권성상(FS-PDWI)서렬소묘.선유2명의사채용쌍맹법분별열편,대DW-MRN서렬완장부정중신경급척신경적현시정황진행평분,재공동대DW-MRN급FS-PDWI도상진행분석,계산불동서렬도상중가청석현시적정중신경주간,척신경주간,제일、이、삼지장측총신경급척신경심지、천지적수목,병관찰7례완장부신경병변환자DW-MRN서렬도상상신경여병변관계적현시정황.2명열편자평분결과진행일치성검험,2충성상서렬대지원자완장부신경현시정황적비교채용배대자료x2검험.결과 2명열편자대정중신경현시적평분균위(4.0±0.0)분,열편자간적일치성호(Kappa치=1.000);대척신경현시적평분분별위(3.45 ±0.74)화(3.43±0.67)분,열편자간적일치성량호(Kappa치=0.793).42명지원자중,DW-MRN도상상능청석현시정중신경주간、척신경주간、제일지장측총신경、제이지장측총신경、제삼지장측총신경、척신경심지、척신경천지자분별42、42、42、42、42、38화37명,FS-PDWI도상상분별위42、39、27、28、25、17화21명,DW-MRN도상대제일、이、삼지장측총신경급척신경심지、천지적현시우우FS-PDWI도상,차이유통계학의의(x2치분별위18.26、16.80、21.31、23.23화14.26,P균＜0.01),대정중신경주간화척신경주간적현시2충서렬차이무통계학의의(P＞0.05).7례완장부신경병변환자DW-MRN서렬균능명학현시병변범위급기여신경적관계.결론 DW-MRN기술능청석현시완부정중신경급척신경주간,제일、이、삼지장측총신경,척신경천지、심지,병능청석현시병변범위급기여신경적관계.
Objective To evaluate the feasibility and clinical value of diffusion weighted MR neurograph(DW-MRN) in the median nerve and ulnar nerve at the wrist and palm.Methods Forty two healthy volunteers and 7 patients whose electromyography indicated the median or ulnar nerve injury underwent fat suppression proton density-weighted imaging(FS-PDWI) and DW-MRN imaging.The certainty of identifying the nerves at the wrist and palm were analyzed by 2 experienced neuroradiologists independently using a four-point grading scale on the basis of shape of nerve depiction and the signal intensity.Interobserver agreement for visualization scores was calculated using the Kappa statistic.The number of the trunk of median nerve and ulnar nerve,palm digitalnerve,deep and superficial branch of ulnar nerve which can be visualized in DW-MRN and FS-PDWI of 42 volunteers was compared by using Chisquare test.Two radiologists reviewed DW-MRN images in patients and analyzed the clinical value of DW-MRN.Results The mean scores of the median nerve were(4.0±0.0) and(4.0±0.0) for observers 1 and 2,respectively.Interobserver agreement was good(Kappa =1.000).The mean scores of ulnar nerve were(3.45±0.74) and(3.43±0.67) for observers 1 and 2,respectively.Interobserver agreement was good(Kappa =0.793).The numbers of visualized trunk of median nerve and ulnar nerve,palm digitalnerve,deep and superficial branch of ulnar nerve were 42,42,42,42,42,38,37 on DW-MRN and 42,39,27,28,25,17,21 on FS-PDWI sequence.The percentage of visualized palm digital nerve,deep and superficial branch of ulnar nerve on DW-MRN were higher than those on FS-PDWI sequence(x2value were18.26,16.80,21.31,23.23,14.26,P＜0.05).The extent of lesions and the relationship with nerves were displayed clearly on DW-MRN images of 7 patients.Conclusion DW-MRN can provide a three dimensional visualization of the median nerve and ulnar nerve at the wrist and palm and can display the extent of the lesions and the relationship with nerves in patients clearly.