| Objective: brachial plexus nerve injury is emphasis and difficulty ofperipheral nerve injury with complex pathogenetic condition, poor efficacyand high disability rate, mostly occurring in young adults.Brachial plexusnerve root injury is the most serious type, and root preganglionic injury has noself-healing capability, and early surgery is the only option.Early and accuratepreoperative diagnosis is of important significance on choosing of clinicaltreatment and improving patient prognosis.In the past, the diagnosis ofbrachial plexus nerve root injury relied on clinical detailed sensorimotorfunction test and conventional electrophysiological examination, but severityand nature of injury could not be identified.Currently, with the development ofimaging techniques, great progress has been made in the diagnosis of brachialplexus nerve injury.MRI provides stereoscopic multi-oriented and multi-planarimaging with high tissue resolution, has an obvious advantage in displayingspinal structure and can display injury severity and nature of intra-spinalbrachial plexus nerve rootlet clearly.Through the retrospective analysis ofclinical and MRI data of29cases of patients with clinically suspectedbranchial plexus nerve preganglionic injury before operation, and comparisonwith intra-operative findings and intra-operative electrophysiologicalexamination, this thesis is aimed to discuss the imaging features anddiagnostic values of MRI direct sign and traumatic meningeal cyst to branchialplexus nerve preganglionic complete injury.Methods: retrospective analysis of clinical and MRI data of29cases ofpatients with clinically suspected branchial plexus nerve preganglionic injurybefore operation, including28cases of male and1cases of female, thepatients ranged in age from17to65with the mean age of30.2;14cases ofleft side and15cases of right side; and14cases of road traffic injury,9cases of machinery traction injury,4cases of tamp injury and2cases of high fallinginjury.All of these29patients received magnetic resonance examination,among whom,25patients received surgical exploration and intra-operativeelectrophysiological examination.Number of nerve roots of direct signs andtraumatic meningeal cysts in magnetic resonance examination, which werediagnosed as preganglionic complete injury and partial injury were counted uprespectively, and with surgical exploration result and intra-operativeelectrophysiological examination result as determination standard, treatingpreganglionic partial injury and no injury as preganglionic incomplete injury,the sensitivity, specificity and accuracy of direct signs and traumaticmeningeal cysts in resonance examination towards preganglionic completeinjury were calculated respectively.Statistical method: SPSS13.0statisticalsoftware was used for statistical analysis of experimental data with chi-squaretest, preoperative MRI examination results were wrote into fourfold tablerespectively, and with surgical exploration result and intra-operativeelectrophysiological examination result as determination standard, thesensitivity, specificity and accuracy of direct signs and traumatic meningealcysts in preoperative MRI examination towards preganglionic complete injurywere calculated respectively.Result: among29cases of patients,4cases showed no obviousabnormality in MRI examination, which were improved by conservativeobserved treatment; and25cases of patients were confirmed by surgicalexploration and intra-operative electrophysiological examination.MRIexamination result of branchial plexus nerve preganglionic injury:1. directsign:(1)53nerves with complete injury:①28nerves withnerve root filiformtexture disappeared②18nerves with nerve root filiform texture broken③7nerves with nerve rootlet thickened, twisted or stiff travelling route withdisordered structure, which could not be traced to intervertebral foramencontinuously.(2)18nerves with partial injury:①7nerves with significantlyless nerve rootlets on the affected side than the healthy side of the coronalplane②11nerves with intra-spinal anterior root or posterior root broken or disappeared with posterior root or anterior root continued, broken ordisappeared in cross section and reconstructed image.2. indirect sign①collection of intra-spinal cerebrospinal fluid and traumatic meningeal cysts:Different shapes of cysts beside spinal cord, single or multiple hyper-intensesignals of cysts.51nerves in total were found in MRI data.②Nerve rootsleeves are of abnormal shapes and asymmetric on two sides:16nerves werefound in this group.③Black line sign: line shaped low-intense signal wasfound in hyper-intense signal of meningeal cyst formed due to cerebrospinalfluid leakage.12cased were found in this group.④Spinal cord shift ordeformation: spinal cord shifts to one side.27cases were found in this group,and all of spinal cord shifted to the health side with cerebrospinal fluid leakageand traumatic meningeal cysts.⑤Abnormal signal of paravertebral muscle:slight hyper-intense signal of paravertebral muscle atrophy.6cased were foundin this group.⑥Spinal cord injury: strip or patch shaped slight hyper-intensesignals in spinal cord showed on coronal plane.4cased were found in thisgroup.Statistical result: chi-square test was used with α=0.05as level ofsignificance to make comparison between examination results of MRI directsign and traumatic meningeal cyst, as well as surgery and intra-operativeelectrophysiological examination result, P＞0.05, and no significant differencewas found.Results testified by surgery and intra-operative electrophysiologicalexamination:57nerves with preganglionic complete injury;53nerves withdirect sign showed on MRI, including48nerves testified by intra-operativeelectrophysiological to be with preganglionic complete injury;51nerves withtraumatic meningeal cysts showed on MRI, including45nerves testified byintra-operative electrophysiological to be with preganglionic completeinjury.Treating preganglionic partial injury and no injury as preganglionicincomplete injury, for the preganglionic complete injury of direct sign showedon MRI, the sensitivity, specificity and accuracy was84.2%,92.6%and88.8%respectively; for the preganglionic complete injury of traumatic meningealcysts showed on MRI, the sensitivity, specificity and accuracy of was78.9%, 91.2%and85.6%respectively。Conclusion:1. the combination of MRI and imaging technique is one ofthe effective diagnostic methods for early and accurate diagnosis of brachialplexus nerve root injury at present, not only the preganglionic andpostganglionic injury, but also preganglionic complete injury and partial injurycan be distinguished from each other.2. Direct sign and traumatic meningealcyst in MRI examination have low sensitivity but high specificity to branchialplexus nerve preganglionic complete injury, thus their combination willbenefit the accurate diagnosis of brachial plexus nerve preganglionic completeinjury. |
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