The Optimal Visualization Of Brachial Plexus With Utilization Of 3D SHINKEI And Its Initial Diagnostic Application

ObjectiveTo assess the optimal visiuality capacity of brachial plexus with three-dimensional nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation imaging(3D SHINKEI),exploring the feasibility of preliminary diagnostic value on brachial plexus diseasesMaterials and MethodsThis study was approved by local institutional review board,and all of participants' informed consent was obtained.MRI scans were performed on 24 healthy volunteers and 46 patients whose outcomes of lesions had been verified as post-ganglionic brachial plexus injuries by surgery or clinical follows-up,brachial plexus injuries using a Philip achieve 3.0T MR system.There is no history of findings related to nerve abnormalities and no history of upper limb and neck trauma and surgery,no history of cervical spondylitis,rheumatic,diabetes disease and other chronic diseases in the healthy volunteers at the onset of the study.Forty-six patients included 4 cases of newborns' injuries caused by obstetric forceps,4 cases of radioactive nerve injury(3 cases of breast cancer after radiotherapy,1 case of radiotherapy of cervical lymphoma),4 cases of thoracic outlet syndrome,4 cases of neurofibroma,traumatic brachial plexus injuries in 32 cases(26 cases of car accident injuries,traction injury in 6 cases)consisting of 19 males and 27 females.These cases above cover 15 cases of surgical treatment,31 cases of clinical conservative treatment and follow-up.The patients in the case group were mainly based on the history(history of burns,radiotherapy,car accident,etc.),clinical manifestations(ipsilateral upper limb movement disorders,weakness,tingling,muscular atrophy and numbness symptoms),electromyography(abnormal motor nerve conduction and sensory nerve conduction,visible spontaneous abnormal potential,suggesting ipsilateral brachial plexus injury),follow-ups(improvement of condition after neurotrophic drug treatment)and/or the corresponding surgical pathology confirmed.All subjects had no claustrophobia or other MRI scan contraindications.MR scan using the Netherlands Philips Achieva 3.0 T TX superconducting MR scanner,the receiver coil applies 16-channel head-neck joint phased-array coil.All examiners are scanned in the supine position,with head advanced,shoulder underlaid and shoulders close to the adjacent coil for MR examination.The MR scan series consist 3D SHINKEI,STIR in the coronal plane as well as DW-MRN in the axial plane.The primitive and post-processed images of 3D SHINKEI and DW-MRN were scored according to the optimal visibility on brachial plexus,in the meanwhile,contrast-to-noise ratio of the original images in the 3D SHINKEI and STIR sequences were calculated separately.The scoring standard as follows:using a four-point grading scale:4=excellent(the nerve was clearly visible and of excellent signal intensity;3=good(the entire nerve was visible and its signal intensity is moderate;2=poor(the nerve was partially invisible;1=poorly visualized(the nerve was not visible.we include these 46 patients and plead two radiologists blindly to compare the detection rate of positive brachial plexus injuries between 3D SHINKEI and STIR respectively.And then analyze the outcomes by means of Kappa identity test,Mann-Whitney test,independent sample t test and Chi-square test.Results1.Post-ganglionic brachial plexus show high intensity in the 3D SHINKEI sequence,and compared with it,that in DW-MRN images was weakly visible.In the 24 healthy volunteers,the scores two radiologists had marked are 3.6±0.6,3.5±0.6,3.0±0.2,2.9±0.1 respectively.And the k-value is 0.8 and 0.6 both of which show favorable consistence,and there is significantly statistical difference between these two sequences,(Z=2.667,P=0.008,P<0.05);2.The CNR of 3D SHINKEI and STIR are 0.61±0.07,0.42±0.03(t=12.78,P=0.001);3.The positive detection rates of post-ganglionic brachial plexus injuries on 3D SKINKEI and STIR are,in order,78.3%,52.2%(?2 =9.421,P<0.05),referring to the outcomes of surgeries or clinical fellows-up.Conclusion3D SHINKEI can demonstrate powerful visibility consistently and can clearly display abnormality of the structures and signals on post-ganglionic.Consequently,compared with DW-MRN and STIR,it is helpful to provide more complementary information and further confirm the diagnosis of brachial plexus injuries.