臂丛神经损伤MRI-ppt课件.ppt

1、l Clinical brachial plexus injury is a common injury, peripheral nerve injury is the most complex one, according to the injury site, can be divided into preganglionic injury and postganglionic injury, accurate diagnosis and localization very difficult.l 臂丛神经损伤是临床常见损伤，也是周围神经损伤中最复杂的一种，根据其损伤部位可分为节前损伤和节

2、后损伤，其准确的诊断和定位非常困难。C5C6C7C8T1上上干干中中干干下下干干前前股股后后股股外外侧侧束束后后束束内内侧侧束束肌肌皮皮.N尺尺 . N桡桡 . N腋腋 . N正正中中.NThe musculocutaneous nerve Radial nerve Median nerve 后后股股后后束束C5腋腋神神经经The musculocutaneous nerveAxillary nerve Radial nerve Median nerve Chest lateral nerve 外外侧侧束束C6肌肌皮皮神神经经Radial nerveThe musculocutaneous n

3、erveMedian nerve中中 干干C 7后后 股股桡桡 神神 经经Median nerveRadial nerveUlnar nerveUlnar nerveRadial nerveMedian nerveThe manifestations of brachial plexus injury in MRI are the signs of the nerves root defect、the shift of spinal cord、the “deform”of spinal cord and the “black line signs”.臂丛神经节前损伤的MRI主要征象是神经根缺失

4、或者瘢痕化、创伤性脊膜囊肿、脊髓变形、脊髓移位及“黑线征”；Post-ganglionic injury MR findings are classified four types :normal 、degenerative 、scar、and absent of nerve. 节后损伤的MRI变现可分为四型，即正常神经变现性、神经变性型、神经疤痕型和神经消失型。lDirect signs直接征象：Nerve root or part of the film completely interrupt: the performance of coronal and root cross-sect

5、ion of the spinal nerve discontinuity, or coronal shows the number of affected nerve root with the wire was less than the opposite.神经根影完全中断或部分中断：表现为冠状为及横断面的脊神经前后跟消失或连续性中断，或冠状位示患侧神经根跟丝数明显少于对侧。Spinal cord shift: coronal cross section can be seen or be pushed to the contralateral or ipsilateral spinal

6、cord.脊髓移位：冠状位或横断面可见脊髓向健侧或患侧移位Preganglionic injury节前损伤：lIndirect signs间接征象间接征象：Traumatic meningeal cyst: T2-weighted coronal and cross-section showing high signal in the spinal cord next to the cystic shadow.创伤性脊膜囊肿：冠状及横断面T2加权像中脊髓旁边的高信号囊状影；Deformation of the spinal cord: the spinal cord showed a norm

7、al low signal oval contour changes as the lateral spinal cord defects;脊髓变形：表现为脊髓的正常低信号椭圆形轮廓改变，如同脊髓外侧缺损；3、Black line sign: traumatic meningeal cyst in the area of high signal low signal black belt, often with the wire tips with severe avulsion.黑线征：创伤性脊膜囊肿高信号区中的低信号黑带，常提示伴随严重跟丝撕脱。Where there are more s

8、igns of any direct or indirect signs, we determine that preganglionic brachial plexus injury MRI showed Positive 凡出现以上任何一种直接征象或间接征象，我们即判定臂丛神经节前损伤MRI表现为（+）l Normal neural phenotype: there is continuity of the nerve, the signal is normal, nerve bundles clear or slightly fuzzy edges;正常神经表现型：神经的连续性存在，信号

9、正常，神经束边缘清楚或稍模糊；l Neurodegenerative type: nerve continuity exists, but in the thickening of nerve on T2-weighted images showed high signal, and T1-weighted image showed equal or lower signal;神经变性型：神经连续性存在，但在T2加权像上神经增粗呈高信号，而T1加权像则呈等或低信号；Postganglionic injury节后损伤：lNerve scar type: nerve continuity of e

10、xistence, but on the nerve on T1-weighted slightly higher as the signal, T2-weighted images showed equal or slightly lower signal, the signal in scalene inequality;神经疤痕型：神经连续性存在，但在T1加权像上神经稍高信号，T2加权像呈等或稍低信号，中斜角肌信号不均；lNerve disappearing type: discontinuity of nerve, nerve structure disappeared, replac

11、ed partly by scar tissue, the signal uneven.神经消失型：神经连续性中断，神经结构消失，局部由不均匀信号之瘢痕组织所取代。 Where there are more than four of any one phenotype, we determined that the postganglionic brachial plexus injury MRI showed positive凡出现以上四种表现型的任何一种，我们即判定臂丛神经节后损伤MRI表现为（+）Fig1:Cervical cross-section: neural foramen is

12、 divided into three parts, the upper part is mainly fat, located in the foraminal veins; the middle is the ventral nerve root, dorsal nerve root foramen piercing the lateral spinal cord, dorsal nerve formation or oval shaped enlargement of the ganglia, dorsal root ganglia in the lower part of the la

13、teral, small medial ventral nerve root is located.颈椎横断面：神经孔分为3部分，上部主要为脂肪，椎间孔间静脉；中部为腹侧神经根，背侧神经根穿出脊髓在椎间孔外侧，背侧神经形成或椭圆形的膨大的神经节，下部的脊神经节位于外侧，小的腹侧神经根位于前内侧。Fig2:Coronal brachial plexus: nerve and low signal in contrast to the high signal of fat. Neural structures showed: C5 8 and T1 neural foramen adjacent

14、to the start of the cord-like low signal, take the line of natural, soft, walk outside and down together in the armpit.臂丛冠状面：低信号的神经与高信号的脂肪形成对比，神经结构表现为C58和T1神经孔旁起始的条索状低信号影，走行自然，柔软，向外和向下行走汇集于腋窝。Fig3:Traumatic meningeal cyst (white high-signal area)创伤性脊膜囊肿(白色高信号区)Fig4:Preganglionic brachial plexus inju

15、ry in the direct signs: spinal cord shift Indirect signs: spinal cord deformation.臂丛神经节前损伤的直接征象:脊髓移位，间接征象:脊髓变形。Fig5:MRI of the brachial plexus nerve injury postganglionic nerve structural disorder, break or disappear, surrounding the signal increased.臂丛节后神经损伤的MRI 神经结构紊乱、中断或消失，周围信号增高l Disorder of neu

16、ral structures, break or disappear, due to violence, the nerve after complete rupture, the distal retraction, local nerve structure disappeared.神经结构紊乱、中断或消失，由于暴力下神经完全性断裂后向远端回缩，局部神经结构消失。l Nerve thickening, with or without sheet around high signal. Avulsion injury of the nerve under the violence will

17、lead to spinal nerve root avulsion at the congestion and edema, due to nerve edema, demyelination and degeneration of mucus, tissue water content increased, so the MRI showed high signal.神经增粗， 周围伴或不伴有片状高信号。暴力下的神经撕脱伤会导致脊髓神经根撕脱处充血水肿，由于神经的水肿，脱髓鞘和粘液变性，组织的含水量增加，所以在MRN 上表现为高信号。lNerve was normal, may be mi

18、ld epineurial adhesion with surrounding tissue, but some of the nerves of the “shock” and “shock” effect caused by temporary nerve conduction dysfunction, MRI showed normal. Such patients mainly relies on clinical diagnosis.神经表现正常，可能神经外膜与周围组织轻度粘连，但部分为神经的“休克”与“震荡”作用而导致的神经暂时性传导功能障碍，MRI 表现基本正常。此类病人主要依靠

19、临床诊断。l Traveling nerve scar tissue formation. Such performance more common in the latter part of brachial plexus injury, nerve injury is not as complete rupture resulting in local bleeding, machines, packages, last nerve fibrosis, so the MRI showed nerve Traveling rigid, partial rendering irregular

20、flakes, lower signal or iso sigal 神经走行区瘢痕组织形成。此种表现多见于臂丛神经损伤后期，由于神经损伤不完全断裂导致局部出血、机化、包裹，最后神经纤维化，故MRI 表现神经走行僵硬，局部呈不规则片状稍低或等信号。lOccasionally traumatic neuroma formation. Resembles the damage seen in this post, there is no distal nerve stump close to the corresponding nerve, you lose the epineurium and e

21、ndoneurium of the barrier, damage to nerve fibers lost in the plane, no regularity to grow in all directions, and money for the journey with the proliferation of fibrous connective tissue, the formation of local mass, that is, traumatic neuroma, showed lower or equal signal nodules. Such patients to combine history, at the same time, be identified with the tumor.偶尔有创伤性神经瘤形成。此种亦多见于损伤后期，神经近断端无远端对应神经时，就失去了神经外膜与神经内膜的屏障作用，神经纤维迷途于损伤平面，无规律性地向各个方向生长，与增生的纤维结缔组织盘缠在一起形成局部肿块， 即创伤性神经瘤，表现为稍低或等信号结节。此类病人要结合病史，并与肿瘤鉴别。