磁共振T2反转恢复压脂序列对骶丛神经损伤诊断价值的初步探讨

摘要

目的 探讨磁共振T2反转恢复压脂(TIRM)序列在骶丛神经损伤的MRN表现及其诊断价值.方法 回顾性分析我院自2011年6月至2012年12月收治的10例临床诊断为骶丛神经损伤患者的临床和影像资料.所有患者术前均行MR检查,后行骨盆前腹膜后手术入路探查及术中肌电图检查.将手术探查所见与术前MRN表现比较,观察神经损伤情况. 结果 10例患者冠状位TIRM序列共显示闭孔神经、腰骶干、S1神经根、S2神经根、盆内段坐骨神经共93段,经手术证实受损神经37段,其损伤MRN征象:6段神经连续,但增粗、边缘模糊、信号升高;22段神经连续,但走行迂曲或僵硬、粘连、信号不均、结构不清;3段神经完全离断,正常信号消失,断端退缩;3段伴创伤性神经纤维瘤形成.T2反转恢复压脂序列(T2-TIRM)诊断骶丛神经损伤条数与手术结果的符合率为81.08％(30/37). 结论 T2-TIRM序列能很好的显示骶丛神经,对骶丛神经损伤作出准确诊断,可在术前明确有无骶丛神经损伤及其位置.%Objective To evaluate the capability of Turbo inversion recovery magnitude (TIRM) magnetic resonance neurography (MRN) in the diagnosie of sacral plexus injury by comparing MRN findings with surgical results.Methods Ten patients with sacral plexus injury confirmed surgically underwent conventional T1WI,T2WI,TIRM and coronal TIRM MRN before operations from June,2011 to December,2012.The MRI data and surgical data were analyzed retrospectively to observe nerve injury.Results The coronal TIRM MRN images displayed 93 trunks of sacral plexus,of which 37 were confirmed injury by operation.The MRI findings were as follows:6 trunks involved continuous nerves,but with thickening and blurred margin,as well as abnormal high signal intensity;22 trunks were continuous,but with distortion,stiffness and adhesion accompanied by heterogeneous signal intensity and structural disorder;3 trunks showed complete loss of continuity,absence of normal signal,accompanied by retraction;and 3 trunks involved formation of traumatic neurofibroma.The coincidence of injured nerve trunks diagnosed by MRN with surgical findings amounts to 81.08％ (30/37).Conclusion MR with coronal TIRM imaging is effective in the diagnosis and depiction of sacral plexus injury,therefore it can be used as conventional sequence in sacral plexus examination to detect sacral plexus avulsion.