【作者】 赵剑婷；

【导师】 谢鹏；

【作者基本信息】 重庆医科大学 ， 神经病学， 2008， 硕士

【摘要】 目的:1.比较正常腰丛神经的磁共振神经成像(MRN)测量数据和大体标本的差异。2.探讨磁共振神经成像(MRN)对格林-巴利综合症(GBS)的诊断价值。方法:1.对健康体检者30例(男19例,女11例)行腰丛神经MRN检查,测量右侧正常的L2-5神经根、神经节、神经干及股神经的短轴径线及神经肌肉信号比;解剖并测量尸体右侧腰丛神经L2-5神经根、神经节、神经干及股神经的形态、大小。比较所获得的MRN测量数据和尸体解剖测量数据。2.对临床诊断为GBS(28例)的患者及正常人(30例)行腰丛神经MRN检查。正常组观测右侧L4神经根、神经节、神经干及股神经的形态、大小及信号;GBS组观察神经及其周围的改变,测量右侧L4神经根、神经节、神经干及股神经的短轴径线及神经肌肉信号比,并检测GBS组的脑脊液蛋白-细胞值,比较所获得的MRN测量数据和GBS组测量数据,比较GBS组的脑脊液蛋白值与NMSR的相关关系。结果:1. MRN可清晰显示L2-5神经的走行,神经节呈圆或椭圆形膨大,大小约为3mm-6mm,神经根及干呈条状,边缘光滑,大小约为2 mm-5 mm,神经节信号高于神经根和干。所获得数据与尸体解剖测量数据之间有可比性,两者无显著的统计学差异。2. 80.9%的GBS腰丛神经周围有片状模糊高信号,神经根和节大小和信号无明显改变,25%神经干增粗,50%的神经干信号增高,边缘模糊。与正常右侧腰4神经比较,GBS的神经根、神经节、神经干大小无明显差异(t=1.74、1.24、1.68,P>0.05),股神经增粗(t=3.44,P<0.05);神经根及神经节的NMSR无增高(t=1.93、1.86,P>0.05),神经干及股神经NMSR增高(t=5.64、19.04,P< 0.05)。GBS脑脊液蛋白及神经干,股神经的NMSR相关检验均成正相关(rs=0.767、0.667,P<0.001)。结论:1.MRN可清晰显示腰丛神经及主要大分支,其测量值可反映腰丛神经改变,可用于腰丛神经疾病和发育异常的诊断标准。2.MRN显示GBS在神经周围有渗出病变,神经增粗不明显,神经干及股神经NMSR增高;GBS脑脊液蛋白的改变会引起神经干、股神经的NMSR的改变,MRN可作为GBS的诊断的重要手段。更多还原

【Abstract】 Objective:1.To Compare the difference between the data of normal lumbar plexus nerve measured through Magnetic Resonance Neurography (MRN)with specimen.2.To investigate the value of diagnosis in patients with Guillain-Barre syndrome(GBS) using Magnetic Resonance Neurography(MRN).Methods:1.Volunteers or 30 healthy lumbar plexus nerve cases (19 males and 11 females)were selected, to measure the short shaft line and neuromuscular signal ratio of the right normal lumbar nerve root, ganglia, nerve and the femoral nerve stem, anatomy and measurements of the right lumbar plexus L2-5 nerve root, ganglia and nerve stem, femoral nerve morphology and size. And comparison of MRN measurement data and autopsy measurement data were conducted.2. MRN was performed to evaluate the lumbar plexus, in 28 patients with clinically diagnosed Guillain-Barre syndrome (GBS) and 30 healthy volunteers. The right L4 nerve root, ganglion, nerve trunk and femoral nerve morphology and signal intensity were evaluated in the healthy volunteers. The peripheral nerve and adjacent tissue changes were observed in patients with GBS. The morphology, size and signal of the right nerve root, ganglion and femoral nerve as well as the brachyaxis and nerve-muscle signal ratio were also measured. In addition, we measured the CSF protein content and cytology and compared the MRN measurements and data in the GBS group. The protein content in the GBS group and its relationship to the NMSR were also evaluated.Results:1.MRN could clearly show L2-5 nerve course, ganglion being circle or Oval enlargement, with the size about 3 mm-6mm; a nerve root and stem displayed strips and smooth edge, with the size about 2 mm-5 mm, nerve Festival signal is more than the nerve root and stem. There was no significant statistical difference with the comparability between the obtained data and autopsy ones.2.80.9% of the lumbar plexus in the GBS group had vague hyperintensities, whereas, the nerve root and ganglion size were normal. We also noticed nerve trunk thickening in 25% patients and 50% patients had increased nerve cord signal intensity and vague periphery in nerve trunks. Compared with normal L4 lumbar plexus, no significant changes of nerve root,nerve trunk and ganglion were observed in GBS group (t=1.74、1.24、 1.68, P>0.05) No significant changes of nerve root and ganglion NMSR were observed. (t=1.93、1.86, P>0.05). However, we also noticed the thickening of femoral nerve(t=3.44,P<0.05) and increased NMSR(t=5.64、19.04, P< 0.05) in the nerve truck and femoral nerve. The protein content, nerve trunk and nerve NMSR were positively correlated. (rs =0.767、0.667,P<0.001)。Conclusions:1.MRN can clearly show lumbar plexus and major branches; its measured value can reflect changes in lumbar plexus. It is possible for diagnostic criteria of the lumbar plexus nerve diseases and dysplasia.2. Exudation around the nerve and increased nerve trunk and nerve root NMSR were observed in GBS, while nerve thickening was not obvious in patients with GBS. The changes in the GBS protein content may lead to nerve trunk and femoral nerve NMSR changes. MRN may be useful in the diagnosis of GBS.更多还原