Brachial plexus injury: Clinical manifestations, conventional imaging findings, and the latest imaging techniques
Brachial plexus injury: Clinical manifestations, conventional imaging findings, and the latest imaging techniques
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DOI：
10.1148/rg.26si065511
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发表时间：
2006-10-01
期刊：
影响因子：
5.5
通讯作者：
Ohtomo, Kuni
中科院分区：
文献类型：
--
作者：
Yoshikawa, Takeharu;Hayashi, Naoto;Ohtomo, Kuni
臂丛神经损伤（Brachial plexus injury， BPI）是一种严重的神经损伤，可导致受累上肢的功能损害。影像学研究在区分神经节前和神经节后损伤方面起着至关重要的作用，这一区分对于最佳治疗计划至关重要。标准脊髓造影、计算机断层扫描（CT）和常规磁共振（MR）成像的结果有助于确定损伤的位置和严重程度。磁共振成像有时显示脊髓的信号强度变化，神经根和棘旁肌肉在磁共振成像上的增强表明存在根撕脱伤。新的技术包括MR脊髓造影、弥散加权神经造影和贝塞尔面重建也可用于BPI的评估和治疗。尽管不能完全取代CT，但采用最先进技术的MR脊髓造影可以产生非常高质量的图像。弥散加权神经造影是一种用于观察神经节后神经根的尖端技术。贝塞尔表面改造允许在单个图像上描绘整个硬膜内神经根。CT脊髓造影似乎是首选的初始成像方式，标准脊髓造影和造影剂增强MR成像被推荐作为额外的研究。检查将根据所使用的设备，周围神经外科医生的管理政策，最重要的是，病人的个人情况而有所不同。
Brachial plexus injury (BPI) is a severe neurologic injury that causes functional impairment of the affected upper limb. Imaging studies play an essential role in differentiating between preganglionic and postganglionic injuries, a distinction that is crucial for optimal treatment planning. Findings at standard myelography, computed tomographic (CT) myelography, and conventional magnetic resonance (MR) imaging help determine the location and severity of injuries. MR imaging sometimes demonstrates signal intensity changes in the spinal cord, and enhancement of nerve roots and paraspinal muscles at MR imaging indicates the presence of root avulsion injuries. New techniques including MR myelography, diffusion-weighted neurography, and Bezier surface reformation can also be useful in the evaluation and management of BPI. MR myelography with state-of-the-art technology yields remarkably high-quality images, although it cannot replace CT myelography entirely. Diffusion-weighted neurography is a cutting-edge technique for visualizing postganglionic nerve roots. Bezier surface reformation allows the depiction of entire intradural nerve roots on a single image. CT myelography appears to be the preferred initial imaging modality, with standard myelography and contrast material - enhanced MR imaging being recommended as additional studies. Work-up will vary depending on the equipment used, the management policy of peripheral nerve surgeons, and, most important, the individual patient.