Investigation for the development of the three-dimensional and quantitative method of evaluating diaphragmatic and chest wall motion in the upright position using a vertically opened MR system

本研究以正常志愿者直立和仰卧位时膈肌和胸壁运动的结果为基础，评估胸外科手术对肺癌患者膈肌运动的影响。39例胸外科患者术前、术后均行动态呼吸MR检查。在1.5 T MR扫描仪或0.5 T垂直开口MR扫描仪上进行动态呼吸MR检查。在2-5个呼吸周期内获得40张连续MR图像，在膈穹顶点和两侧正中矢状面肋背角四分之一处测量完全吸气和呼气之间的膈肌偏移（D.E.）。手术侧膈肌术后平均D.E. （26.1 mm）明显低于术前（40.8 mm）。此外，切除一个以上肺叶的患者在非手术侧D.E.增加，而右中肺叶切除术的D.E.差异无统计学意义。此外，在3例膈神经麻痹患者中，坐位D.E.显著高于仰卧位（P<0.05）。坐位和仰卧位的呼吸动力学磁共振成像可以提供有关各种疾病引起的膈肌异常运动机制的有用信息。

Based on the results of the diaphragmatic and chest wall motion in upright and supine positions in normal volunteers, the influence of thoracic surgery on the diaphragmatic motion in patients with lung cancer was evaluated in this research term. Thirty-nine patients who had thoracic surgery underwent dynamic respiratory MR examination pre-operatively and post-operatively. Dynamic respiratory MR examination was performed on a 1.5 T MR scanner or 0.5 T vertically opened MR scanner. Forty sequential MR images were obtained during 2-5 respiration cycles The diaphragmatic excursions (D.E.) between full inspiration and expiration was measured on the points of the top of diaphragmatic dome and one-quarter from the dorsal costphrenic angle in the mid-sagittal plane on both sides.In the operated side, the post-opeartive average D.E. of the diaphragm (26.1 mm) was significantly lower than the preoperative value (40.8 mm). In addition, complimentary increase of D.E. in non-operative side was observed in patients who had lung resection of more than one lobe However, right middle lobectomy showed no significant difference of D.E. In addition, in three patients with phrenic nerve paralysis, D.E. was significantly greater (P<0.05) in the sitting position than the supine position.Respiratory dynamic MR imaging in the sitting and supine position may provide the useful information about the mechanism of abnormal diaphragmatic motion caused by various diseases.