MRI臂丛神经检查ppt课件

Evaluation of Brachial Plexus with MR echo planar imaging: initial experience 回波平面成像显示臂丛神经的初步研究 1 Background and purpose lBrachial plexus be made up of Ventral rami, ganglion, trunks, cords and branches.besides ,all of parts are not in line or plane and adjacent complex structures. unfortunately, conventional MRI scanning cant reveal entire brachial plexus. 臂丛神经在结构上由根、干、股、束、支组 成，空间走行既不共线也不共面且毗邻关系 复杂 2 Anatomy of brachial plexus 臂丛神经解剖 3 C5 C6 C7 C8 T1 C5 C6 C7 C8 T1 正常臂丛解剖 4 回顾：臂丛神经成像方法 lCTM CT脊髓造影 lUltrasound 超声 lMRI 磁共振 -SE -TSE -IR and TIR 5 脊髓造影是指经腰椎穿刺将特殊的碘油、水溶性碘造影剂或其他不透 X线的造 影剂注射入椎管内的蛛网膜下腔，与脑脊液混合，然后拍摄 X线片，观察脊髓 形态的一种方法 CTM 6 A = Axillary Artery M = Median nerve U = Ulnar Nerve R = Radial nerve MC = Musculocutaneous Nerve Ultrasound 7 中国医学影像学杂志 2005 年第 13 卷第 6 期 MRI-SE方法 8 MRI-IR方法 University of California San Francisco 9 Disadvantages of Imaging methods mentioned above既往成像方法的缺点 l CT成像方法需要造影剂，有电离辐射，只能显示 硬膜囊内的部分神经 l 超声分辨率较 CT、 MRI低，只能显示较为表浅的 部分 l MRI常规扫描只能显示部分臂丛神经，很难完整 显示其形态结构， 不能全景显示臂丛神经 l 能否全景显示臂丛神经？ 10 Background and purpose lTo determine the optimal sequences and scan parameters of Brachial Plexus MRI with Echo Planar Imaging with Short TI Inversion Recovery (STIR-EPI) 本研究利用基于短 TI反转恢复回波平面成像（ STIR-EPI）技术来评价臂丛神经及其病变 11 Methods lEighteen volunteers were underwent conventional MRI and echo planar imaging scanning. The images acquired were compared with the standard anatomical pictures. 对 18例志愿者行回波平面成像序列和常规 MRI 扫描，图像重建后与人体相应部分的解剖图谱 对照 12 :a detailed account of methods: lClinical data:18 volunteers were undergone MRI scanning, men 11 and women 7,age:2552year,average:37.PE(-) 一般资料： 18例志愿者，均为本院学生和本科 工作人员，其中男性 11例，女性 7例，年龄为 25 52岁，平均 37岁。所有病例体格检查均无 阳性发现，无臂丛神经损伤的病史和症状 13 lMRI examination protocol: Siemens,Magnetom Trio, A Tim System 3T, syngo MR 2006T, standard head coil and spine coil MRI检查方法： Siemens,Magnetom Trio, A Tim System 3T, syngo MR 2006T。线圈选择 颈部阵列线圈加颈后脊柱表面线圈 14 lConventional MR sequences: T1WI, T2WI, T2*WI 常规 MR扫描 ,包括 T1WI, T2WI, T2*WI lSTIR-EPI（ developed by ourselves） 短 TI反转恢复回波平面成像序列（自行设 计） 15 STIR-EPI introduction 短 TI反转恢复回波平面成像序列介绍 lBased on EPI l3D FT method lSTIR lSegment K space and minimum EPS lSENSE（ GRAPPA） lNerve explorer lPatent right registering 16 lAxial images were obtained, and post-processing techniques such as Maximum Intensity Projection (MIP), thin slice MIP and MultiPlanar Reformation (MPR) were made to generate images of brachial plexus, and the images acquired were evaluated by two experienced radiologists with Grays anatomical sections and diagrams. 对获得的原始图像进行最大信号强度投影（ MIP），薄层 MIP，多曲面重建（ MPR）等后 处理，由 2名高年资放射科医师观察并参照格 氏解剖学图谱评价后处理图像 17 lEvaluation contents: brachial plexus demonstration, include preganglion and postganglion parts; integrality of brachial plexus 评价内容包括： 臂丛神经在 STIR-EPI序列 中的影像学表现； 臂丛节前神经和节后神 经的显示情况； 臂丛神经显示的完整性 18 Results l Ventral rami, ganglion, trunks, cords and some peripheral nerves of brachial plexus were demonstrated very well by echo planar imaging with the post-processing techniques such as MIP, thin slice MIP and MPR ; in 18/18 cases the postganglions on both sides and 17/18 cases the preganglions of brachial plexus on both sides could be visualized in EPI pre-processed and post-processed images. STIR-EPI结合 MIP、薄层 MIP、 MPR等图像后处 理技术能够准确显示臂丛神经根、节、干、股、 束等结构； 18例的臂丛神经节后部分均良好显示 ， 17例的节前神经也清晰显示 19 20 21 进一步的临床应用 22 变异臂丛（ C5+C6:;C7+T1:;C8:） L 23 C5 C6 C7 C8 T1 变异臂丛（ C5+C6:;C7+T1:;C8:） 24 评价病变对神经的侵犯程度 副节瘤 25 C5 C6 C7 C8 T1 C5 C6 C7 C8 T1 26 Conclusion l Echo planar imaging is an effective technique of accurately displaying brachial plexus and adjacent structures. It has potential value in the diagnosis and treatment of