Raphael David T, McIntee Diane, Tsuruda Jay S, Colletti Patrick, Tatevossian Ray
Department of Anesthesiology, Keck School of Medicine, University of Southern California, 1200 North State Street, Rm. 14-901, Los Angeles, CA 90033, USA.
Anesthesiology. 2005 Dec;103(6):1218-24. doi: 10.1097/00000542-200512000-00017.
Magnetic resonance neurography (MRN) is an imaging method by which nerves can be selectively highlighted. Using commercial software, the authors explored a variety of approaches to develop a three-dimensional volume-rendered MRN image of the entire brachial plexus and used it to evaluate the accuracy of infraclavicular block approaches.
With institutional review board approval, MRN of the brachial plexus was performed in 10 volunteer subjects. MRN imaging was performed on a GE 1.5-tesla magnetic resonance scanner (General Electric Healthcare Technologies, Waukesha, WI) using a phased array torso coil. Coronal STIR and T1 oblique sagittal sequences of the brachial plexus were obtained. Multiple software programs were explored for enhanced display and manipulation of the composite magnetic resonance images. The authors developed a frontal slab composite approach that allows single-frame reconstruction of a three-dimensional volume-rendered image of the entire brachial plexus. Automatic segmentation was supplemented by manual segmentation in nearly all cases. For each of three infraclavicular approaches (posteriorly directed needle below midclavicle, infracoracoid, or caudomedial to coracoid), the targeting error was measured as the distance from the MRN plexus midpoint to the approach-targeted site.
Composite frontal slabs (coronal views), which are single-frame three-dimensional volume renderings from image-enhanced two-dimensional frontal view projections of the underlying coronal slices, were created. The targeting errors (mean +/- SD) for the approaches-midclavicle, infracoracoid, caudomedial to coracoid-were 0.43 +/- 0.67, 0.99 +/- 1.22, and 0.65 +/- 1.14 cm, respectively.
Image-processed three-dimensional volume-rendered MNR scans, which allow visualization of the entire brachial plexus within a single composite image, have educational value in illustrating the complexity and individual variation of the plexus. Suggestions for improved guidance during infraclavicular block procedures are presented.
磁共振神经成像（MRN）是一种能够选择性突出显示神经的成像方法。作者使用商业软件探索了多种方法，以生成整个臂丛神经的三维容积再现MRN图像，并使用该图像评估锁骨下阻滞方法的准确性。
在获得机构审查委员会批准后，对10名志愿者进行了臂丛神经的MRN检查。使用相控阵体部线圈在GE 1.5特斯拉磁共振扫描仪（通用电气医疗技术公司，威斯康星州沃基沙）上进行MRN成像。获取臂丛神经的冠状面短TI反转恢复（STIR）序列和T1加权斜矢状面序列。探索了多个软件程序，以增强对复合磁共振图像的显示和操作。作者开发了一种额状板复合方法，可对整个臂丛神经的三维容积再现图像进行单帧重建。几乎在所有情况下，自动分割都辅以手动分割。对于三种锁骨下阻滞方法（锁骨中点下方向后进针、喙突下或喙突的尾内侧）中的每一种，将靶向误差测量为从MRN神经丛中点到进针靶点的距离。
创建了复合额状板（冠状面视图），即从基础冠状面切片的图像增强二维额状面投影生成的单帧三维容积再现图像。锁骨中点、喙突下、喙突尾内侧进针方法的靶向误差（均值±标准差）分别为0.43±0.67、0.99±1.22和0.65±1.14厘米。
经图像处理的三维容积再现MNR扫描能够在单个复合图像中显示整个臂丛神经，在说明臂丛神经的复杂性和个体差异方面具有教学价值。本文还提出了改进锁骨下阻滞操作引导的建议。
