Yu Ai-Ping, Jiang Su, Zhao Hua-Li, Liang Zong-Hui, Qiu Yan-Qun, Shen Yun-Dong, Wang Guo-Bao, Liang Chunmin, Xu Wen-Dong
Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, China.
Br J Neurosurg. 2023 Jun;37(3):442-447. doi: 10.1080/02688697.2019.1584661. Epub 2019 Mar 12.
The objective of the study was to investigate the feasibility of CUBE-SITR MRI and high-frequency ultrasound for the structural imaging of the brachial plexus to exclude neoplastic brachial plexopathy or structural variation and measure the lengths of anterior and posterior divisions of the C7 nerve, providing guidelines for surgeons before contralateral cervical 7 nerve transfer.
A total of 30 patients with CNS and 20 with brachial plexus injury were enrolled in this retrospective study. All patients underwent brachial plexus CUBE-STIR MRI and high-frequency ultrasound, and the lengths of the anterior and posterior divisions of C7 nerve were measured before surgery. Precise length of anterior and posterior divisions of contralateral C7 nerve was measured during surgery.
MRI-measured lengths of anterior and posterior divisions of C7 nerves were positively correlated with that measured during surgery (anterior division, = 0.94, < .01; posterior division, = 0.92, < .01). High agreement was found between MRI-measured and intra-surgery measured length of anterior and posterior divisions of C7 nerve by BLAD-ALTMAN analysis. Ultrasonography could feasibly image supraclavicular C7 nerve and recognize small variant branches derived from middle trunk of C7 nerve root, which could be dissected intra-operatively and confirmed by electromyography during the procedure of contralateral C7 nerve transfer.
CUBE-STIR MRI had advantages for the imaging of the brachial plexus and measurement of the length of root-trunk-anterior/posterior divisions of C7 nerve. The clinical role of ultrasonography may be a simple way of evaluating general condition of C7 nerve and provide guidelines for contralateral C7 nerve transfer surgery.
本研究的目的是探讨容积内插体部检查法短反转恢复序列（CUBE-SITR）磁共振成像（MRI）和高频超声用于臂丛神经结构成像以排除肿瘤性臂丛神经病变或结构变异，并测量C7神经前支和后支的长度，为对侧颈7神经移位术前的外科医生提供指导。
本回顾性研究共纳入30例中枢神经系统疾病患者和20例臂丛神经损伤患者。所有患者均接受了臂丛神经CUBE-STIR MRI和高频超声检查，并在手术前测量了C7神经前支和后支的长度。在手术中测量对侧C7神经前支和后支的精确长度。
MRI测量的C7神经前支和后支长度与手术中测量的长度呈正相关（前支，r = 0.94，P <.01；后支，r = 0.92，P <.01）。通过Bland-Altman分析发现，MRI测量的和手术中测量的C7神经前支和后支长度之间具有高度一致性。超声检查能够对锁骨上C7神经进行可行的成像，并识别源自C7神经根中间干的小变异分支，这些分支在对侧C7神经移位手术过程中可在术中进行解剖并通过肌电图进行确认。
CUBE-STIR MRI在臂丛神经成像以及测量C7神经从神经根到干再到前/后支的长度方面具有优势。超声检查的临床作用可能是评估C7神经总体状况的一种简单方法，并为对侧C7神经移位手术提供指导。
