Filler A G, Kliot M, Howe F A, Hayes C E, Saunders D E, Goodkin R, Bell B A, Winn H R, Griffiths J R, Tsuruda J S
Department of Neurological Surgery, University of Washington, Seattle, USA.
J Neurosurg. 1996 Aug;85(2):299-309. doi: 10.3171/jns.1996.85.2.0299.
Currently, diagnosis and management of disorders involving nerves are generally undertaken without images of the nerves themselves. The authors evaluated whether direct nerve images obtained using the new technique of magnetic resonance (MR) neurography could be used to make clinically important diagnostic distinctions that cannot be readily accomplished using existing methods. The authors obtained T2-weighted fast spin-echo fat-suppressed (chemical shift selection or inversion recovery) and T1-weighted images with planes parallel or transverse to the long axis of nerves using standard or phased-array coils in healthy volunteers and referred patients in 242 sessions. Longitudinal and cross-sectional fascicular images readily distinguished perineural from intraneural masses, thus predicting both resectability and requirement for intraoperative electrophysiological monitoring. Fascicle pattern and longitudinal anatomy firmly identified nerves and thus improved the safety of image-guided procedures. In severe trauma, MR neurography identified nerve discontinuity at the fascicular level preoperatively, thus verifying the need for surgical repair. Direct images readily demonstrated increased diameter in injured nerves and showed the linear extent and time course of image hyperintensity associated with nerve injury. These findings confirm and precisely localize focal nerve compressions, thus avoiding some exploratory surgery and allowing for smaller targeted exposures when surgery is indicated. Direct nerve imaging can demonstrate nerve continuity, distinguish intraneural from perineural masses, and localize nerve compressions prior to surgical exploration. Magnetic resonance neurography can add clinically useful diagnostic information in many situations in which physical examinations, electrodiagnostic tests, and existing image techniques are inconclusive.
目前，涉及神经疾病的诊断和管理通常在没有神经自身图像的情况下进行。作者评估了使用磁共振（MR）神经成像新技术获得的直接神经图像是否可用于做出临床上重要的诊断区分，而这是现有方法难以轻易实现的。作者在242次检查中，使用标准或相控阵线圈，对健康志愿者和转诊患者获取了与神经长轴平行或横向的平面的T2加权快速自旋回波脂肪抑制（化学位移选择或反转恢复）和T1加权图像。纵向和横断面的束状图像能轻易区分神经周围肿物和神经内肿物，从而预测可切除性和术中电生理监测的需求。束状模式和纵向解剖结构能明确识别神经，从而提高图像引导手术的安全性。在严重创伤中，MR神经成像术前能在束状水平识别神经连续性中断，从而证实手术修复的必要性。直接图像能轻易显示受伤神经直径增大，并显示与神经损伤相关的图像高信号的线性范围和时间进程。这些发现证实并精确地定位了局灶性神经压迫，从而避免了一些 exploratory 手术，并在需要手术时允许进行更小的靶向暴露。直接神经成像可显示神经连续性，区分神经内肿物和神经周围肿物，并在手术探查前定位神经压迫。在体格检查、电诊断测试和现有图像技术结果不明确的许多情况下，磁共振神经成像可提供临床上有用的诊断信息。
