论文部分内容阅读
目的:探讨背景抑制扩散加权成像（DWIBS）评价格林-巴利综合征（GBS）患者下肢神经损伤的价值。方法:回顾性分析2018年1月至2019年12月在淄博市中心医院诊断为GBS的30例患者及与其年龄、性别相匹配的30名健康志愿者的临床及影像学资料。30例GBS患者接受下肢神经电生理检查，1周后所有受检者接受下肢神经DWIBS检查。由两名高年资放射科医师对正常志愿者及GBS患者DWIBS图像重组后的胫神经、腓总神经的显示情况进行评分。采用Kappa一致性检验分析两名医师评分的一致性；不同DWIBS评分间GBS患者胫神经、腓总神经的运动神经传导速度（MCV）、运动神经传导幅度值比较采用单因素方差分析；采用Spearman相关分析评估GBS患者DWIBS胫神经、腓总神经评分与电生理参数的相关性。结果:30名健康志愿者的60条胫神经、腓总神经均完整清晰显示，信号强度好，评分均为4分，医师间的一致性很好（Kappa值为1.0）。30例GBS患者的60条胫神经、腓总神经中，53条胫神经、52条腓总神经有不同程度的异常改变，包括边缘模糊、扭曲变形、辨认困难、信号强度减弱等；两名医师对胫神经、腓总神经显示情况评分一致性很好（Kappa值分别为0.879、0.863）。随着DWIBS评分的减低，GBS患者胫神经MCV、腓总神经MCV、胫神经传导幅度、腓总神经传导幅度降低，各评分组间的差异均具有统计学意义（n P<0.01）。GBS患者胫神经、腓总神经DWIBS评分与MCV呈正相关（n r分别为0.83、0.84，n P<0.05），与运动神经传导幅度均呈正相关（n r分别为0.81、0.79，n P<0.05）。n 结论:DWIBS能够三维立体地清晰显示胫神经、腓总神经，并能在一定程度上反映GBS患者下肢神经损伤，且与神经电生理参数有较好的相关性。“,”Objective:To evaluate the value of DWI with background suppression (DWIBS) in evaluating the injury of the low limb nerves in patients with Guillain-Barre syndrome (GBS).Methods:The clinical and imaging data of 30 patients with GBS and 30 healthy volunteers matched with their age and gender in Zibo Central Hospital from January 2018 to December 2019 were analyzed retrospectively. All patients received lower limb nerve electrophysiological examination and all subjects received lower limb nerve DWIBS examination one week later. The display of tibial nerve and common peroneal nerve after DWIBS image reconstruction in normal volunteers and GBS patients was scored by two senior radiologists. Kappa consistency test was used to analyze the consistency of the two senior radiologists′ scores. One-way ANOVA was used to compare the motor nerve conduction velocity (MCV) and motor nerve conduction amplitudes of tibial nerve and common peroneal nerve in patients with GBS among different DWIBS scores. Spearman correlation analysis was used to evaluate the correlation between DWIBS tibial nerve and common peroneal nerve scores and electrophysiological parameters in patients with GBS.Results:In the DWIBS images of 30 healthy volunteers, 60 tibial nerves and common peroneal nerves showed clear, sharp edges, good signal intensity, uniformity, and the scores were 4. The consistency between the two radiologists was good (Kappa value=1.0). In the 60 tibial nerves and common peroneal nerves of 30 GBS patients, 53 tibial nerves and 52 common peroneal nerves showed abnormal changes in varying degrees, including blurred edges, distortions, difficulty in recognition, and weakened signal strength, etc. The consistency between the two readers was good (Kappa value=0.879,0.863,respectively.).With the decrease of DWIBS score, the MCV and motor nerve conduction amplitude values of tibial nerves and common peroneal nervesin GBS patients decreased, and the differences between the score groups were statistically significant (n P<0.01). The scores of tibial nerves and common peroneal nerves in DWIBS were positively correlated with MCV (n r=0.83, 0.84, respectively, n P<0.05) and motor nerve conduction amplitude (n r=0.81, 0.79, respectively, n P<0.05).n Conclusion:DWIBS could provide a three dimensional visualization of tibial nerves and common peroneal nerves, and evaluate the disorders of peripheral nerves in patients with GBS. There has correlation between the scores of tibial nerves and common peroneal nerves in DWIBS with electrophysiology parameters.