BỘ GIÁO DỤC VÀ ĐÀO TẠO BỘ QUỐC PHÒNG SCIENTIFIC RESEARCH INSTITUTE OF CLINICAL MEDICINE 108 NGUYEN NGOC TRUNG RESEARCH ON VISUAL CHARACTERISTICS AND VALUE OF MRI IN THE DIAGNOSIS OF TR
Trang 1BỘ GIÁO DỤC VÀ ĐÀO TẠO BỘ QUỐC PHÒNG SCIENTIFIC RESEARCH INSTITUTE OF CLINICAL
MEDICINE 108
NGUYEN NGOC TRUNG RESEARCH ON VISUAL CHARACTERISTICS AND VALUE OF MRI IN THE DIAGNOSIS OF
TRAUMATIC BRACHIAL PLEXUS INJURY
Specialisation: Image Diagnostics
Code: 62.72.01.66
SUMMARY OF THE DISSERTATION OF MEDICINE
HA NOI - 2019
Trang 2THE DISSERTATION WAS ACCOMPLISHER
SCIENTIFIC RESEARCH INSTITUTE OF CLINICAL MEDICINE 108
Supervisors:
1 Lam Khanh, Associate Professor, Doctor
2 Tran Van Riep, Associate Professor, Doctor
Trang 3INTRODUCTION
Brachial plexus occurs when one or more nerve roots are removed from the spinal cord at the base, or the nerves are stretched, cut, collapsed, inserted squeezing out of the hole Brachial plexus injuries due to traumatic injury tend to increase, mainly due to traffic accidents Worldwide studies such as Oliveira CM (2015), Jain DK (2012) all confirmed the main cause of traffic accidents (78.7 and 94%) In Vietnam, according to NC of Ho Huu Luong (1992), the incidence of neck spine injuries was high (60-70%) According to Le Van Doan (2013), Brachial plexus injuries due to traumatic injuries are not rare and the main cause
is traffic accidents
In the world and in Vietnam, there have been some researches of MRI of brachial plexus injuries due to traumatic injury However, these studies do not have a multifaceted assessment of injury due to disease limitation Based on the above situation, we conducted a study entitled
"Research on visual characteristics and value of MRI in the diagnostic of traumatic brachial plexus injury" with two objectives:
1 Characterization of imaging of brachial plexus injuries due to traumatic injury on 3 Tesla MRI
2 Determine the value of the 3 Tesla MRI in Diagnosis of brachial plexus injuries versus surgery
Dessertation novelty: The study is the first one in Vietnam to
apply 3 Telsa MRI in the evaluation of traumatic brachial plexus injury
Contribution to Image Diagnostics: A new diagnostic technique
is developed
Contribution to Treatment: The study assesses systematic
brachial plexus injury and simultaneously indicates the correlation between clinic and image diagnostics, thus assisting clinical practitioners
in the determination of an appropriate treatment policy to recover effectively the patients’ functions
Thesis structure
The dissertation consists of 124 pages: Question 2 pages, overview
36 pages; Subject and methodology 15 pages; Results 31 pages; Comment 37 pages; Conclusion 2 pages; Recommendation: 1 page The thesis consists of 41 tables, 45 figures, 7 graphs, 119 references (Vietnamese: 18; 101)
Trang 4Chapter 1 OVERVIEW DOCUMENT 1.1 The role of MRI in the diagnosis of brachial plexus injuries
MRI is a visualization method based on the principle of putting the body into a strong magnetic field to synchronize the direction of motion of the hydrogen atoms in the water molecules and then use a radio frequency antenna Low to activate the tissues in the body, hydrogen atoms will resonate and emit signals In the magnetically stable magnetic field, the radio frequency will vary according to the purpose of the survey, the target group of the various organs (parenchyma, muscle, fat, water, blood vessels, etc.) The emitted signal is picked up by the antenna and transmitted to the signal processing computer and the control computer, whereby the image of the body structure is displayed
With the new high-powered MRI camera, the Gyroscan Achieva 3 Tesla from Phillips (The Netherlands), uses T2W of Vista Sense with the help
of 3D rendering and rendering software, the root, stem, bundle, and part
of the branches are separated, while separating the rotifer with other complex structures in the neck
1.2 Situation of MRI in diagnosis of traumatic brachial plexus injury
Early in the world, there were some researches related MRI traumatic brachial plexus injury, namely Blair DN et al (1987), Bilbey JH
et al (1994) Authors Cejas DC (2015) and Fan YL (2016) conclude that MRI is a useful supplement to clinical diagnosis, helping to select the best course of treatment for patients
In Vietnam, as we know, only a few published results of the group of authors of 108 Military Central Hospital, namely Dinh Hoang Long (2012) concluded that MRI and surgical outcome were highly relevant (80.6%) after comparisons
Chapter 2 OBJECTIVES AND RESEARCH METHODS
2.1 Research subjects and methods
The study was conducted on 60 patients who were examined and treated at the 108 Military Central Hospital from January 2012 to December 2014
Trang 52.1.1 Standard selection
- Patients with a history of trauma, traumatic events with paralysis or paralysis and clinical examination and determination of lesions and
symptoms of MRI Tesla 3
- Being treated for traumatic brachial plexus injury at the Military Orthopedic Trauma Institute, 108 Military Central Hospital and a surgery document describing the lesions of traumatic brachial plexus injury according to the medical records of this study
2.1.2 Exclusion criteria
Patients who is suffering from traumatic brain injury, but not due to traumatic injury, but due to medical disease, multiple injuries Patients who do not agree to participate in this study Patients who are not recorded in the medical records
2.2.2 Research content
2.2.2.1 General characteristics of brachial plexus injuries: Age, gender, causes of injury, combined injury, place of injury, time from illness to imaging, duration from illness to surgery
2.2.2.2 Image of brachial plexus injuries on MRI
In combination with the diagnostic criteria of some authors, we propose to investigate 10 signs of brachial plexus injuries on MRI 3 Tesla
as follows: spinal cord stenosis, oedema from preganglionic, root avulsion, pseudomeningocele, diarrhea (root, trunk, cords), swelling (root, trunk, cords), Rupture in the sheath (root, trunk, cords),
Incomplete rupture, rupture (root, trunk, cords), atrophy
- The above-mentioned brachial plexus injuries are described
in the following positions: divided by anatomy and T1W vertical, T2W longitudinal, T2W horizontal, T2-weighted, T2-weighted, T2-weighted, myelography ), MIP and 3D
- Location of marrow and root, trunk, cords on all MRI
2 2
) 2 / 1 (
)p1(pZn
Trang 62.2.2.3 Results diagnosis of surgeon
- Results of root, trunk and cords according to the surgeon: root avulsion (including pseudomeningocele), rupture (root, trunk, cords)
2.2.2.4 Comparing the diagnosis of MRI with surgery based on two signs: root avulsion (including pseudomeningocele), rupture (root, trunk,
cords)
2.2.3 Tools
MRI Gyroscan Achieva 3 Tesla camera from Phillips (Netherlands) located in the Department of Diagnostic Imaging, 108 Hospital with coil NeuroVascular NV-16
2.2.5 Image and data processing
- Patients' MRI images are stored as DICOM 3.0 and PNG images The images are based on the Vista sense software from Phillips (The Netherlands)
MRI readings are saved as Word files Statistical data is stored in a computer in Excel format and then processed using SPSS 16.0
- The algorithms used in the study: Statistics describing the frequency of
occurrence of signs of brachial plexus injuries (10 signs) by absolute
number and percentage on each type of pulse and section to find out Rules related to position, number, level of injury, injury mechanism and the advantages of each type of image Compare the results of the diagnosis
of MRI brachial plexus injuries with results in surgery Calculate the suitability, sensitivity, specificity of CHT in the diagnosis of localization, the number of lesions compared with the diagnosis of surgeon
Trang 7Study map
Trang 8Chapter 3 RESEARCH RESULTS 3.1 General characteristics of patients with brachial plexus injuries
- Brachial plexus injuries is mainly in young and in men: mean age 28.8
± 11.8 years, male / female = 29
- Causes of brachial plexus injuries are mainly caused by traffic accidents,
accounting for 76.7% the left brachial plexus injuries > right Most are without combined lessions (88.3%)
- The majority of patients (43.3%) were given MRI for a period of 30 -
<90 days after injury 43.4% of patients underwent surgery during 90 -
<180 days (3-6 months) after injury
3.2 Picture of resonance from traumatic Brachial plexus injuries 3.2.1 Damage on T1W images
Table 3.2 Change the spinal curve
Patient
Percentage (%)
3.2.2 Damage on T2W vertical image
Table 3.3 Myelo and root injuries on T2W images
1,7
2 3,3
1 1,7
0
0
0
0 Oedema from
preganglionic
4 6,6
4 6,6
2 3,3
1 1,7
0
0 Pseudomeningocele 2
3,3
10 16,7
26 43,3
19 31,7
9 15,0
90,0
44 73,3
31 51,7
40 66,7
51 85,0
Trang 93.2.3 Damage on T2W intraocular image
Table 3.4 Myelo and root injuries of brachial plexus on the horizontal T2W image
60 patients) Spinal cord stenosis 0
0
0
0
1 0,3
preganglionic
4 1,3
0
0
2 0,7
1 0,3
0
0
7 2,3 Root avulsion 7
2,3
10 3,3
14 4,7
11 3,7
6 2,0
48 16,0
Pseudomeningocele 3
1,0
9 3,0
27 9,0
20 6,7
9 3,0
68 22,7
0,7
2 0,7
1 0,3
0
0
1 0,3
6 2,0
4,0
10 3,4
8 2,7
7 2,4
5 1,7
42 14,2 Rupture in the
sheath
1 0,3
1 0,3
0
0
2 0,7
9,0
31 10,3
31 10,3
26 8,7
19 6,3
134 44,7
4,7
11 3,7
10 3,3
19 6,3
30
10
84 28,0
Table 3.5 Trunk injury on T2W horizontal
Location
Damage
Upper trunk
(%)
Middle trunk
Số lượng (%)
Lower trunk
(%)
Total
(180 trunks of
60 patients)
Trang 1027 15,0
Rupture in the
sheath
1 0,6
7,8
5 2,8
4 2,2
23 12,8
19,4
47 26,1
50 27,8
132 73,3
Table 3.6 Cord Injuries of brachial plexus on T2W images
Location
Damage
Outside cord
(%)
Inside cord
(%)
Behind cord
(%)
Total
(180 cords of
60 patients) Spinal cord
stenosis
21 11,7
20 11,1
22 12,2
63 35,0
2,2
2 1,1
3 1,7
9 5,0
No damage 18,9 34 21,1 38 19,4 35 107
59,4
3.2.4 Damage on T2W horizontal line image
Table 3.7 Myelo and root injuries on T2W horizontal line image
60 patients) Spinal cord stenosis 1
0,3
1 0,3
2,3
10 3,3
14 4,7
11 3,7
6
2
48 16,0 Pseudomeningocele 2
0,7
9 3,0
27 9,0
20 6,7
9 3,0
67 22,3
0,7
2 0,7
1 0,3
0
0
1 0,3
6 2,0
Trang 11Swelling 12
4,0
9 3,0
8 2,7
7 2,3
5 1,7
41 13,7
1 0,3
1 0,3
0
0
3 1,0
9,0
30 10,0
31 10,3
26 8,7
19 6,3
133 44,3
5,0
12 4,0
10 3,3
19 6,3
30 10,0
86 28,7
Table 3.8 Trunk injuries on the T2W images cut horizontal
Location
Damage
Upper trunk
(%)
Middle trunk
Số lượng (%)
Lower trunk
(%)
Total
(180 trunks of
60 patients)
6,1
9 5,0
7 3,9
27 15,0
Rupture in the
sheath
1 0,6
4,7
6 3,3
4 2,2
24 13,3
19,4
46 25,6
50 27,8
131 72,8
Table 3.9 Cords injuries on the T2W image of horizontal cut Location
Damage
Outside cord
(%)
Inside cord
(%)
Behind cord
(%)
Total
(180 cords
of 60 patients)
11,7
20 11,1
22 12,2
63 35,0
2,2
2 1,1
3 1,7
9 5,0
18,9
38 21,1
35 19,4
107 59,4
Trang 123.2.5 Damage on T2W Vista Sense Photo Intersection
Table 3.10 Mycelo and root injuries on T2W Vista-Sense image Location
Damage
C5
(%)
C6 (%)
60 patients) spinal cord stenosis 1
0,3
2 0,7
1 0,3
preganglionic
4 1,3
4 1,3
2 0,7
1 0,3
0
0
11 3,7 Root avulsion 7
2,3
10 3,3
14 4,7
11 3,7
6 2,0
48 16,0
Pseudomeningocele 2
0,7
4 1,3
27 9,0
20 6,7
9 3,0
62 20,7
4
10 3,4
8 1,6
7 2,4
5 1,7
42 14,0 Rupture in the
sheath
4 1,3
1 0,3
1 0,3
0
0
3 1,7
8,0
31 10,3
31 10,3
26 8,7
19 6,3
131 43,7
4,7
10 3,3
10 3,3
19 6,3
30
10
83 27,7
Table 3.11 Trunk injuries on photos T2W Vista- Sense cut off
Location
Damage
Upper trunk
(%)
Middle trunk
Số lượng (%)
Lower trunk
(%)
Total
(180 trunks of
60 patients)
6,1
9 5,0
7 3,9
27 15,0
Rupture in the
sheath
1 0,6
Trang 13Rupture 15
8,3
5 2,8
4 2,2
24 13,3
18,9
47 26,1
50 27,8
131 72,8
Table 3.12 Cords injuries on the T2W Vista-Sense cut
Location
Damage
Outside cord
(%)
Inside cord
(%)
Behind cord
(%)
Total
(180 cords of
60 patients)
11,7
20 11,1
22 12,2
63 35,0
2,2
2 1,1
3 1,7
9 5,0
18,9
38 21,1
35 19,4
107 59,4
3.2.6 Damage of Mycelo and root on mycelography
Table 3.13 Mycelo and root injuries on mycelography
Trang 143.2.7 Damaged on image MIP
Table 3.14 Mycelo and root injury of brachial plexus on MIP Location
Damage
C5
(%)
C6 (%)
60 patients) Root avulsion 7
2,3
10 3,3
14 4,7
10 3,3
5 1,7
46 15,3
Pseudomeningocele 2
0,7
10 3,3
27 9,0
13 4,3
8 2,7
60 20,0
0,7
2 0,7
1 0,3
0
0
1 0,3
6 2,3
2,0
4 1,3
3 1,0
3 1,0
2 0,7
18 6,0
9,0
29 9,7
30 10,0
25 8,3
19 6,3
130 43,3
6,0
15 5,0
12 4,0
22 7,3
32 10,7
99 33,0
Table 3.15 Trunk injuries on MIP image
Location
Damage
Upper trunk
(%)
Middle trunk
Số lượng (%)
Lower trunk
(%)
Total
(180 trunks of
60 patients)
3,3
4 2,2
3 1,7
13 7,2
7,2
4 2,2
3 1,7
20 11,1
22,8
53 29,4
55 30,6
149 82,8
Trang 15Table 3.16 Cord injuries on MIP image
Location
Damage
Outside cord
(%)
Inside cord
(%)
Behind cord
(%)
Total
(180 cords of
60 patients)
7,2
12 6,7
13 7,2
38 21,1
2,2
2 1,1
3 1,7
9 5,0
23,3
46 25,6
44 24,4
132 73,3
60 patients) Root avulsion 7
2,3
10 3,3
14 4,7
10 3,3
5 1,7
46 15,3
Pseudomeningocele 2
0,7
9 3,0
27 9,0
19 6,3
8 2,7
65 21,7
0,7
2 0,7
1 0,3
0
0
1 0,3
6 2,0
4,0
9 3,0
8 2,7
7 2,3
5 1,7
41 13,7
1 0,3
1 0,3
0
0
3 1,0
8,7
29 9,7
30 10,0
26 8,7
19 6,3
130 43,3
5,3
12 4,0
10 3,3
19 6,3
30 10,0
87 29,0
Trang 16Table 3.18 Trunk injuries on MPR image
Location
Damage
Upper trunk
(%)
Middle trunk
Số lượng (%)
Lower trunk
(%)
Total
(180 trunks of
60 patients)
6,1
9 5,0
7 3,9
27 15,0
8,3
5 2,8
4 2,2
24 13,3
19,4
47 26,1
50 27,8
132 73,3
Table 3.19 Cord injury on MPR image
Location
Damage
Outside cord
(%)
Inside cord
(%)
Behind cord
(%)
Total
(180 cords of
60 patients)
11,7
20 11,1
22 12,2
63 35,0
2,2
2 1,1
3 1,7
9 5,0
18,9
38 21,1
35 19,4
107 59,4
Trang 1760 patients) Root avulsion 7
2,3
10 3,3
13 4,3
9 3,0
5 1,7
44 14,7
Pseudomeningocele 2
0,7
9 3,0
26 8,7
20 6,7
10 3,3
67 22,3
0,3
1 0,3
1 0,3
0
0
1 0,3
4 1,3
3,7
8 2,7
7 2,3
7 2,3
5 1,7
38 12,7 Rupture in the
sheath
1 0,3
1 0,3
0
0
2 0,7
8,7
31 10,3
30 10,0
26 8,7
19 6,3
132 44,0
5,7
13 4,3
12 4,0
19 6,3
30 10,0
91 30,3
Table 3.21 Trunk injuries on 3D images
Location
Damage
Upper trunk
(%)
Middle trunk
Số lượng (%)
Lower trunk
(%)
Total
(180 trunks of
60 patients)
5,0
7 3,9
6 3,3
22 12,2
8,3
5 2,8
4 2,2
24 13,3
21,1
49 27,2
51 28,3
138 76,7