【作者】 黄晶；

【导师】 蔡金华；

【作者基本信息】 重庆医科大学 ， 儿科学， 2013， 硕士

【摘要】 目的：探讨脊柱磁共振（MRI）增强扫描对儿童格林－巴利综合症（GBS）的诊断价值。材料和方法：对2010年1月~2013年3月我院收治并经临床确诊的17例GBS的临床及影像学资料进行回顾性分析。17例患儿均行常规脊柱MRI平扫及增强扫描。判断腰骶段脊神经根及马尾有无增粗和强化，并根据强化部位和强化程度分为4型：仅前根强化(I型)；前、后根均有强化，但前根较后根强化明显（II型）；前、后根均有强化，前根和后根强化程度类似（III型）；前、后根均有强化，但后根较前根强化明显（IV型）。统计分析强化类型和临床表现之间的关系。结果：1、2名医生达成共识的脊神经根和马尾增粗5例，达成共识的脊神经根和马尾无明显增粗4例，其余8例判断结果不一致。2、增强扫描显示腰骶段脊神经根和马尾均有不同程度的强化，其中仅前根强化(I型)4例，占23.5%；前、后根均有强化，但前根较后根强化明显（II型）9例，占52.9%；前、后根均有强化，前根和后根强化程度类似（III型）3例，占17.6%；前、后根均有强化，但后根较前根强化明显（IV型）1例，占5.9%。3、所有病例临床上均存在运动障碍。17例中12例有感觉障碍，其中I型（仅前根受累）2例（2/4）；II~IV型(前后根均受累)10例（10/13）。Fisher确切概率法检验I型（后根不强化）和II~IV型（后根强化）之间感觉障碍出现率，p值为0.538，大于0.05。趋势检验I~IV型感觉障碍出现率，卡方值为1.4796，p值为0.2238，大于0.05。提示不同强化类型与感觉障碍的出现与否没有必然联系。结论：1、脊柱MRI增强扫描对于GBS同样具有重要的诊断和鉴别诊断价值。2、以前根为主的腰骶段脊神经根及马尾异常强化是GBS的主要征象。3、腰骶段脊神经和马尾的强化类型和临床表现之间的关系需进一步研究，设计严格对照的前瞻性研究有望能够解决这一问题。更多还原

【Abstract】 Objective：To evaluate enhanced magnetic resonance imaging of the spine for thediagnosis of Guillain-Barre syndrome (GBS) in children.Methods：Clinical and imaging data of17pediatric patients with GBS which wereadmitted into our hospital on2010.01~2013.03were retrospectivelyanalyzed. Plain and enhanced magnetic resonance imaging of the spine wasperformed in all cases. We analysed that whether lumbosacral nerve rootsand cauda equine have thickened and enhanced or not. The enhancementpatterns were categorized into four: I=anterior nerve roots enhance only;II=anterior nerve roots enhance stronger than the posterior; III=anteriorand posterior nerve roots enhance equally; IV=posterior nerve roots enhancestronger than the anterior. Statistical analysis was performed to determinethe relationship between different enhancement patterns and clinicalsensory disorder.Results:1、Two doctors considered that5cases had spinal nerve roots and cauda equina thickened, and4cases had no thickened. For the remaining8cases, the coincidence was not achieved.2、MR imaging showed contrast enhancement of the lumbosacral nerveroots and cauda equina in all cases. The enhancement patterns werecategorized into four: I=anterior nerve roots enhance only (4cases,23.5%);II=anterior nerve roots enhance stronger than the posterior (9cases,52.9%);III=anterior and posterior nerve roots enhance equally (3cases,17.6%);IV=posterior nerve roots enhance stronger than the anterior (1cases,5.9%).3、All of the cases had paralysis. Twelve cases had sensory disorder, inwhich2cases were included into type I (anterior nerve roots enhance only)and10cases into type II to IV (both anterior and posterior nerve rootsenhance). The Fisher exact probability test showed that P is0.538, morethan0.05. The trend test showed the chi-square value is1.4796and P is0.2238, more than0.05. The statistical analysis suggested that there is nosignificant difference between the enhancement patterns and with theclinical sensory disorder,Conclusion:1、Spinal enhanced MR imaging is highly valuable in the diagnosis anddifferential diagnosis of GBS.2、The main MR imaging finding of GBS is the contrast enhancementof the spinal nerve roots and cauda equina. The anterior nerve rootsenhance is more frequently detected in most of the cases. 3、The relationship between the enhance patterns of spinal nerve rootsand clinical features needs further study. Designed strictly controlledprospective study is expected to be able to solve this problem.更多还原