PDF(Pubmed)
Abstract：
BACKGROUND: Iatrogenic mandibular nerve damage resulting from oral surgeries and dental procedures is painful and a formidable challenge for patients and oral surgeons alike, mainly because the absence of objective and quantitative methods for diagnosing nerve damage renders treatment and compensation ambiguous while often leading to medico-legal disputes. The aim of this study was to examine discriminating factors of traumatic mandibular nerve within a specific magnetic resonance imaging (MRI) protocol and to suggest tangible diagnostic criteria for peripheral trigeminal nerve injury.
METHODS: Twenty-six patients with ipsilateral mandibular nerve trauma underwent T2 Flex water, 3D short tau inversion recovery (STIR), and diffusion-weighted imaging (DWI) acquired by periodically rotating overlapping parallel lines with enhanced reconstruction (PROPELLER) pulse sequences; 26 injured nerves were thus compared with contra-lateral healthy nerves at anatomically corresponding sites. T2 Flex apparent signal to noise ratio (FSNR), T2 Flex apparent nerve-muscle contrast to noise ratio (FNMCNR) 3D STIR apparent signal to noise ratio (SSNR), 3D STIR apparent nerve-muscle contrast to noise ratio (SNMCNR), apparent diffusion coefficient (ADC) and area of cross-sectional nerve (Area) were evaluated.
RESULTS: Mixed model analysis revealed FSNR and FNMCNR to be the dual discriminators for traumatized mandibular nerve (p < 0.05). Diagnostic performance of both parameters was also determined with area under the receiver operating characteristic curve (AUC for FSNR = 0.712; 95% confidence interval [CI]: 0.5660, 0.8571 / AUC for FNMCNR = 0.7056; 95% confidence interval [CI]: 1.011, 1.112).
CONCLUSIONS: An increase in FSNR and FNMCNR within our MRI sequence seems to be accurate indicators of the presence of traumatic nerve. This prospective study may serve as a foundation for sophisticated model diagnosing trigeminal nerve trauma within large patient cohorts.
METHODS: Twenty-six patients with ipsilateral mandibular nerve trauma underwent T2 Flex water, 3D short tau inversion recovery (STIR), and diffusion-weighted imaging (DWI) acquired by periodically rotating overlapping parallel lines with enhanced reconstruction (PROPELLER) pulse sequences; 26 injured nerves were thus compared with contra-lateral healthy nerves at anatomically corresponding sites. T2 Flex apparent signal to noise ratio (FSNR), T2 Flex apparent nerve-muscle contrast to noise ratio (FNMCNR) 3D STIR apparent signal to noise ratio (SSNR), 3D STIR apparent nerve-muscle contrast to noise ratio (SNMCNR), apparent diffusion coefficient (ADC) and area of cross-sectional nerve (Area) were evaluated.
RESULTS: Mixed model analysis revealed FSNR and FNMCNR to be the dual discriminators for traumatized mandibular nerve (p < 0.05). Diagnostic performance of both parameters was also determined with area under the receiver operating characteristic curve (AUC for FSNR = 0.712; 95% confidence interval [CI]: 0.5660, 0.8571 / AUC for FNMCNR = 0.7056; 95% confidence interval [CI]: 1.011, 1.112).
CONCLUSIONS: An increase in FSNR and FNMCNR within our MRI sequence seems to be accurate indicators of the presence of traumatic nerve. This prospective study may serve as a foundation for sophisticated model diagnosing trigeminal nerve trauma within large patient cohorts.
摘要：
背景：口腔手术和牙科手术导致的医源性下颌神经损伤对患者和口腔外科医生来说都是痛苦和巨大的挑战，主要是因为缺乏诊断神经损伤的客观和定量方法，使得治疗和赔偿含糊不清，同时往往导致医学法律纠纷。这项研究的目的是在特定的磁共振成像（MRI）方案中检查创伤性下颌神经的辨别因素，并为三叉神经周围损伤提供切实的诊断标准。
方法：26例同侧下颌神经损伤患者行T2Flex水，三维短tau反转恢复(STIR)，和弥散加权成像（DWI）通过周期性旋转重叠的平行线和增强重建（PROPELLER）脉冲序列获得；因此，在解剖学上相应的部位将26条受伤的神经与对侧健康神经进行了比较。T2Flex表观信噪比(FSNR)，T2Flex表观神经-肌肉对比度噪声比（FNMCNR）3DSTIR表观信噪比（SSNR），3DSTIR表观神经-肌肉对比度噪声比（SNMCNR），评估表观扩散系数（ADC）和横截面神经面积（Area）。
结果：混合模型分析显示，FSNR和FNMCNR是下颌神经创伤的双重鉴别器（p<0.05）。两个参数的诊断性能也用接收器工作特征曲线下面积确定(FSNR的AUC=0.712;FNMCNR的95%置信区间[CI]:0.5660,0.8571/AUC=0.7056;95%置信区间[CI]:1.011,1.112)。
结论：我们的MRI序列中FSNR和FNMCNR的增加似乎是存在创伤性神经的准确指标。这项前瞻性研究可以作为大型患者队列中诊断三叉神经创伤的复杂模型的基础。
方法：26例同侧下颌神经损伤患者行T2Flex水，三维短tau反转恢复(STIR)，和弥散加权成像（DWI）通过周期性旋转重叠的平行线和增强重建（PROPELLER）脉冲序列获得；因此，在解剖学上相应的部位将26条受伤的神经与对侧健康神经进行了比较。T2Flex表观信噪比(FSNR)，T2Flex表观神经-肌肉对比度噪声比（FNMCNR）3DSTIR表观信噪比（SSNR），3DSTIR表观神经-肌肉对比度噪声比（SNMCNR），评估表观扩散系数（ADC）和横截面神经面积（Area）。
结果：混合模型分析显示，FSNR和FNMCNR是下颌神经创伤的双重鉴别器（p<0.05）。两个参数的诊断性能也用接收器工作特征曲线下面积确定(FSNR的AUC=0.712;FNMCNR的95%置信区间[CI]:0.5660,0.8571/AUC=0.7056;95%置信区间[CI]:1.011,1.112)。
结论：我们的MRI序列中FSNR和FNMCNR的增加似乎是存在创伤性神经的准确指标。这项前瞻性研究可以作为大型患者队列中诊断三叉神经创伤的复杂模型的基础。
