正中神經神經脂肪瘤病超聲表現1例

田 野，邱 邐

(四川大學華西醫院超聲科，四川 成都 610041)

正中神經神經脂肪瘤病超聲表現1例

田 野，邱 邐

(四川大學華西醫院超聲科，四川 成都 610041)

神經脂肪瘤病；正中神經；超聲檢查

圖1 正中神經神經脂肪瘤病聲像圖 A.右側正中神經橫切面，正中神經增粗(箭)，神經束(*)間被強回聲區充填； B.右側正中神經縱切面，正中神經增粗，回聲增強(箭)

患者女，23歲，因“發現右腕掌側、右手大魚際肌處腫物5年，近2年來腫物增大，伴一過性手指麻木”就診。查體：右腕關節橈、掌側可觸及3.0 cm×1.0 cm腫塊，手掌大魚際肌處可觸及3.0 cm×3.0 cm腫塊，兩處腫塊均為類圓形，質軟，活動度可，按壓腫塊時患者手指有麻木感。右手對掌功能障礙，右腕關節活動正常。超聲檢查：右前臂、腕部及掌部正中神經明顯增粗，最粗處位于大魚際肌，病變范圍約5.3 cm×1.2 cm×2.3 cm，可見強回聲區包繞正中神經，部分神經束顯示欠清(圖1)；CDFI未見明顯血流信號。超聲診斷：右側正中神經病變，考慮神經纖維瘤病。右掌局部腫瘤切除術+右腕部正中神經探查術中見正中神經明顯增粗，正常結構消失，神經束間充滿黃色脂肪樣組織。病理診斷：右側正中神經神經脂肪瘤病。

討論 神經脂肪瘤病是一種罕見的、發生于神經組織的良性腫瘤，曾有多種命名，如神經脂肪

纖維瘤、周圍神經纖維脂肪瘤、纖維脂肪瘤樣錯構瘤、神經內脂肪瘤等，2002年WHO腫瘤分類中將其統一命名為神經脂肪瘤病。本病好發于正中神經及其分支，病理特征為受累神經增粗，成熟的脂肪組織及纖維組織在神經束之間浸潤生長并分隔神經束，神經束可無明顯變化或有不同程度變性、萎縮。臨床表現主要為手腕、掌部緩慢增長的無痛性腫塊，伴或不伴有正中神經分布區的感覺、運動異常，部分患者可出現巨指癥。典型的超聲常表現為正中神經增粗，神經束周圍被彌漫分布的強回聲脂肪組織包繞，病灶無包膜，局部血流信號不豐富。熟悉本病的超聲特征有利于減少誤、漏診。

[Key words] Chest; Tomography, X-ray computed; Adaptive statistical iterative reconstruction Veo; Radiation dose; Image quality

DOI：10.13929/j.1003-3289.201611063

Lipomatosis of nerve; Median nerve; Ultrasonography

Ultrasonic manifestations of lipomatosis of median nerve: Case report

Impact of pre-setted adaptive statistical iterative reconstruction Veo on radiation dose and image quality of chest CT scanning: Chest model and clinical study

YANLihui,CHENFei,YAOLizheng*,LIXin

(DepartmentofRadiology,AffiliatedYanchengHospitalofSoutheastUniversityMedicalCollege,Yancheng224001,China)

Objective To explore the impact of pre-setted generation adaptive statistical iterative reconstruction Veo (ASiR-V) on chest CT radiation dose and image quality. Methods The chest model and 120 patients (divided into 6 groups, eachn=20) were scanned by GE Revolution CT under the condition of pre-setted ASiR-V weights for 0, 20%, 40%, 60%, 80% and 100% respectively. The tube voltage was 120 kV, the tube current was automated mAs (Smart mA10-500) technology, the noise index was 11. The dose-length product of each chest model group and patients group were record, the effective dose (ED) of each group was calculated and compared. The image quality among groups through combining the objective CT and standard deviation (SD) values of different organizations (lung tissue, the soft tissue near by spine, the aorta and vertebral body) in chest model and the image subjective rating of patients were compared, and the subjective score of patients' images was also compared among groups. Results With the increase of pre-setted ASiR-V, the ED of chest model and patients reduced as a logarithmic fitting, there are no obvious changes of the CT value and image noise SD value of different organizations in model. The subjective score of mediastinal and pulmonary window was begin to decline at 40% weighted ASiR-V. The subjective score of mediastinal and pulmonary window descend obviously at 60% weighted ASiR-V compare to 40% (P<0.05). ED of pre-setted 40% weighted ASiR-V reduced to 57.21% compared to that of 0 weighted ASiR-V. Conclusion The pre-setted ASiR-V can reduce the radiation dose, and does not affect the objective image quality at the same time. The pre-setted 40% weighted ASiR-V has the highest clinical application value due to the radiation dose can be obviously reduced with ensuring the image quality, which can meet the demand of diagnosis.

田野(1981—)，男，遼寧阜新人，碩士，醫師。

E-mail： 55194028@qq.com

2016-09-29

2016-10-26

10.13929/j.1003-3289.201609142

R739.9； R445.1

B

1003-3289(2017)03-0467-01