• Korean Journal of Radiology
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• 제24권11호
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• pp.1114-1130
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• 2023

Magnetic resonance neurography (MRN) is increasingly used to visualize peripheral nerves in vivo. However, the implementation and interpretation of MRN in the brachial and lumbosacral plexi are challenging because of the anatomical complexity and technical limitations. The purpose of this article was to review the clinical context of MRN, describe advanced magnetic resonance (MR) techniques for plexus imaging, and list the general categories of utility of MRN with pertinent imaging examples. The selection and optimization of MR sequences are centered on the homogeneous suppression of fat and blood vessels while enhancing the visibility of the plexus and its branches. Standard 2D fast spin-echo sequences are essential to assess morphology and signal intensity of nerves. Moreover, nerve-selective 3D isotropic images allow improved visualization of nerves and multiplanar reconstruction along their course. Diffusion-weighted and diffusion-tensor images offer microscopic and functional insights into peripheral nerves. The interpretation of MRN in the brachial and lumbosacral plexi should be based on a thorough understanding of their anatomy and pathophysiology. Anatomical landmarks assist in identifying brachial and lumbosacral plexus components of interest. Thus, understanding the varying patterns of nerve abnormalities facilitates the interpretation of aberrant findings.

• Investigative Magnetic Resonance Imaging
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• 제11권2호
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• pp.119-126
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• 2007

상완신경총의 영상 진단은 복잡한 해부학적인 구조와 다양하게 침범하는 병들로 인해 어렵고 도전적이다. 상완신경총 영상 진단의 일차적인 목표는 외상성 손상과 비외상성 손상의 구별이다. MRI의 급속경사와 전용표면코일을 이용한 적절한 공간분해능을 가진 영상기기의 발전과 이를 이용한 다양한 펄스열의 개발이 상완신경총의 외상성 손상과 비외상성 손상에 대한 구별에 많은 도움을 주어 정확한 진단으로 수술 여부의 결정에 이용된다. MRI는 비외상성 상완신경총 병변의 진단에 가장 좋은 영상진단이며, CT 척수강조영술은 상완신경총을 침범하는 신경근견열 병변의 검사에 많이 이용된다. 그리고 일반적으로 고화질, 고해상력의 MRI 가 상완신경총 비외상성병변의 진단에 일차적인 영상검사로 중요한 역할을 하고 있다.

• 한국방사선학회논문지
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• 제8권5호
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• pp.271-278
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• 2014

상완신경총에서 STIR(short TI inversion recovery) 지방소거 강조영상과 SPAIR(spectral adiabatic inversion recovery) T2, T1 지방소거 강조영상기법을 비교 평가하여 최적의 지방소거 기법을 알아보고자 하였다. 총 30 명 상완신경총에 질환이 없는 정상인 지원자를 대상으로 3.0 T MRI 기기를 이용하여 검사를 하였고, 분석방법으로 세 기법에 대하여 SNR, CNR 및 4단계 점수로 평가를 하였다. 정량적 분석 결과로 SPAIR T1 기법에 대한 SNR, CNR 값은 상완신경총기시부($03.07{\pm}0.98$, $-2.25{\pm}0.54$), 상완신경총몸체($06.70{\pm}1.81$, $36.31{\pm}2.17$)에서 높은 값을 제공하였다 (p<0.05). 정성적 분석결과 상완신경총 묘출도와 지방소거 정도, 영상의 인공물은 SPAIR T1($3.2{\pm}0.70$, $3.6{\pm}0.51$, $3.4{\pm}0.10$)기법이 의미 있게 높게 나타났다(p<0.05).

• Korean Journal of Radiology
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• 제21권4호
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• pp.483-493
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• 2020

Objective: To evaluate the distribution and characteristics of peripheral nerve abnormalities in chronic inflammatory demyelinating polyneuropathy (CIDP) using magnetic resonance neurography (MRN) and to examine the diagnostic efficiency. Materials and Methods: Thirty-one CIDP patients and 21 controls underwent MR scans. Three-dimensional sampling perfections with application-optimized contrasts using different flip-angle evolutions and T1-/T2- weighted turbo spin-echo sequences were performed for neurography of the brachial and lumbosacral (LS) plexus and cauda equina, respectively. Clinical data and scores of the inflammatory Rasch-built overall disability scale (I-RODS) in CIDP were obtained. Results: The bilateral extracranial vagus (n = 11), trigeminal (n = 12), and intercostal nerves (n = 10) were hypertrophic. Plexus hypertrophies were observed in the brachial plexus of 19 patients (61.3%) and in the LS plexus of 25 patients (80.6%). Patterns of hypertrophy included uniform hypertrophy (17 [54.8%] brachial plexuses and 21 [67.7%] LS plexuses), and multifocal fusiform hypertrophy (2 [6.5%] brachial plexuses and 4 [12.9%] LS plexuses) was present. Enlarged and/or contrast-enhanced cauda equina was found in 3 (9.7%) and 13 (41.9%) patients, respectively. Diameters of the brachial and LS nerve roots were significantly larger in CIDP than in controls (p < 0.001). The largest AUC was obtained for the L5 nerve. There were no significant differences in the course duration, I-RODS score, or diameter between patients with and without hypertrophy. Conclusion: MRN is useful for the assessment of distribution and characteristics of the peripheral nerves in CIDP. Compared to other regions, LS plexus neurography is more sensitive for CIDP.

• 대한한방소아과학회지
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• 제28권1호
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• pp.14-23
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• 2014

Objectives The objective of this study is to report the effects of acupuncture on neonatal brachial plexus palsy (neonatal brachial plexopathy). Methods We treated the patient with acupuncture for 4 months. Acupuncture was performed on the infant with flaccid paresis of a lower extremity. The effects of neonatal brachial plexus injury were measured by the active movement scale and the electromyographic test. Results 1. In electromyographic test, conduction velocity in left median nerve was elevated. 2. Active movement scale score was increased from 6 to 27 during the 4 months of treatment. 3. Grasping power of the patient's left hand was 60% stronger than the first medical examination. Conclusions This study showed that acupuncture was effective in treating the symptoms of brachial plexopathy. The further studies might be also needed.

• The Korean Journal of Pain
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• 제7권2호
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• pp.205-210
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• 1994

The effects of either clonidine or epinephrine into local anesthetics administered into brachial plexus sheath were evaluated in 42 patients who underwent surgery of the upper limb. All patient received 0.5 ml/kg of 2:1 mixture of bupivacaine and lidocaine injected into the brachial plexus sheath, using the subclavian perivascular technique. The patients were randomly allocated into two groups; Group I(n=25) received $150{\mu}g$ of clonidine hydrochloride, and Group II(n=27) received $200{\mu}g$ of epinephrine. The duration of analgesia and the degree of sedation reflecting the systemic effect of clonidine were assessed. The block produced by the addition of clonidine was longer($100.3{\pm}469.8$ vs $648.8{\pm}192.1$ min) and superior to that by epinephrine(p < 0.05). The highest degree of sedation was achieved about 20 minutes after block, which roughly equals the time required for intramuscular clonidine to show the similar effect. The author concludes that the injection of clonidine mixed to local anesthetics into the brachial plexus sheath prolongs analgesia than that of epinephrine, but this prolongation may be due to the systemic effect of clonidine.

• The Korean Journal of Pain
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• 제6권2호
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• pp.199-203
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• 1993

Inferior mesenteric plexus block(IMPB) is a nerve block for lower abdominal pain originating from GI tract of distal transverse colon to sigmoid colon and other polvic organ where the inferior mesenteric plexus contains visceral afferent fibers of that organ. We performed IMPB on two patients with lower abdominal pain. Case I: 61 year old female diagnosed with cancer of stomach and uterine cervix and carcinomatosis, experienced complete relief from pain for a period of 7 months after IMPB. Case II: male, 28 years old, who had contracted cancer of the descending colon with obstructive jaundice and pancreatitis had complained of pain in the whole of the abdominal area. IMPB was performed for lower abdominal pain. Seven days after, a celiac plexus block was also performed for upper abdominal pain. The patient complained of recurring pain in the left & upper lower abdomen 30 days after the IMPB. The intensity of the pain was visual analogue scale 4 and it was managed by continuous epidural block. Conclusion: It is our recommendation that IMPB is a reliable method for treatment of lower abdominal pain originating from malignant condition of GI tract from distal transverse colon to sigmoid colon and urinary bladder.

• Journal of Korean Neurosurgical Society
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• 제59권1호
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• pp.58-61
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• 2016

Choroid plexus papillomas (CPPs) are relatively rare neuroectodermal tumors that develop from choroid plexus epithelial cells and are usually restricted to the ventricles. Extraventricular CPPs are very unusual and can be difficult to diagnose and treat. A 50-year-old male patient was admitted to our clinic complaining of headache and visual deterioration. Neurological examination found no abnormalities except decreased light perception and secondary optic atrophy in the left eye. Endocrine testing revealed normal levels of hormones produced by the pituitary and target glands. Magnetic resonance imaging of the brain revealed a huge regular-shaped lesion in the sellar-suprasellar region occupying the sella turcica and extending into the suprasellar cistern and planum sphenoidale. The lesion was completely excised by microsurgery via an ordinary left-sided pterional approach. Histopathology identified the lesion as a choroid plexus papilloma. Following the case report, literature on the origin, differential diagnosis, and treatment of this rare tumor is reviewed.

• 대한한방소아과학회지
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• 제28권1호
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• pp.24-31
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• 2014

Objectives The purpose of this study is to know the effect of acupuncture on brachial plexus palsy due to birth injury. Methods We decided to treat one week of Vojta therapy and occupational therapy, but other were combined, and then add three weeks of acupuncture treatment as well. Results Right clavicle fracture at birth brachial plexus injury due to decreased locomotion of the right upper extremity, muscle weakness in children aged 7 months to Vojta therapy, occupational therapy and acupuncture, when performed in conjunction mobility increase of the shoulder joint, elbow support improvement, recovery of motor function of the hand grip, etc. to obtain a significant motor function recovery improvement. Conclusion Acupuncture was a good treatment of choice for the better shoulder, joint and hands movements.

• The Korean Journal of Pain
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• 제5권1호
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• pp.108-112
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• 1992

Pain from pelvic cancer is very difficult to manage because it's vague ness and bilateral nature. Furthermore, nerve blocks in this area are dangerous because sensory afferent nerves from pelvic viscera are adjacent to nerves that regulate bowel and bladder control, and motor nerve of lower extremities'. Bilateral lumbar sympathectomy has been used for malignant pelvic pain with little risk of neurologic complication. However it is not a specific block for pelvic visceral pain, because the lumbar sympathetic chain does not innervate pelvic viscera in a direct manner. Therefore the potentials of lumbar sympathectomy for pelvic visceral pain are attributed to caudad diffusion of neurolytic agents to the smperior hypogastric plexus. I have experienced 3 cases of superior hypogastric plexus neurolysis per se without any significant complications.