| Purpose:Peripheral neuropathy is still one of the most common reasons people visit neurology.How to perform the best static and dynamic imaging of peripheral nerves to obtain information on changes in neural structure has become a new challenge.The technological advancement of fine surgery such as peripheral nerve injury repair promoted by the development has also put forward an urgent demand for high-resolution images.At present,for peripheral small nerves,imaging technologies such as CT and MRI are limited by resolution or real-time,and it is difficult to achieve real-time dynamic observation and tracking.New imaging technologies are urgently needed.With the rapid progress of high-frequency ultrasound technology,the resolution of ultrasound continues to improve,and it is possible to observe some small nerves using high-frequency ultrasound.This study intends to explore the application value of ultrasound in the diagnosis of small peripheral nerve imaging that is difficult to display on a variety of CT or MRI,and to count the normal and abnormal values of related nerves in order to provide more references for the application of small nerve ultrasound in clinical applications.Methods:This study retrospectively analyzed the patients who had been treated in the Sixth People's Hospital of Shanghai Jiao Tong University from 2008 to 2019 and had undergone ultrasound imaging examination of the lateral femoral cutaneous nerve,gastrocnemius nerve,and volar intrinsic nerve.The total number of patients was 162,52,and 32,respectively.Statistical analysis was performed on the patient's basic information,symptoms,neuroelectrophysiology,MRI,and neuroimaging imaging data,including normal and abnormal nerve cross-sectional areas,anteroposteriordiameter,anatomicallocation,and electrophysiological information.Results:In the study of the lateral femoral cutaneous nerve,for all162 patients,ultrasound could clearly show the lateral femoral cutaneous nerve,showing a hyperechoic oval structure between the latissimus fasciae muscle and the sartorius muscle.Ultrasound images of the lateral femoral cutaneous nerve in 99 cases(61.11%)showed abnormal sonographic features.Of the 99 cases,81(81.82%)patients showed obvious swelling and thickening of the main part of the lateral femoral cutaneous nerve,6(6.06%)showed mild swelling,and 6(6.06%)showed a lateral femoral cutaneous nerve.Swelling and thickening of a bundle branch,3 cases(3.03%)showed limited hypoechoic space occupying the lateral femoral cutaneous nerve,and 2 cases(2.02%)mainly showed no thickening but echo changes in the lateral femoral cutaneous nerve.One case(1.01%)showed continuous discontinuity of the inner bundle branch of the lateral femoral cutaneous nerve.The average cross-sectional area of 81 cases of thickened lateral femoral cutaneous nerve was 9.53±3.87mm~2,and the anteroposterior diameter was 2.28±0.63mm.Among them,the average cross-sectional area of normal lateral femoral cutaneous nerve recorded in 33 cases was 4.00±1.82mm~2,before and after The diameter was 1.33±0.47mm,and the difference was significant(p<0.05).Of the 162 cases,22 cases were examined with electromyography,of which the positive rate was 18.18%;23 cases were examined with MRI,positive rate 39.13%.In the study of the gastrocnemius nerve,for all 52 patients,the ultrasound can clearly show the gastrocnemius nerve as a round or oval sieve mesh around the non-echoic area of the small saphenous vein in the middle and lower 1/3 of the back of the calf.In the hyperechoic area,35 cases(67.30%)of the sural nerve showed abnormal sonograms.Twenty-three of the 35 patients(65.71%)showed swelling and thickening of the gastrocnemius nerve,7(20.00%)showed hypoechoic space occupying the gastrocnemius nerve,and 2(5.71%)showed gastrocnemius nerve continuity Discontinued,1 case(2.86%)showed simple changes in the gastrocnemius nerve echo(thickness of the epineurium),and 1 case(2.86%)mainly showed localized dark areas around the gastrocnemius nerve,and 1 case(2.86)(%)Shows that the gastrocnemius nerve is not clearly distinguished from the surrounding low echo.Among them,the average cross-sectional area of 17 cases of thickened lateral femoral cutaneous nerve recorded with specific data was 6.65±1.91mm~2,and the anterior-posterior diameter was 2.49±0.44mm.Among them,the average cross-sectional area of the normal gastrocnemius nerve recorded in 4 cases was 2.25±0.83 mm~2,the anterior-posterior diameter is1.40±0.25mm,the difference is significant(p<0.05).Of the 52cases,11 cases were examined by electromyography,and the positive rate was 90.90%;In the study of the extrinsic nerve of the finger,for all 32 patients,ultrasound can clearly show the extrinsic nerve of the digit of the finger,which is shown next to the extrinsic artery of the digit of the finger,and the cross section of the nerve is a low point surrounded by medium and strong echo.Echo,faintly visible or unable to show the reticular structure,30 cases(93.75%)of the gastrocnemius nerve showed abnormal sonograms in the ultrasound image.Twenty of the 30(66.67%)patients showed a thickened nerve cross-sectional area,4(13.33%)showed a paraneural hypoechoic area,3(10.00%)showed a neurogenic tumor,and 2(6.67%)showed abnormal neuroechoic structure.Among them,the average cross-sectional area of 18 cases of thickened fingers with palmar extrinsic nerves was 4.50±3.19mm~2,and the anteroposterior diameter was 1.97±0.65mm.Among them,the average cross-sectional area of normal femoral cutaneous nerves recorded in 14cases was 1.38±0.622,the anterior-posterior diameter was 1.14±0.30,and the difference was significant(p<0.05).Conclusion:High-frequency ultrasound can clearly show the lateral femoral cutaneous nerve,sural neuropathy,accessory nerve,and extrinsic nerve of the digit of the finger.It can effectively find the lesion and provide physiological information such as blood flow signals and the cause of the lesion.Information is of great help in the diagnosis,differential diagnosis,and efficacy evaluation of clinical peripheral nerve-related diseases.It is a reliable tool for peripheral small nerve diagnosis and is worthy of further popularization and application in the clinic. |
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