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摘要: 目的 探讨MR神经成像定量评估急性周围性面瘫患者面神经及周围淋巴结的价值。方法 采用前瞻性实验设计，纳入32例急性周围性面瘫患者，基于MR神经成像技术采集双侧面神经MR高分辨薄层图像，测量双侧面神经不同节段(包括迷路段、膝状神经节、水平段、垂直段、茎乳孔段、腮腺段主干、颞面干、颈面干)直径以及耳周、腮腺淋巴结的定量指标(数量、最大淋巴结的长短径)。采用配对t检验及Wilcoxon符号秩检验，比较双侧面神经直径、周围淋巴结定量指标差异。结果 面瘫侧膝状神经节、茎乳孔段、腮腺段主干、颞面干、颈面干直径明显大于健侧(均P < 0.05)，但迷路段、水平段、垂直段直径与健侧比较差异无统计学意义；面瘫侧耳周淋巴结的数量明显多于健侧(P=0.001)。结论 MR神经成像可定量评估急性周围性面瘫患者面神经结构变化：膝状神经节、茎乳孔段、腮腺段主干、颞面干及颈面干增粗；同时发现患侧耳周淋巴结数量增多。上述发现可辅助评估疗效、判断预后。Abstract: Objective To exploring the value of MR neuroimaging for quantitative assessment of the facial nerve and peripheral lymph nodes in patients with acute peripheral facial paralysis.Methods Based on a prospective experimental design, 32 patients with idiopathic peripheral facial palsy were enrolled in the experiment. Based on MR neuroimaging technology, MR high-resolution thin-layer images of bilateral facial nerves were acquired. The diameters of different segments of the bilateral facial nerve were measured, including the labyrinthine segment, the geniculate ganglion, the horizontal segment, the vertical segment, the stem-mammary foramen segment, the trunk of the parotid segment, the temporal trunk, and the cervical trunk, as well as the quantitative indicators of peri-auricular and parotid lymph nodes(number, length and diameter of the largest lymph nodes). Differences in quantitative indices of nerve diameter and peripheral lymph nodes between the paraplegic and healthy sides were compared using the paired t-test and Wilcoxon signed rank test.Results The diameter of geniculate ganglion, mastoid foramen stem, parotid main trunk, temporal facial trunk, and cervical facial trunk were notably increased on the facial paralysis side compared to the contralateral side(P < 0.05). However, no significant differences were observed in the diameter of labyrinthine segment, horizontal segment, or vertical segment compared to the contralateral side. There were significantly more periauricular lymph nodes on the facial paralysis side than the contralateral side(P=0.001).Conclusion MR neuroimaging enables the quantitative assessment of structural changes in the facial nerve of patients with acute peripheral facial paralysis, demonstrating nerve enlargement in the geniculate ganglion, stylomastoid foramen segment, main trunk of the parotid segment, temporal facial trunk, and cervical facial trunk. Additionally, an increased number of periauricular lymph nodes is observed on the affected side. These findings may aid clinicians in assessing the efficacy of treatments and predict the prognosis of these patients.
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Key words:
- acute peripheral facial palsy /
- Bell facial palsy /
- hunt syndrome /
- MR neurography /
- facial nerve
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表 1 面瘫侧与健侧面神经不同节段直径和淋巴结的比较
组别 阳性 阴性 统计值 P 迷路段 0.98±0.24 1.00±0.23 0.440 0.662 膝状神经节长径 2.56±0.53 2.29±0.39 3.340 0.002 膝状神经节短径 2.02±0.48 1.81±0.35 2.290 0.029 水平段 1.19±0.29 1.13±0.23 0.880 0.387 垂直段 1.65±0.34 1.59±0.20 0.830 0.413 茎乳孔 1.83±0.31 1.5±0.22 6.996 < 0.001 腮腺段主干 1.63±0.31 1.35±0.31 3.640 0.001 颞面干 1.36(1.24，1.56) 1.05(0.70，1.25) 3.820 < 0.001 颈面干 1.26±0.38 0.86±0.28 5.760 < 0.001 最大淋巴结长径 10.58±4.07 10.63±3.95 0.070 0.943 最大淋巴结短径 5.95±1.98 5.83±1.89 0.340 0.736 耳周淋巴结 5.00(3.25，7.00) 3.00(1.25，4.00) 3.480 0.001 腮腺淋巴结 10.00(7.00，12.75) 9.00(6.25，11.75) 1.903 0.053 
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