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Clinical research of features of magnetic resonance imaging of high-voltage electrical burns in limbs at early stage.

Abstract Objective: To analyze the features of magnetic resonance imaging (MRI) of patients with high-voltage electrical burns in limbs at early stage. Methods: Thirty-eight patients with high-voltage electrical burns, conforming to the study criteria, were hospitalized in our unit from March 2013 to August 2016. T(1) weighted imaging (T(1)WI), T(2)WI, fat-suppression T(2)WI plain scan, and fat-suppression T(1)WI enhanced scan of MRI were performed in 78 limbs, including 56 upper limbs and 22 lower limbs at post injury hour 72. The MRI signal characteristics of electrical burns in skin and subcutaneous tissue, skeletal muscle, tendon, joint ligament, and skeleton of limbs were analyzed. " Sandwich-like" necrosis and injury in skeletal muscle, injuries of tendon, joint ligament, and skeleton were observed. MRI signal characteristics of amputated upper limbs and salvaged limbs were also analyzed. All patients underwent surgery within 24 h after MRI examination, and the muscle vitality was judged during operation. Muscle tissue without reaction to electrical stimulation which was completely necrotic as shown by MRI, muscle tissue with weak reaction to electrical stimulation which was injured with blood supply as shown by MRI, and muscle tissue with edema as shown by MRI were collected, and then the pathological characteristics of muscle tissue were observed with HE staining. Results: (1) The defect area of patients at entrance of current was bigger than that at exit. The skin and subcutaneous tissue extensively unevenly thickened. T(2)WI manifested hyperintensity, and T(1)WI manifested isointensity, while fat-suppression enhanced T(1)WI manifested uneven enhancement. Zonal effusion was seen in the region of serious subcutaneous edema. (2) For complete necrosis of skeletal muscle, T(2)WI manifested hypointense, isointensity, or slight hyperintensity, and T(1)WI manifested isointensity, slight hyperintensity, or mixed signal of isointensity and slight hyperintensity, while fat-suppression enhanced T(1)WI manifested most no enhancement area with clear boundary. The MRI signals of injured skeletal muscle could be divided into two types. Type Ⅰ signal was for partial necrotic muscle adjacent to the completely necrotic zone. T(2)WI manifested uneven hyperintensity or slight hyperintensity, with unclear boundary. T(1)WI manifested isointensity or slight hyperintensity. Fat-suppression enhanced T(1)WI manifested significant banding or laciness enhancement. Type Ⅱ signal was for deep muscle tissue far from the complete necrotic zone. T(2)WI manifested hyperintensity, and T(1)WI manifested isointensity or main isointensity mixed with hyperintensity, while fat-suppression enhanced T(1)WI manifested uneven moderate or slight enhancement. Normal muscle signal, type Ⅰ signal, and type Ⅱ signal were all mixed with necrotic signal, showing " sandwich-like" change. For skeletal muscle edema, T(2)WI manifested slight hyperintensity and unclear boundary, and T(1)WI manifested hypointense, while fat-suppression enhanced T(1)WI manifested no obvious enhancement. (3) For complete necrosis of tendon, T(2)WI manifested isointensity or slight hyperintensity, and T(1)WI manifested isointensity, while fat-suppression enhanced T(1)WI manifested no enhancement. For tendon injury, T(2)WI manifested isointensity, and T(1)WI manifested isointensity or hypointense, while fat-suppression enhanced T(1)WI manifested slight enhancement. (4) Severe injury of wrist joint were manifested as complete necrosis of soft tissue around joint. T(2)WI manifested slight hyperintensity or isointensity, and T(1)WI manifested isointensity, while fat-suppression enhanced T(1)WI manifested no enhancement or slightly uneven enhancement. For completely destroyed wrist joints, the structures were not clear from outside to inside. T(2)WI manifested slight hyperintensity or isointensity, and T(1)WI manifested hypointense or isointensity, while fat-suppression enhanced T(1)WI manifested no enhancement. For elbow injury, T(2)WI manifested hyperintensity, and T(1)WI manifested isointensity or hypointense, while fat-suppression enhanced T(1)WI manifested uneven enhancement. For knee injury, T(2)WI manifested hyperintensity, and T(1)WI manifested hypointense, while fat-suppression enhanced T(1)WI manifested slight enhancement. (5) For bone edema, T(2)WI manifested isointensity, while fat-suppression T(2)WI manifested slight hyperintensity. T(1)WI manifested isointensity, and fat-suppression enhanced T(1)WI manifested patchy enhancement. (6) MRI of amputated upper limbs showed necrosis signals, type Ⅰ signals, type Ⅱ signals, and mixed signals of type Ⅰ and type Ⅱ in skeletal muscle. The necrosis signal and type Ⅰ signal area of the distal end were more than 50% greater than those of the lesion. The scope of the ecological tissue was large and the boundary was not clear. There were diffuse injuries in both anterior and posterior muscles, and the ulnar and radial artery pulsation disappeared in the upper limbs. The MRI of salvaged limbs were type Ⅰ signal, type Ⅱ signal, mixed signals of type Ⅰ and type Ⅱ, and local necrosis signals of skeletal muscle. The type Ⅰ signal was the main type, and the distal end showed type Ⅱ signal. (7) For completely necrotic skeletal muscle as shown by MRI, surgical exploration showed loss of muscle viability, and pathological examination showed complete necrosis of striated muscle tissue. For injury area of skeletal muscle as shown by MRI, surgical exploration showed interecological muscle with activity worse than mormal muscle, and pathological examination showed normal muscle cells and muscle fiber mixed with necrotic striated muscle cells having karyopyknosis, with different degree of injury. For edema area of skeletal muscle as shown by MRI, surgical exploration showed swelling skeletal muscle and normal muscle vitality, and pathological examination showed striated muscle interstitial edema with a large number of inflammatory cells infiltration. The manifestions of MRI were consistent with the results of surgical exploration and pathological examination. Conclusions: Skeletal muscle complete necrosis, injury, and edema could be preferably differentiated by MRI, and the definite scope and depth of electrical injury, the injury of skin, tendon, joint ligament, and bone could also be displayed well on MRI. It can provide objective imaging basis for the diagnosis of high-voltage electrical burns in limbs at early stage, the establishment of clinical operation plan, and the judgment of intraoperative tissue vitality.
PMID
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Authors

Mayor MeshTerms

Magnetic Resonance Imaging

Keywords

Burns, electric

Extremities

Magnetic resonance imaging

Journal Title zhonghua shao shang za zhi = zhonghua shaoshang zazhi = chinese journal of burns
Publication Year Start




PMID- 29275616
OWN - NLM
STAT- MEDLINE
DCOM- 20180105
LR  - 20180105
IS  - 1009-2587 (Print)
IS  - 1009-2587 (Linking)
VI  - 33
IP  - 12
DP  - 2017 Dec 20
TI  - [Clinical research of features of magnetic resonance imaging of high-voltage
      electrical burns in limbs at early stage].
PG  - 750-756
LID - 10.3760/cma.j.issn.1009-2587.2017.12.006 [doi]
AB  - Objective: To analyze the features of magnetic resonance imaging (MRI) of
      patients with high-voltage electrical burns in limbs at early stage. Methods:
      Thirty-eight patients with high-voltage electrical burns, conforming to the study
      criteria, were hospitalized in our unit from March 2013 to August 2016. T(1)
      weighted imaging (T(1)WI), T(2)WI, fat-suppression T(2)WI plain scan, and
      fat-suppression T(1)WI enhanced scan of MRI were performed in 78 limbs, including
      56 upper limbs and 22 lower limbs at post injury hour 72. The MRI signal
      characteristics of electrical burns in skin and subcutaneous tissue, skeletal
      muscle, tendon, joint ligament, and skeleton of limbs were analyzed. "
      Sandwich-like" necrosis and injury in skeletal muscle, injuries of tendon, joint 
      ligament, and skeleton were observed. MRI signal characteristics of amputated
      upper limbs and salvaged limbs were also analyzed. All patients underwent surgery
      within 24 h after MRI examination, and the muscle vitality was judged during
      operation. Muscle tissue without reaction to electrical stimulation which was
      completely necrotic as shown by MRI, muscle tissue with weak reaction to
      electrical stimulation which was injured with blood supply as shown by MRI, and
      muscle tissue with edema as shown by MRI were collected, and then the
      pathological characteristics of muscle tissue were observed with HE staining.
      Results: (1) The defect area of patients at entrance of current was bigger than
      that at exit. The skin and subcutaneous tissue extensively unevenly thickened.
      T(2)WI manifested hyperintensity, and T(1)WI manifested isointensity, while
      fat-suppression enhanced T(1)WI manifested uneven enhancement. Zonal effusion was
      seen in the region of serious subcutaneous edema. (2) For complete necrosis of
      skeletal muscle, T(2)WI manifested hypointense, isointensity, or slight
      hyperintensity, and T(1)WI manifested isointensity, slight hyperintensity, or
      mixed signal of isointensity and slight hyperintensity, while fat-suppression
      enhanced T(1)WI manifested most no enhancement area with clear boundary. The MRI 
      signals of injured skeletal muscle could be divided into two types. Type signal
      was for partial necrotic muscle adjacent to the completely necrotic zone. T(2)WI 
      manifested uneven hyperintensity or slight hyperintensity, with unclear boundary.
      T(1)WI manifested isointensity or slight hyperintensity. Fat-suppression enhanced
      T(1)WI manifested significant banding or laciness enhancement. Type signal was
      for deep muscle tissue far from the complete necrotic zone. T(2)WI manifested
      hyperintensity, and T(1)WI manifested isointensity or main isointensity mixed
      with hyperintensity, while fat-suppression enhanced T(1)WI manifested uneven
      moderate or slight enhancement. Normal muscle signal, type signal, and type
      signal were all mixed with necrotic signal, showing " sandwich-like" change. For 
      skeletal muscle edema, T(2)WI manifested slight hyperintensity and unclear
      boundary, and T(1)WI manifested hypointense, while fat-suppression enhanced
      T(1)WI manifested no obvious enhancement. (3) For complete necrosis of tendon,
      T(2)WI manifested isointensity or slight hyperintensity, and T(1)WI manifested
      isointensity, while fat-suppression enhanced T(1)WI manifested no enhancement.
      For tendon injury, T(2)WI manifested isointensity, and T(1)WI manifested
      isointensity or hypointense, while fat-suppression enhanced T(1)WI manifested
      slight enhancement. (4) Severe injury of wrist joint were manifested as complete 
      necrosis of soft tissue around joint. T(2)WI manifested slight hyperintensity or 
      isointensity, and T(1)WI manifested isointensity, while fat-suppression enhanced 
      T(1)WI manifested no enhancement or slightly uneven enhancement. For completely
      destroyed wrist joints, the structures were not clear from outside to inside.
      T(2)WI manifested slight hyperintensity or isointensity, and T(1)WI manifested
      hypointense or isointensity, while fat-suppression enhanced T(1)WI manifested no 
      enhancement. For elbow injury, T(2)WI manifested hyperintensity, and T(1)WI
      manifested isointensity or hypointense, while fat-suppression enhanced T(1)WI
      manifested uneven enhancement. For knee injury, T(2)WI manifested hyperintensity,
      and T(1)WI manifested hypointense, while fat-suppression enhanced T(1)WI
      manifested slight enhancement. (5) For bone edema, T(2)WI manifested
      isointensity, while fat-suppression T(2)WI manifested slight hyperintensity.
      T(1)WI manifested isointensity, and fat-suppression enhanced T(1)WI manifested
      patchy enhancement. (6) MRI of amputated upper limbs showed necrosis signals,
      type signals, type signals, and mixed signals of type and type in skeletal
      muscle. The necrosis signal and type signal area of the distal end were more than
      50% greater than those of the lesion. The scope of the ecological tissue was
      large and the boundary was not clear. There were diffuse injuries in both
      anterior and posterior muscles, and the ulnar and radial artery pulsation
      disappeared in the upper limbs. The MRI of salvaged limbs were type signal, type 
      signal, mixed signals of type and type , and local necrosis signals of skeletal
      muscle. The type signal was the main type, and the distal end showed type signal.
      (7) For completely necrotic skeletal muscle as shown by MRI, surgical exploration
      showed loss of muscle viability, and pathological examination showed complete
      necrosis of striated muscle tissue. For injury area of skeletal muscle as shown
      by MRI, surgical exploration showed interecological muscle with activity worse
      than mormal muscle, and pathological examination showed normal muscle cells and
      muscle fiber mixed with necrotic striated muscle cells having karyopyknosis, with
      different degree of injury. For edema area of skeletal muscle as shown by MRI,
      surgical exploration showed swelling skeletal muscle and normal muscle vitality, 
      and pathological examination showed striated muscle interstitial edema with a
      large number of inflammatory cells infiltration. The manifestions of MRI were
      consistent with the results of surgical exploration and pathological examination.
      Conclusions: Skeletal muscle complete necrosis, injury, and edema could be
      preferably differentiated by MRI, and the definite scope and depth of electrical 
      injury, the injury of skin, tendon, joint ligament, and bone could also be
      displayed well on MRI. It can provide objective imaging basis for the diagnosis
      of high-voltage electrical burns in limbs at early stage, the establishment of
      clinical operation plan, and the judgment of intraoperative tissue vitality.
FAU - Li, S J
AU  - Li SJ
AD  - Department of Radiology, Shanghai Electric Power Hospital, Shanghai 200050,
      China.
FAU - Wang, Z L
AU  - Wang ZL
FAU - Zhu, W P
AU  - Zhu WP
FAU - Xiang, Y
AU  - Xiang Y
FAU - Lin, J
AU  - Lin J
FAU - Yu, Y J
AU  - Yu YJ
FAU - Li, P
AU  - Li P
LA  - chi
PT  - Journal Article
PL  - China
TA  - Zhonghua Shao Shang Za Zhi
JT  - Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns
JID - 100959418
SB  - IM
MH  - Burns, Electric/*diagnostic imaging
MH  - Edema
MH  - Electricity
MH  - Extremities/*diagnostic imaging
MH  - Female
MH  - Humans
MH  - *Magnetic Resonance Imaging
MH  - Male
MH  - Muscle, Skeletal
MH  - Necrosis
OTO - NOTNLM
OT  - Burns, electric
OT  - Extremities
OT  - Magnetic resonance imaging
EDAT- 2017/12/26 06:00
MHDA- 2018/01/06 06:00
CRDT- 2017/12/26 06:00
PHST- 2017/12/26 06:00 [entrez]
PHST- 2017/12/26 06:00 [pubmed]
PHST- 2018/01/06 06:00 [medline]
PST - ppublish
SO  - Zhonghua Shao Shang Za Zhi. 2017 Dec 20;33(12):750-756.