磁共振3D-TOF-MRA和3D-FIESTA-C序列联合应用在原发性面肌痉挛诊断中的价值

目的 探讨磁共振（magnetic resonance imaging，MRI）3D-TOF-MRA和3D-FIESTA-C序列联合应用于原发性面肌痉挛患者神经血管关系诊断中的价值。 方法 回顾性分析58例经微血管减压术的原发性面肌痉挛患者的MRI资料，所有患者均行MRI 3D-TOF-MRA和3D-FIESTA-C序列扫描， 并对脑干、面神经及周围血管进行多平面重建，判定面肌痉挛患者面神经与血管的毗邻关系， 统计症状侧与非症状侧面神经根部与周围血管接触关系以及神经受压、变形的数量，进一步辨明责任血管及来源， 并与术中解剖结果相比较。 结果 所有原发性面肌痉挛患者中， MRI 3D-TOF-MRA和3D-FIESTA-C序列联合应用与微血管减压术术后结果对照分析显示，MRI发现症状侧血管与神经接触、受压阳性率为94.83%（55/58），非症状侧血管与神经接触、受压的阳性率为17.24%（10/58），差异有统计学意义（χ2=373.812,P＜0.05），其中小脑前下动脉压迫最为常见，占比63.79%（37/58），其次为小脑后下动脉、椎动脉、基底动脉、静脉以及椎动脉+前下动脉复合性压迫。58例患者行59次微血管减压术，其中2例术前判断为面神经未受压迫，术中所见亦未受压迫；术前1例判断为面神经无压迫，术中证实为小脑后下动脉压迫；术前应用MRI3D-TOF-MRA和3D-FIESTA-C序列联合判定面神经责任血管压迫的敏感度98.2%，特异度100%。 结论 原发性面肌痉挛患者联合应用磁共振3D-TOF-MRA和3D-FIESTA-C序列可准确判断颅脑神经血管的毗邻关系，并可指导临床选择合适的治疗方案。

Value of combined application of MRI 3D-TOF and 3D-FIESTA-C sequences in the diagnosis of primary hemifacial spasm

Objective To explore the value of combined application of magnetic resonance imaging(MRI) 3D-TOF-MRA and 3D-FIESTA-C sequence in the diagnosis of the neurovascular relationship in primary hemifacial spasm(pHFS).Methods The MRI data of 58 patients with pHFS who underwent microvascular decompression were retrospectively analyzed. All patients underwent 3D-TOF-MRA and 3D-FIESTA-C sequence scanning, and multiplanar reconstruction was performed on the brainstem, facial nerve and peripheral blood vessels.The adjacent relationship between facial nerve and blood vessel in patients with hemifacial spasm(HFS) was determined.The contact relationship between nerve root and peripheral blood vessels on symptomatic side and non-symptomatic side, as well as the number of nerve compression and deformation was calculated. The responsible blood vessel and its source were further identified, and compared with the intraoperative anatomical results.Results In all patients with HFS, compared with the postoperative results of microvascular decompression, the combined application of MRI 3D-TOF-MRA and 3D-FIESTA-C sequence showed that the positive rate of neurovascular contact and compression on the symptomatic side was 94.83%(55/58), and the positive rate of neurovascular contact and compression on the non-symptomatic side was 17.24%(10/58); the difference between the two groups was statistically significant(χ2=373.812, P＜0.05). Anterior inferior cerebellar artery compression was the most common, accounting for 63.79%(37/58), followed by compression of posterior inferior cerebellar artery, vertebral artery, basilar artery, vein and the combined compression of vertebral artery + anterior inferior artery.Of them, 58 patients underwent 59 times of microvascular decompression, of which 2 cases were evaluated as no compression of the facial nerve before operation and during operation, and 1 case as no facial nerve compression before operation but posterior inferior cerebellar artery compression during operation. The sensitivity and specificity of combined application of preoperative MRI 3D-TOF-MRA and 3D-FIESTA-C sequence in the diagnosis ofresponsible vascular compression of the facial nerve were 98.2% and 100% respectively.Conclusion The combined application of MRI 3D-TOF-MRA and 3D-FIESTA-C sequence in patients with primary facial spasm can accurately determine the adjacent relationship of cranial nerves and blood vessels, and can guide the selection of appropriate treatment plans in clinical practice.