磁共振断层血管成像对原发性三叉神经痛的诊断价值

目的：探讨磁共振断层血管成像(MRTA)对原发性三叉神经痛(ITN)患者神经血管关系的诊断价值及可靠性。方法回顾性分析280例 ITN 患者的临床及 MR 资料,并与手术结果进行盲法对照。结果280例 ITN 患侧神经血管接触、可疑接触或压迫共267例(阳性率95.3%),健侧有66例(假阳性率23.6%);120例手术者,术中发现神经血管接触或压迫118例。患侧与健侧神经血管接触或压迫比较差异有统计学意义(P <0.05)。以手术结果为金标准,MRTA 诊断神经血管接触或压迫的特异度、灵敏度、诊断符合率分别为100%,96.6%,96.7%。结论MRTA 能可靠地显示 ITN 神经血管的关系,其诊断灵敏度和准确率高,对ITN 病因诊断和手术治疗提供客观的依据。     

磁共振体层血管造影对三叉神经痛诊断价值的研究

目的：探讨磁共振体层血管造影（MRTA）对三叉神经痛的诊断价值。方法：回顾性地分析120例经手术治疗的三叉神经痛患者的MRTA表现及手术结果。结果：120例症状侧MRTA检查有血管压迫者为79侧，接触者为28侧，共107侧，敏感性为89．17％。120例症状侧行手术治疗，手术发现有血管压迫或接触者76侧，MRTA检查诊断神经血管压迫和接触的特异性分别为96．2％和82．14％。结论：MRTA成像作为一项新的影像学检查技术，能较好地显示三叉神经根与周围血管之间的关系，从而为三叉神经痛的病因诊断及临床的治疗提供可靠的影像学依据。     

MRI and MR angiography of persistent trigeminal artery

We describe the MRA and MR angiography (MRA) features of persistent trigeminal artery (PTA) found incidentally in eight patients, with special attention to its origin, site and course. The different patterns of posterior communicating arteries were also noted. The PTA were shown on sagittal, coronal and axial MRI and on MRA. In four cases, the PTA arose from the lateral aspect of the intracavernous internal carotid artery, ran caudally, passing round the bottom of the dorsum sellae to join the basilar artery. In the other four cases, it arose from the medial aspect, ran caudally through the sella turcica and pierced the dorsum sellae to join the basilar artery. The posterior communicating arteries were present unilaterally in five cases and bilaterally in one, and absent bilaterally in two. Identification of a PTA with a trans-sellar course is crucial if a trans-sphenoidal surgery is planned. Received: 20 September 1995 Accepted: 20 January 1996     

MR imaging and MR angiography of persistent trigeminal artery and its variant

Six patients with persistent trigeminal artery (PTA) and one patient with its variant (PTAV) were studied using a 1.0-T magnetic resonance unit. With both magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), four of the six PTAs were detected as abnormal connecting arteries between the cavernous internal carotids and the basilar arteries. The remaining two PTAs and one PTAV were not detected using MRI, but were imaged by MRA. It was concluded that relatively large PTAs can be detected using MRI, but small PTAs and PTAVs may be missed using MRI.     

Magnetic resonance tomographic angiography: diagnostic value in trigeminal neuralgia

A combination of MRI, MR angiography and MR tomographic angiography (MRTA) was used to study the relationship to the root exit zone of the trigeminal nerve to surrounding vascular structures in seven patients with trigeminal neuralgia (TN) and ten patients with no evidence at a lesion in this region. MRTA is the technique for showing the relationship between vessels, cranial nerves and brain stem. MRTA clearly demonstrated the presence of a vessel at the root exit zone of the trigeminal nerve in all patients with TN. In the ten other patients, examination of 20 trigeminal nerves revealed that only one nerve (5%) was in contact with a vessel at the root exit zone. This study supports vascular compression of trigeminal nerves as a cause of TN, and demonstrates the value of MRTA as noninvasive technique for demonstrating compression.     

面肌抽搐与三叉神经痛的MRI诊断

目的　探讨面肌抽搐及三叉神经痛患者血管压迫病因的MR表现及其诊断价值。方法　回顾性分析了 12 0例面肌抽搐及三叉神经痛患者MR表现及手术结果。结果　 (1) 6 3例面肌抽搐患者MR显示 12 6侧面听神经共发现 5 8侧存在神经血管压迫或接触 ,17侧可疑接触 ;5 7例三叉神经痛患者MR显示 114侧三叉神经共发现 4 5侧存在神经血管压迫或接触 ,12侧可疑接触。 (2 )统计学分析结果 :面肌抽搐患者症状侧和无症状侧差异有非常显著性意义 (χ2 =31 6 6 ,P <0 0 0 1) ;三叉神经痛患者症状侧和无症状侧差异有非常显著性意义 (χ2 =4 2 98,P <0 0 0 1)。 (3)根据手术结果 ,MR诊断面肌抽搐及三叉神经痛患者神经血管压迫或接触的敏感度为 94 % ,准确度为 83% ,阳性似然比为1 88。结论　MRI能清晰显示三叉神经脑池段与毗邻血管之间的关系 ,对面听神经及三叉神经血管压迫或接触的正确诊断具有较高的敏感度和准确度 ,为临床医师提供术前评估和指导治疗有极其重要的意义。     

Persistent trigeminal artery variants detected by MR angiography

Persistent trigeminal artery (PTA) variants are cerebellar arteries that originate directly from the precavernous portion of the internal carotid artery (ICA). The goal of our study was to determine the incidence and MR angiographic features of PTA variants. Between April 1996 and September 1999, 523 cranial MR angiographies were performed at our institution. Most of the patients examined had or were suspected of having cerebrovascular disease. We retrospectively reviewed these 523 MR angiograms. A 1.5-T scanner was used in all studies, and maximum intensity projection (MIP) images obtained using the three-dimensional time-of-flight (3D TOF) technique were displayed stereoscopically. Four PTA variants were detected on MR angiograms, at a rate of 0.76 %. At least three of the four PTA variants were anterior inferior cerebellar arteries (AICAs), small tortuous arteries arising from the precavernous portions of the ICAs and taking a posterior course. Although the clinical significance is not great, we found a relatively high incidence of PTA variants on MR angiograms. We stress that knowledge and recognition of these anomalous cerebellar arteries are useful and important in the interpretation of cranial MR angiograms. Received: 4 November 1999; Revised: 16 February 2000; Accepted: 16 March 2000     

Acute subarachnoid Haemorrhage: 3D time-of-flight MR angiography versus intra-arterial digital angiography

To evaluate the efficacy and reliability of 3D time-of-flight MR angiography (TOF MRA) as a noninvasive procedure, 27 patients with acute subarachnoid haemorrhage (SAH) were studied with MRA immediately before or after intra-arterial digital subtraction angiography (DSA). 3DTOF MRA was performed with an axial slab of 60 mm centred on the circle of Willis and isotropic voxels. DSA showed 22 aneurysms and 1 dural arteriovenous fistula in 21 patients; the aneurysms ranged in size from 2 to 8 mm. MRA failed to show 2 small aneurysms, at the origin of the posterior and anterior communicating arteries. The 3D display of the intracranial vessels obtained with maximum intensity projection (MIP) or targetted MIP sometimes rendered the aneurysms better than DSA. However, due to its high spatial resolution, DSA more clearly defined the overall anatomy of the walls of the normal and abnormal vessels.1992 Scientific Award of the ESNR     

原发性三叉神经痛的多模态MRI研究进展

原发性三叉神经痛(TN)是最常见的颅神经疾病之一,以三叉神经感觉支分布区反复发作的触电样剧烈疼痛为临床特征,病因不明。多模态MRI技术能够全面评估三叉神经脑池段与邻近血管的毗邻关系、三叉神经形态学改变、三叉神经纤维束的完整性以及相关脑区的结构与功能改变,可以为深入理解TN的发病机制、指导治疗方案的制定以及预后评估提供大量有价值信息。现就多模态MRI技术在TN研究中的技术进展和发展现状予以综述。     

血管压迫性三叉神经痛的MRI研究

目的 采用MR断层血管成像术对血管压迫性三叉神经痛的责任血管作深入研究。方法 235侧正常三叉神经及147侧有三叉神经痛症状的三叉神经MR三维时间飞跃（3D-TOF）扫描图像由2名医师以盲法读片，评判所见三叉神经周围有无血管及其与血管的关系，并记录所见血管的直径、血管至脑干的距离及血管的走行方向。分别进行团体t检验和卡方检验以明确有无统计学意义。结果 共有242侧三叉神经周围可以见到关系密切的血管，其中111侧为无症状组，131侧为有症状组，经统计表明有症状组三又神经所见责任血管距脑干的距离中位数为2mm，明显较无症状组（中位数为4mm）短（P〈0．01），有症状组三叉神经所见责任血管与血管夹角（89．3％，117／131）〉45。（P〈0．01）。无症状组中仅有1例（0．4％，1／235）发现三叉神经受血管推压移位，而在有症状组中有45例（30．6％，45／147），因此有症状组三叉神经受压推移率明显高于无症状组（P〈0．01）。结论 MRI对血管压迫性三叉神经痛的责任血管的评估非常有价值。责任血管距脑干的最短距离及走行与血管压迫性三叉神经痛的发病非常有关。     

Retrograde flow in the dural sinuses detected by three-dimensional time-of-flight MR angiography

Introduction Retrograde flow in the left dural sinuses is sometimes detected by three-dimensional time-of-flight (3D-TOF) magnetic resonance (MR) angiography. The purpose of this study was to evaluate the incidence of this phenomenon and its characteristic features on 3D-TOF MR angiograms. Methods We retrospectively reviewed cranial MR angiography images of 1,078 patients examined at our institution. All images were obtained by the 3D-TOF technique with one of two 1.5-T scanners. Maximum intensity projection (MIP) images in the horizontal rotation view were displayed stereoscopically. We reviewed the source images, inferosuperior MIP images, and horizontal MIP images and identified retrograde flow in the dural sinuses. Results We found retrograde flow in the dural sinuses of 67 patients on the source images from 3D-TOF MR angiography; the incidence was 6.2%. In 47 of the 67 patients, retrograde flow was identified in the left inferior petrosal sinus, in 13, it was seen in the left sigmoid sinus, and in 6, it was seen in the left inferior petrosal and left sigmoid sinuses. The remaining patient had retrograde flow in the left inferior petrosal and left and right sigmoid sinuses. The mean age of the patients with retrograde flow was slightly greater than that of the patients without this phenomenon (70 years vs 63 years). Conclusion Retrograde flow in the dural sinuses frequently occurs on the left side in middle-aged and elderly patients during 3D-TOF MR angiography performed with the patient in the supine position. This phenomenon should not be misdiagnosed as a dural arteriovenous fistula. This article was presented as an electronic poster paper at the 31st Congress of the ESNR held in Geneva in September 2006.     

三维显示增强磁共振血管造影

目的:探讨应用两种公式计算三维对比血管造影(3D CEMRA)的延时时间对改善头部和体部血管影像质量的价值。方法:86例分为两组:头颈组65例使用3D CEMRA检查头颈时间计算公式,即延迟时间=对比剂达峰时间-采集中心时间-1/2对比剂团注时间。体部组21例使用3D CEMRA经典计算公式,即延迟时间=对比剂达峰时间-采集中心时间 1/2对比剂团注时间。结果:86病例3D CEMRA图像中各级血管显示的总优良率达到96%。结论:头部和体部采用不同的公式计算扫描延迟时间可得到良好的3D CEMRA影像。     

三维增强MR血管成像对冠状动脉桥血管的评价

目的：探讨三维增强MR血管成像（3D CEMRA）评价冠状动脉搭桥术（CABG）桥血管开通状况的临床价值。方法：20例CABG患者共47支桥血管，用3D CEMRA方法进行了研究。MR检查距手术15d至16年。20例患者中14例CABG术后5个月至16年有胸痛症状再发，2例术后临床疑桥血管急性闭塞。对3D CEMRA资料进行评价，确认桥血管开通状况。对7例15支桥血管同时有3D CEMRA和X线血管造影者进行了双盲分析。结果：47支桥血管，3D CEMRA显示通畅25支，闭塞22支，闭塞率为46.8％。7例同时有3D CEMRA和X线血管造影者共15支桥血管，通畅8支，闭塞7支，二者显示完全一致。结论：3D CEMRA对桥血管的评价是可靠和准确的，可作为CABG术后患者一种无创性影像检查方法。     

Preliminary evaluation of volume-rendered three-dimensional display of time-of-flight MR angiography in the diagnosis of intracranial aneurysms

We assessed the value of the volume-rendering method of displaying images of three-dimensional (3D) time-of-flight MR angiography (MRA) in the diagnosis of intracranial aneurysms. We obtained three-dimensional volume-rendered MRA from 21 patients with intracranial aneurysms. The images were evaluated in comparison with maximum-intensity-projection images (in 21 patients), conventional angiograms (in 21 ) and CT angiography (in nine). In 17 patients, 3D volume-rendered images were thought to show morphological features most clearly. They were superior to the other methods for demonstrating the precise location of the aneurysm in three patients and in showing the shape of the bleb in another three. 3D volume-rendered MRA can be effectively added to conventional imaging techniques for diagnosis of intracranial aneurysms. Received: 12 October 2000 Accepted: 12 December 2000     

磁共振3D-TSE序列和3D-VIBE序列在诊断血管压迫性三叉神经痛中的价值

目的探讨磁共振3 D-TSE序列和3 D-VIBE序列对于血管压迫性三叉神经痛的诊断价值。方法采用3 DTSE序列和3 D-VIBE序列扫描28例临床拟诊为血管压迫性三叉神经痛的患者。经3 DMRP、MIP、min-MIP后处理图像,观察三叉神经与周围血管的关系。结果 28例患者手术证实26例存在血管神经接触或压迫,3 D-VIBE、3 D-TSE序列综合判断血管压迫性三叉神经痛的阳性预测值、阴性预测值、敏感性、手术符合率分别为92.0%(23/25)、33.3%(1/3)、92.0%(23/25)、85.7%(24/28)。而且MRI所显示的责任血管与神经的相对位置关系与术中所见具有高度的一致性(K=0.81)。结论 3 D-TSE序列和3 D-VIBE序列结合可以清楚显示脑池内血管和三叉神经的空间关系并辨认责任血管的来源,对血管压迫性三叉神经痛的术前评估具有较高的价值。     

Congenital absence of the internal carotid artery diagnosed during investigation of trigeminal neuralgia

Congenital absence of the unilateral internal carotid artery (ICA) was found in a patient during MR imaging examination for right trigeminal neuralgia. Magnetic resonance angiography showed complete absence of the right ICA and a large tortuous basilar artery (BA). The source images revealed a deformed right trigeminal nerve resulting from compression by the BA. Computed tomography of the skull base showed absence of the right carotid canal, suggesting agenesis of the right ICA. Longstanding hemodynamic stress may have caused the BA to become extremely tortuous, resulting in the trigeminal neuralgia.     

血管压迫性三叉神经痛责任血管的3.0T MRI研究

目的 采用3.0 T MRI显示三叉神经及周围血管的解剖关系,分析产生原发性三叉神经痛(TN)的血管压迫特点.方法 选择50例TN患者(50支TN患侧和50支TN对侧三叉神经;其中23例行微血管解压术)和50名没有面部疼痛的志愿者(100支非TN三叉神经),在3.0TMR采用三维快速稳态梯度回波序列(3D TRU-FISP)及3D 三维时间飞跃(TOF-MRA)扫描.若判断TN患者为静脉病变,并行增强3D快速小角度反转序列(3DFLASH)扫描.以上图像融合重建成虚拟脑池图,评价神经血管压迫程度分级(1级无压迫,2级静脉性压迫,3级神经与动脉接触,4级有动脉压痕,5级动脉压迫导致神经明显移位),以及血管接触神经的方位(三叉神经的上侧或其他侧)、血管神经接触点的位置(近:位于三叉神经脑池段近脑干1/3长度区域,远:位于三叉神经脑池段远脑干2/3长度区域).3D TRU-FISP序列重建的冠、矢状面图像用于测量神经长度、神经横截面及脑池面积.采用卡方检验观察2组的三叉神经:血管压迫神经引起神经切迹或移位(4级和5级)、血管神经压迫点和神经出脑干处距离、血管压迫神经的位置位于神经上侧方的发生率.采用t检验观察测量数值的统计学意义,并用Logisac回归分析三叉神经痛的发病因素.结果 两序列及融合图像可以清晰显示神经血管的关系,与23例微血管解压术中所见吻合度高,术后症状消失或明显减轻21例.血管压迫或接触三叉神经的发生率在志愿者组(1级79支,2级5支,3级8支,4级8支)、TN对侧(1级27支,2级6支,3级9支,4级8支)及TN患侧(1级4支,2级t2支,3级12支,4级7支,5级15支)分别为21.0％(21/100)、46.0％ (23/50)、92.0％ (46/50).TN患侧三叉神经较志愿者三叉神经血管受压迫程度4、5级者差异有统计学意义(x2=27.0,P ＜0.01);血管接触点的位置在TN患侧近32支、远14支,在志愿者近4支、远17支(x2=14.8,p＜0.01);压迫血管位置中,TN患侧位于神经上侧36支、其他侧10支,志愿者中位于神经上侧5支、其他侧16支(x2=18.0,P＜0.01);所在层面脑桥池面积,TN患侧为(183.9+52.5) mm2、对侧为(217.8±58.8)mm2(t=-3.04,P＜0.01);脑池段神经中点截面积,TN患侧为(6.3±1.3)mm2、对侧为(7.7±1.6) mm2(t=-4.8,P＜0.01);脑池段神经长度,TN患侧为(8.0±1.9)mm、对侧为(9.0±2.0)mm(t=-2.64,P＜0.05),差异均有统计学意义.结论 MR可以清楚显示TN患者血管与三叉神经的关系,受压迫神经位置更靠神经近端及头侧、神经所在层面脑桥池面积较小者,均是较强的手术指征.     

三维增强MR血管成像诊断脑动静脉畸形的价值

目的 评价三维增强MR血管成像（3DCEMRA）及相关MRI对脑动静脉畸形（AVM）的诊断价值。方法 22例脑AVM患者行头颅MRI及3DCEMRA检查，17例同时行DSA检查。3DCEMRA原始图像减影后至工作站用实时三维容积显示技术进行三维重组。结果 22例中19例MRI显示脑AVM特征性流空血管影，3DCEMRA显示明确异常血管团、供血动脉及引流静脉。病灶均位于幕上，单叶13例，跨叶3例，大脑深部3例；单支供血动脉9例，联合供血10例；引流静脉人上矢状窦6例，至大脑深部8例，向脑表面及脑深部均有引流5例。14例3DCEMRA与DSA比较，DSA显示供血动脉37支，引流静脉25支。3DCEMRA结合MRI对异常血管团的定位及立体显示优于DSA，但在一些细节显示上不如DSA；3DCEMRA对供血动脉的显示率为78．4％（29／37），对引流静脉的显示率为84．0％（21／25）。另外，3例DSA发现〈1cm的微小异常血管，但3DCEMRA未见，MRI仅表现为脑内出血灶。结论 3DCEMRA结合MRI对脑AVM能无创性准确定位、定性，并可显示其结构组成，可作为临床高度怀疑脑AVM患者的首选影像检查方法。但在显示某些细节及〈1cm的微小AVM方面仍需DSA检查。     

三维平衡式快速场梯度回波和时间飞跃法血管造影技术对三叉神经的对比研究

目的:探讨MR扫描三叉神经与周围血管的最佳序列。方法:对16例三叉神经痛患者行三叉神经3D BTFE和3D TOF MRA扫描。测量双侧三叉神经与桥前池的CNR、椎-基底动脉与桥前池CNR、三叉神经与桥前池对比度。根据三叉神经图像质量、周围血管显示、神经与血管的关系进行评分。结果:3D BTFE组三叉神经与桥前池CNR、对比度较3D TOF MRA组高〔22.94±4.18(左)and 21.68±5.51(右)vs 5.92±3.01(左)and 6.37±3.86(右)〕、〔1834±294(左)and 1968±351(右)vs 572±42(左)and 468±55(右)〕。3D BTFE组椎-基底动脉与桥前池CNR较3D TOFMRA低〔2.47±1.17 vs 6.21±2.87〕(P0.01)。3D BTFE组三叉神经图像质量较好。3D TOF MRA组血管显示较好、血管与神经关系较清晰(P0.05,Kappa0.75)。结论:3D BTFE和3D TOF MRA序列联合应用,可以清晰观察到三叉神经解剖学改变及神经与周围血管关系,对设计和优化MVD具有重要意义。     

三维增强MR血管成像在周围型动脉闭塞症分级中的应用价值

目的探讨三维增强MR血管成像（3DCE-MRA）在周围型动脉闭塞症（PAOD）分级中的应用价值。方法选择25例临床诊断为PAOD的患者进行3D CE-MRA扫描，采用连续动床三段采集法，高压注射36ml钆喷替酸葡甲胺（GD-DTPA），将采集到的图像进行最大信号投影（MIP）、多平面重组（MPR）或者容积重组（VRT）。结果25例患者成功行3DCE-MRA检查，腹主动脉下段至小腿动脉显示对比度均可达到诊断要求，与DSA和（或）手术结果相比较，3DCE-MRA诊断PAOD总符合率达96．95％（509／525），诊断轻度狭窄、中度狭窄、重度狭窄和闭塞的符合率分别为84．62％（44／52）、84．85％（28／33）、95．45％（21／22）、98．67％（74／75），对轻度、中度、重度狭窄的高估率分别为11．54％（6／52）、12．12％（4／33）、4．55％（1／22），对轻度、中度、重度狭窄和闭塞的低估率分别为3．85％（2／52）、3．03％（1／33）、0（0／22）、1．33％（1／75）。结论3DCE-MRA可以对下肢动脉的狭窄和闭塞进行准确定位和分级，在临床应用中具有重要价值。