三叉神经痛患者血管压迫MRI表现与手术结果对照研究

目的 分析三叉神经痛患者ＭＲＩ表现,探讨ＭＲＩ对三叉神经痛神经血管压迫的诊断价值。材料与方法 回顾性分析８５例三叉神经痛患者ＭＲＩ表现及手术结果。结果 ８５例三叉神经痛患者共１７０侧脑池段三叉神经ＭＲＩ检查中,５９侧存在三叉神经血管压迫或接触,可疑接触３５侧,其中症状侧有神经血管压迫、接触或可疑接触者为７５例,经统计学分析,三叉神经痛患者症状有无与是否存在血管压迫或接触有显著意义（Ｐ〈０．００１）     

三叉神经痛:MRI序列选择及MRI诊断价值

目的 探讨三叉神经痛患者的MRI影像表现及最佳成像序列和方法，评价MRI对三叉神经痛的诊断价值。资料与方法 应用三维稳态构成干扰序列（constructive interference in steady state,CISS)和三维稳态旋进快速成像序列（fast imaging with steady state precession,FISP)结合三维预磁化快速梯度回波序列（magnetization prepared rapid gradient echo imaging,MPRAGE or 3D-MPR),并采用三维多平面或曲面重建技术对25例（50条）正常对照组及50例（50条，单发）三叉神经痛患者行MR成像，观察MRI图像中神经、血管显示情况和三叉神经痛在MRI中的表现形式。结果 （1）正常对照组神经血管压迫或接触为30％，三叉神经痛患者病侧为96％，血管包绕神经及神经变形，对照组没有出现，病例组5例。（2）50例三叉神经痛患者中病例MRI诊断为血管压迫或接触的为38例，手术证实有血管压迫为18例，另有10例行γ－刀治疗，术后症状消失；桥小脑角肿瘤7例，均为手术证实；血管病变5例，均由微血管减压术或手术证实。（3）正常对照组与病例组神经血管压迫或接触的阳性率差异有显著意义（P＜0．005），诊断敏感性为96％，特异性为79％。结论 磁共振3D－CISS和3D－FISP序列结合3D－MPR序列能够清晰显示三叉神经与邻近血管、肿瘤性病变和血管性病变之间的关系，对临床提供术前评估和指导治疗有极其重要的意义。     

MRTA在血管压迫性三叉神经痛病因诊断中的价值

目的探讨MRTA检查方法在三叉神经痛患者中神经血管压迫表现及其在病因诊断中的价值。方法对28例三叉神经痛患者的MR表现与手术结果对照,并进行回顾性分析。结果 MR图像显示,23例患者存在血管压迫或接触关系,5例无接触关系。手术结果显示,MRTA在诊断三叉神经痛血管压迫或接触的准确率为82%。结论 MRTA能较清晰显示三叉神经痛病损神经与责任血管压迫的解剖关系,在三叉神经痛神经病因诊断中具有较高的价值,在为临床提供术前评价和指导手术方案方面具有重要的意义。     

三叉神经痛神经血管压迫的MRI研究

目的探索三能（ＴＮ）神经血管压迫（ＮＶＣ）的最佳扫描序列和扫描方法。试图发现正常人和人之间神经血管在接触上的差异。评价ＭＲＩ对ＴＮ的诊断价值。方法 对２具福尔马林罪恶的头颅,按照ＭＲＩ扫描平面切层,观察三叉神经的走行及与邻近血管的关系。且２０例,原发性ＴＮ１５例,使用ＳＥＴ１Ｗ少三维时间飞跃破坏性稳态梯度回聚回波（３Ｄ－ＴＤＦ－ＳＰＧＲ）序列。１１例病人做了增强扫描。盲法观察３个平面血管神经关系。     

海马硬化的MRI诊断

目的 探讨海马硬化的ＭＲＩ表现和病理特征。方法 对１６例海马硬化患者进行ＭＲ横断面和垂直于海马长轴的段斜冠状面ＳＥＴ１ＷＩ、Ｔ２ＷＩ和液体衰减恢复序列（ＦＬＡＩＲ）扫描。结果 １６例患者中,１例为双侧海马硬化,１５例为单侧海马硬化（左侧９例,右侧６例）,１５例经手术病理证实,１６例１７个患侧ＭＲＩ表现为患侧海马萎缩变小;Ｔ２ＷＩ（１５侧）和ＦＬＡＩＲ成像（１７例）呈高信号;１１个患侧海马头部浅沟消     

颈静脉孔区肿瘤的MRI和MRA诊断（附五例报告）

目的：分析颈静脉孔区肿瘤的影像学特点，探讨ＭＲＡ对其诊断与鉴别诊断的价值。材料与方法：对５例经手术病理证实的颈静脉孔区肿瘤（颈静脉球瘤２例、神经鞘瘤２例、脑膜瘤１例）病人行ＭＲＩ和ＴＯＦ法ＭＲＡ检查，应用１．０Ｔ超导ＭＲ系统，在常规ＭＲＩ基础上采用２Ｄ或３ＤＦＩＳＰ序列和ＭＩＰ图像后处理技术获取ＭＲＡ图像。４例有ＣＴ，３例有ＤＳＡ资料。结果：ＭＲＩ显示了全部病灶和颈静脉孔的扩大与破坏，准确定性诊断了４例，结合ＭＲＡ后，５例均正确定性诊断。颈静脉球瘤的ＭＲＩ瘤内流空征和ＭＲＡ血管团块征颇具特征性。神经鞘瘤与脑膜瘤的ＭＲＩ信号有别，且前者易囊变，两者ＭＲＡ均未显示肿瘤血管。结论：ＭＲＩ，尤其结合ＭＲＡ对颈静脉孔区肿瘤诊断与鉴别诊断颇有价值。     

脑血管畸形磁共振血管成像与脑血管造影对照研究

目的：探讨了ＴＯＦ法ＭＲＡ评价脑血管畸形的价值及限度，材料与方法：２９例经ＭＲＩ（ｎ＝２９），脑血管造影（ｎ＝１５）和／或手术病理（ｎ＝１０）证实的脑血管畸形（ＡＶＭ２４例，ＡＶＦ２例，隐匿性ＡＶＭ３例）患者进行ＴＯＦ法ＭＲＡ检查，应用１．０Ｔ超导ＭＲ系统的二维或三维ＦＩＳＰ序列（预置０～３条预饱和带）和ＭＩＰ图像后处理技术，１５例同时经股动脉行全脑血管造影，采用Ｋａｐｐａ统计量对两种血管成像方法     

先天性主动脉缩窄的磁共振成像诊断

目的研究先天性主动脉缩窄（ＣｏＡ）的磁共振成像（ＭＲＩ）征象并与超声心动图（Ｅｃｈｏ）和手术对照，探讨其在诊断中的意义和作用。方法ＣｏＡ１２例，单纯型１０例，复杂型２例。１０例经手术证实，１例行ＤＳＡ，１例行血管造影和经皮主动脉球囊成形术。ＭＲＩ均行ＳＥ序列成像，其中８例兼作梯度回波（ＧＲＥ）的电影（ｃｉｎｅ）ＭＲＩ或（和）ＭＲ血管造影（ＭＲＡ）。所有病例均有经胸Ｅｃｈｏ检查。结果９例（７５％）ＭＲＩ显示为局限性膜状或嵴状狭窄，３例（２５％）呈长管状狭窄。８例ｃｉｎｅＭＲＩ或（和）ＭＲＡ均能显示狭窄段和扩张的肋间动脉和乳内动脉等侧支循环。１２例ＣｏＡ，ＭＲＩ均获得正确诊断，Ｅｃｈｏ８例（６６．７％）获正确诊断。结论ＭＲＩ是检查ＣｏＡ的一种优良的无创性方法，能准确判断狭窄部位、形态、范围和程度，显示狭窄前、后主动脉及头臂血管改变，以及侧支循环情况。对ＣｏＡ的诊断优于Ｅｃｈｏ，基本上可取代血管造影检查。     

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。     

脑动静脉畸形的MRI及MRA诊断价值

目的：研究脑动静脉畸形（ＡＶＭ）的ＭＲＩ特征,探讨其诊断价值。方法：使用ＧＥｓｉｇｎａ ｅｃｈｏ ｓｐｅｅｄ１．５Ｔ超导ＭＲ机对７１例ＡＶＭ患者分别行ＭＲＩ及ＭＲＡ检查。ＭＲＩ采用ＳＥＴ１和ＦＳＥＴ２加权序列,ＭＲＡ采用３Ｄ－ＴＯＦ序列。结果：ＭＲＩ及ＭＲＡ能显示ＡＶＭ的瘤巢,ＡＶＭ的继发改变ＭＲＩ能很好显示,ＭＲＡ能显示ＡＶＭ的三维解剖结果。结论：ＭＲＡ和ＭＲＩ是无创性评从脑ＡＶＭ的有效方法,两     

3D-TSE序列在三叉神经痛病因诊断中的价值

目的　探讨MRI三维快速自旋回波 (3D TSE)序列在三叉神经痛 (TN)病因研究中的价值。资料与方法　应用 3D TSE序列 ,结合常规MRI序列 ,分析 5 0例TN患者和 5 0名正常对照者的MRI表现及手术结果。结果　 (1) 5 0名正常对照者 10 0侧脑池段三叉神经MRI检查中 ,11侧存在三叉神经血管接触。 5 0名TN患者疼痛侧有血管压迫或接触的为 32例 ,非疼痛侧 5 0侧三叉神经中 ,有血管接触的为 7例 ,经统计学分析 ,TN患者疼痛有无与是否存在血管压迫或接触有统计学意义 (P <0 .0 0 5 )。 (2 ) 5 0例TN患者疼痛侧 ,MRI诊断TN病因中血管压迫或接触占 6 4 % (32 / 5 0 ) ;肿瘤性病变占 16 % (8/ 5 0 ) ;其他占 2 0 % (10 / 5 0 )。 (3)根据手术结果 ,3D TSE序列对TN诊断的敏感性为 10 0 % ,特异性为 80 %。结论　三叉神经脑池段的血管压迫或接触是TN的主要病因 ,3D TSE成像能清晰显示三叉神经与邻近血管、肿瘤性病变或其他病变之间的关系 ,为临床确定治疗方案有重要的指导意义     

Trigeminal neuralgia: MR imaging features

Magnetic resonance (MR) imaging was used to evaluate the relationship of the cisternal portion of the fifth cranial nerve to surrounding vascular structures in six patients with documented trigeminal neuralgia and in 85 asymptomatic patients. MR imaging clearly demonstrated the course of the fifth nerve from its root entry zone (REZ) to the Meckel cave and its relationship to the surrounding vertebrobasilar system. In the six patients with trigeminal neuralgia, the presence of a vascular structure at the REZ of the fifth nerve was identified. In the 85 asymptomatic patients, examination of 170 trigeminal nerves revealed that 30% had contact between a vascular structure and the fifth nerve at the REZ, but only 2% had actual deformity. These results indicate that although neurovascular contact may be asymptomatic, MR demonstration of a vascular structure at the REZ of the fifth cranial nerve in a patient with trigeminal neuralgia may implicate this as the cause of symptoms, which may influence the treatment of choice. Because of the inherent limitations of computed tomography in the visualization of posterior fossa structures, MR imaging should be considered the initial screening procedure in the assessment of patients with trigeminal neuralgia.     

Magnetic resonance in trigeminal neuralgia]

One of the possible causes of the so-called "essential" trigeminal neuralgia is a neurovascular compression of the fifth cranial nerve root at the pons. The demonstration of this hypothesis could orientate the surgical treatment to microvascular decompression. In order to evaluate the role of MRI in the diagnosis of trigeminal neuralgia due to neurovascular compression, the authors present the results of a prospective evaluation of the cranial MR studies of 18 neuralgic patients in comparison with a retrospective evaluation of the cranial MR studies of 50 healthy control subjects. The results show that neurovascular compression can be demonstrated in 83.3% of the neurological patients. In all cases a good correlation between the clinical symptoms, the side of positive MR findings and the surgical findings, when available, was demonstrated. On the other hand, neurovascular compression was demonstrated in 28% of the healthy control subjects. The authors conclude that neurovascular compression can be demonstrated in a high percentage of patients with the so-called "essential" trigeminal neuralgia. Compared with the other imaging modalities (angiography, Computed Tomography) MRI is the best technique in the diagnosis of this disease. In fact, MRI is not only able to differentiate the symptomatic from the essential type of neuralgia, but is also very sensitive in the identification of trigeminal neuralgia due to neurovascular compression. This diagnosis could direct the surgical treatment to microvascular decompression.     

低场强磁共振CBASS序列在三叉神经痛病因诊断中的应用价值

目的:探讨低场强MRI CBASS序列在三叉神经痛(TN)病因中的研究价值。方法:对50例TN患者依次采用CBASS序列,结合FE序列,FE3D-TOF序列进行检查,对CBASS序列成像MRI表现及手术结果作回顾性分析。结果:①50例TN患者中,肿瘤性病变7例,其它3例,排除上述继发性TN10例;40例原发性TN患者入选,疼痛侧MRICBASS序列发现有三叉神经血管压迫或接触29例(29/40),非疼痛侧有三叉神经血管接触9例(9/40),两组相比有显著性差异2=20.050,(P<0.0001);②50例患者均行手术治疗,CBASS序列对原发性TN诊断的敏感性为93.1%,特异性为81.8%,准确性90.01%,假阴性为18.21%,假阳性为6.9%。结论:三叉神经脑池段血管压迫或接触是TN的首要原因,CBASS序列成像能清晰显示三叉神经与邻近血管、肿瘤病变或其他病变之间的关系,对临床诊治具有重要指导意义。     

3D-TOF磁共振血管成像诊断血管压迫性三叉神经痛的价值

目的　探讨增强薄层三维体积扫描时间飞跃法磁共振血管成像 ( 3D -TOFMRA)诊断血管压迫性三叉神经痛的价值。方法　回顾性分析 37例临床拟诊为血管压迫性三叉神经痛患者的常规颅脑MRI及增强薄层 3D -TOF磁共振血管成像资料。结果　增强薄层 3D -TOFMRA发现 37例中 2 4例共 2 7侧三叉神经存在血管压迫或接触 ,其中症状侧三叉神经有血管压迫或接触 2 4例 ,无症状侧三叉神经有血管压迫或接触 3例 ,本组病例统计学分析表明 ,三叉神经痛患者症状的出现与三叉神经存在血管压迫或接触有显著相关关系 (Ρ <0 .0 0 5 )。 13例为非血管压迫性三叉神经痛。压迫三叉神经的血管为小脑上动脉 (SCA) 14例 ,小脑前下动脉(AICA) 5例 ,起源不清的血管 3例 ,扭曲的椎动脉 1例 ,血管畸形 1例。结论　增强薄层 3D -TOFMRA可清楚显示三叉神经脑池段与毗邻血管的关系 ,明显优于常规颅脑MRI,是目前检测血管压迫性三叉神经痛最佳的影像学检查方法 ,对明确诊断和指导治疗三叉神经痛具有重大意义。     

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.     

3D-CISS序列MR成像在血管压迫性三叉神经痛中的应用

目的　探讨三叉神经痛患者的神经血管解剖关系。方法　应用 3D -CISS序列并结合 3D -TOF血管造影及MPR重建技术对 49例三叉神经痛患者进行MR检查并部分与手术结果对照。结果　 (1) 13例手术患者中 ,10例 3D -CISS和 3D -TOF序列均显示血管压迫的患者经手术证实为动脉压迫 ,另 3例仅在 3D -CISS序列显示的压迫血管 ,手术证实为静脉压迫。 (2 ) 2 0例伴有上颌神经症状的病人有 18例 (90 % )在三叉神经根部内侧有压迫点 ;19例伴有下颌神经症状的病人有 15例 (79% )在三叉神经外侧有压迫点 (经 χ2 检验 ,P <0 .0 0 1)。结论　 3D -CISS序列对显示三叉神经痛病人的神经血管关系、三叉神经的压迫部位与三叉神经痛区域相关性有重要作用。     

Vascular anomalies of the cerebellopontine angle

Vascular anomalies of the cerebellopontine angle are rare compared to tumors in this area. Irritation of the trigeminal, facial, or vestibulocochlear nerve may cause trigeminal neuralgia, hemifacial spasm and vertigo, or tinnitus accordingly. Vessel loops in the cerebellopontine cisterns may cause compression at the root entry or exit zone of the cranial nerves V, VII, and VIII, a phenomenon which is called "vascular loop syndrome." Megadolichobasilar artery and aneurysms of the vertebrobasilar system can also lead to dislocation and compression of the cranial nerves and brain stem. Three-dimensional CISS MR imaging and MR angiography are useful in the detection of neurovascular compression. Microvascular decompression is an effective surgical procedure in the management of compression syndromes of the cranial nerves V, VII, and VIII.     

Vaskuläre Erkrankungen des Kleinhirnbrückenwinkels

Vascular anomalies of the cerebellopontine angle are rare compared to tumors in this area. Irritation of the trigeminal, facial, or vestibulocochlear nerve may cause trigeminal neuralgia, hemifacial spasm and vertigo, or tinnitus accordingly. Vessel loops in the cerebellopontine cisterns may cause compression at the root entry or exit zone of the cranial nerves V, VII, and VIII, a phenomenon which is called “vascular loop syndrome.” Megadolichobasilar artery and aneurysms of the vertebrobasilar system can also lead to dislocation and compression of the cranial nerves and brain stem. Three-dimensional CISS MR imaging and MR angiography are useful in the detection of neurovascular compression. Microvascular decompression is an effective surgical procedure in the management of compression syndromes of the cranial nerves V, VII, and VIII.