对比增强三维时间飞跃法扰相梯度回波序列在三叉神经痛神经血管压迫诊断中的价值

目的探讨磁共振断层血管成像对三叉神经痛病因诊断的临床应用价值,评价3D-FIESTA、3D-TOF-SPGR及3D-CETOF-SPGR序列显示颅神经与血管的三维空间关系的能力。方法我院自2013年1月至2015年12月共收治行微血管减压术(MVD)治疗的三叉神经痛患者69例,术前行MRTA扫描,观察三叉神经与周围血管的空间关系,并与术中探查结果进行对照,评价3D-FIESTA、3D-TOF-SPGR及3D-CE-TOFSPGR序列在术前评估三叉神经与周围血管关系的能力。结果 MRTA能清晰且同时显示三叉神经和责任血管,3D-FIESTA、3DTOF-SPGR和3D-CE-TOF-SPGR序列显示症状侧三叉神经与血管有密切关系,即阳性分别为55例(79.7%)、58例(84.1%)和65例(94.2%),显示非症状侧三叉神经与血管有密切关系分别为4例(5.8%)、6例(8.7%)和15例(21.7%)。3D-FIESTA与3D-TOFSPGR显示三叉神经痛症状侧、非症状侧三叉神经与周围血管关系能力,差异无统计学意义;3D-FIESTA与3D-CE-TOF-SPGR、3D-TOF-SPGR与3D-CE-TOF-SPGR序列显示三叉神经痛症状侧、非症状侧三叉神经与周围血管关系能力,差异均具有统计学意义。结论 MRTA技术对三叉神经痛的术前病因诊断及手术适应证的选择具有重要价值,3D-CE-TOF-SPGR序列能提高显示三叉神经脑池段与临近血管的关系;三叉神经与周围血管接触是三叉神经痛的重要病因之一。

The Value of Three Dimensional Contrast Enhanced Time of Flight Spoiled Gradient Recalled Acquisction in the Diagnosis of Trigeminal Neuralgia with Neurovascular Compression

Objective To investigate the clinical value of magnetic resonance tomography angiography (MRTA) for diagnosing cause of trigeminal neuralgia,and evaluate the ability of 3D-FIESTA,3D-TOF-SPGR and 3D-CE-TOF-SPGR sequences display the three-dimensional spatial relationship between cranial nerves and blood vessels.Methods The 69 patients with trigeminal neuralgia were treated with microvascular decompression (MVD) therapy at the Department of Neurosurgery for the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from January 2013 to December 2015.MRTA were performed to observe the spatial relationship between the trigeminal nerve and peripheral vascular,and were compared with intraoperative exploration results to evaluate sequence of 3D-FIESTA,3D-TOF-SPGR and 3D-CE-TOF-SPGR in pre-operative assessment of the ability of relationship between the trigeminal nerve and peripheral vessels.Results MRTA can clearly and simultaneously display the trigeminal nerve and relevant vessels and 3D-FIESTA,3D-TOF-SPGR and 3D-CE-TOF-SPGR sequences display close relationship between the trigeminal nerve and vessels in symptomatic side,the positive were 55(79.7 ％),58(84.1％) and 65(94.2％).While the positive were 4(5.8％),6(8.7％) and 15(21.7％) respectively in non-symptomatic side.There was no statistical significance in the ability of 3D-FIESTA and 3D-TOF-SPGR for trigeminal nerve and peripheral vascular in symptomatic and non-symptomatic side,while there were statistical difference of 3D-FIESTA and 3D-CE-TOF-SPGR,3D-TOF-SPGR and 3D-CE-TOF-SPGR.Conclusion There was significant value of MR TA to diagnose preoperative cause of trigeminal neuralgia and evaluate selection of surgical indications,3D-CE-TOF-SPGR sequence can improve display the relationship between trigeminal nerve cisternal segnent and the adjacent vessel and trigeminal nerve contacting with peripheral vascular is one of the important factors for trigeminal neuralgia.