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

Evaluation of 3D-TSE in the Diagnosis of Trigeminal Neuralgia

Objective To evaluate the diagnostic value of 3D-TSE in the invstigation of etiology in trigeminal neuralgia (TN).Materials and Methods MR manifestations and surgical results of 50 normal subjects and 50 patients with trigeminal neuralgia were reviewed retrospectively, using 3D-TSE combined with conventional MRI sequence.Results (1) 11 trigeminal nerves were identified as contact type in one hundred trigeminal nerves of 50 normal subjects. In 50 patients studied, contacted or compressed with nerves were detected in 32 cases on symptomatic sides,and 7 cases on the asymptomatic sides. The difference between the control subjects and the symptomatic sides of TN were highly significant (P<0.005). (2)Of 50 patients with trigeminal neuralgia at MR imaging, the percentages of neurovascular contact or compress, tumors and other lesions which were the etiologles of trigeminal neuralgia were 64%(32/50), 16%(8/50) and 20%(20/50). (3)According to surgical results, the sensitivity and specificity of MR diagnosis with 3D-TSE was 100% and 80%. Conclusion Neurovascular compression of cisternal portion of the fifth cranial never is the main reason of trigeminal neuralgia. 3D-TSE plays an important role in demonstrating the relationship of the fifth cranial nerve to surrounding vascular structures and tumors, which may be of great help in selecting the proper method of treatment for the patient with trigeminal neuralgia (TN).