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。

The value of MR 3D-TSE and 3D-VIBE sequence in diagnosis of trigeminal neuralgia caused by vascular compression

Objective To evaluate MRI findings and diagnostic value of 3D-TSE and 3D-VIBE on trigeminal neuralgia. Methods 3D-TSE sequence and 3D-VIBE sequence were used for the MR scan. The MR scan was performed in 28 pa- tients with unilateral vascular compressive trigeminal neuralgia. 3D MRP, MIP and min-MIP views were reconstructed to identify the relationship between trigeminal nerves and surrounding vessels. The MR images were compared with surgical results. Results Of the 28 cases, 26 were shown vascular contact or compression by operation. The positive predictive value, negative predictive value, sensitivity and accuracy of the diagnosis of vascular-nerve compression by 3D-VIBE and 3D-TSE MR images were 92%（23/25）, 33.3%（1/3）, 92%（23/25）, 85.7%（24/28）. The positive rate was higher than 3D-TOF MR images. Agreement between the results of MR imaging and the findings at surgery was excellent in indentifi- cation of vascular （K=0.81）, 95%cofidence interval （0.67～1.00）. Conclusion 3D-VIBE and 3D-TSE MR images can clearly show the trigeminal nerve and the vessel compression, which is a useful tool in evaluating the offending vessels of vascular compressive trigeminal neuralgia preoperatively.