原发性三叉神经痛特征性MRI序列检查的临床应用

目的探讨磁共振断层血管成像(MRTA)不同成像序列在诊断三叉神经痛血管神经压迫的价值。方法回顾分析128例原发性三叉神经痛病人的临床资料,全部行微血管减压术(MVD)。术前均行MRTA检查,运用三维时间飞跃成像序列(3D-TOF)、超快平衡场回波序列(B-TFE)、T1高分辨率各向同性容积激发序列(THRIVE)及最大密度投影法(MIP)重建,观察血管神经走行关系,并与术中所见进行对比。结果 MRTA检查共发现责任血管115例,三叉神经无血管压迫13例;术中观察发现责任血管122例,三叉神经无血管压迫6例。MRTA检查与术中观察情况一致121例(95%)。本组治愈106例,显效15例,有效5例,无效2例。结论 MRTA检查对发现原发性三叉神经痛的责任血管与神经关系具有重要价值,3D-TOF、B-TFE、THRIVE及MIP序列扫描可显示责任血管,并具有较高的准确性,对术前评估和指导手术具有重要意义。

Clinical application of characteristic MRI sequence in primary trigeminal neuralgia

Objective To study the value of different sequence of magnetic resonance tomographic angiography （MRTA） in diagnosing neurovascular compression in patients with trigeminal neuralgia. Methods Clinical data of 128 patients with primary trigeminal neuralgia treated by microvascular decompression （MVD） were analyzed retrospectively. MRTA examinations including 3D time of flight （3D-TOF）, balanced turbo field echo （B-TFE）, T~ high resolution isotropic volume examination （THRIVE） and maximum intensity projection （M/P） sequence were performed in all the patients for observing the course of trigeminal nerves and surrounding vessels, and the findings ~om these examinations were compared with the outcomes of intraoperative observation. Results The offending vessels were found in 115 and 122 cases and no vascular compression in 13 and 6 cases respectively by MRTA examination and intraoperative observation. The outcomes of MRTA examination matched with intraoperative observation in 121 cases （95%）. The patients were cured in 106 cases, excellent in 15, effective in 5 and ineffective in 2. Conclusions MRTA has an important value for finding the relationship between the offending vessels and nerves in patients with primary trigeminal neuralgia. 3D-TOF,B-TFE, THRIVE and MIP sequences can show offending vessels with higher accuracy, and there is important significance for preoperative evaluation and guidance of operation.