磁共振断层血管造影诊断面肌痉挛的临床应用评估

目的 探讨磁共振断层血管造影(MRTA)以及MRTA评分诊断法对于偏侧面肌痉挛(HFS)的病因诊断价值。资料与方法 回顾性分析78例HFS患者MRI表现及手术结果。结果 MRTA评分法诊断结果显示78例HFS患者中患侧面神经出脑干段受压迫69例，其中面神经受血管压迫或与之关系密切者61例，血管对面神经有可疑压迫者7例，1例为小脑扁桃体疝压迫面神经。9例未见异常。手术结果显示面神经根部受血管压迫75例，1例为小脑扁桃体疝压迫面神经，另有2例手术未见异常。与MRTA评分法诊断结论基本一致。压迫血管为小脑前下动脉(AICA)、小脑后下动脉(PICA)、椎动脉(VA)、不知名血管。结论 多平面MRTA成像可清楚显示VA、AICA、PICA、面神经出脑干段。同时采用MRTA评分法对诊断HFS病因及制定手术方案有很大帮助。

Clinical Evaluation of MR Tomographic Angiography in Diagnosing Hemifacial Spasm

Objective To evaluate MR tomographic angiography (MRTA) in the clinical diagnosis of the etiology of hemifacial spasm (HFS).Materials and Methods MRTA of facial nerve was performed in 78 patients (26 males and 52 females) with HFS. MRI findings were retrospectively analyzed and compared with surgical results.Results MRTA image-grading method showed that in 68 of 78 HFS patients the facial nerve was compressed by, or closely contact to, the vessel. In one patient, the facial nerve was compressed by cerebellar tonsillar hernia. In the remaining 9 cases, no facial nerve abnormality was seen on MRI. Surgical results showed that vascular compression or contact of the facial nerve root exit/entry zone (REZ) was present in 75 cases, compression of the facial nerve due to cerebellar tonsillar hernia in one case, and no vascular compression in 2 cases. Surgical result was basically the same as that of MRTA image-grading method. The sensitivity and specificity of MRTA image-grading method for the diagnosis of vascular compression or contact at REZ of facial nerve was 88% and 89%, respectively, which was higher than that of traditional diagnostic method.Conclusion MRTA combined with MRTA image-grading method can improve the diagnostic sensitivity and specificity for HFS.