3.0 T MR三维高分辨成像序列联合MRVE在三叉神经痛术前评估中的应用
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摘要
目的探讨3.0 T MR三维高分辨成像联合MR仿真内镜(MRVE)在三叉神经痛术前评估中的应用价值。方法回顾性分析2016年4月—2017年12月40例因原发性三叉神经痛(PTN)行微血管减压术(MVD)病人的资料,其中男21例,女19例,年龄37～86岁,平均(59.6±2.2)岁。所有病人均行3.0 T MR三维高分辨成像,进行双激发平衡式稳态自由进动(3D-FIESTA-c)和三维时间飞跃法MR血管成像(3D-TOF-MRA)序列扫描,并进行MRVE重建。采用χ~2检验比较三维高分辨成像及三维高分辨成像联合MRVE预判断责任血管的阳性率,并以手术结果作为金标准,分析上述2种成像方法对责任血管的检出率。结果术前40例病人采用2种成像方法检查,MR三维高分辨成像联合MRVE成像对责任血管压迫显示的阳性率(95%,38/40例)高于MR三维高分辨成像(85%,34/40例)(χ~2=1.826,P=0.04)。术中发现40例PTN病人均存在责任血管压迫,其中动脉压迫33例(82.5%)、单纯静脉压迫3例(7.5%)、动静脉混合压迫4例(10.0%)。2种成像方法对动脉压迫的检出率均为100%。MR三维高分辨成像联合MRVE成像对静脉及动静脉混合压迫的检出率(71.4%,5/7)高于单独MR三维高分辨成像(14.3%,1/7)。结论 MR三维高分辨成像序列联合MRVE技术能有效显示神经与血管的三维空间关系,能够对三叉神经痛的病因诊断提供重要价值。
Objective To investigate the application value of 3D high resolution imaging sequences combined with magnetic resonance virtual endoscopy(MRVE) in preoperative assessment of trigeminal neuralgia in a 3.0 T MRI system.Methods The data of 40 patients with primary trigeminal neuralgia were analyzed retrospectively. All of patients underwent the microvascular decompression(MVD) during April 2016 to December 2017. There were 21 males and 19 females, between37-86 years old, with an average age of 59.6±2.2 years. All patients conducted three-dimensional(3D) high-resolution MR imaging, including fast imaging employing steady-state acquisition with phase cycling(FIESTA-c) and time-of-flight magnetic resonance angiography(TOF-MRA) in a 3.0 T MRI system, and data were reconstructed using MRVE. The χ~2 test was used to compare the positive rate of the responsible vessels judged on 3D high-resolution imaging and 3D high-resolution imaging + MRVE, using operation results as the golden standard. Results The positive rate on 3D high-resolution imaging sequence + MRVE(95%, 38/40) was significantly higher than on the pure 3D high-resolution imaging sequence(85%,34/40)(χ~2=1.826, P =0.04). The responsible vessels were identified in all 40 patients during operation,including compression by artery in 33 patients(82.5%), simple venous in 3 patients(7.5%), and both artery and venous in 4 cases(10%). The detection rate of arterial compression by two imaging methods was 100%. The detection rate of venous and arteriovenous compression by 3D high resolution-imaging + MRVE(71.4%, 5/7) was higher than by the pure 3D high-resolution imaging(14.3%, 1/7). Conclusion MR 3D high-resolution imaging sequence combined with MRVE technology may effectively display the 3D space between responsible vessels and nerves, and provide important value for the etiological diagnosis of trigeminal neuralgia.
Objective To investigate the application value of 3D high resolution imaging sequences combined with magnetic resonance virtual endoscopy(MRVE) in preoperative assessment of trigeminal neuralgia in a 3.0 T MRI system.Methods The data of 40 patients with primary trigeminal neuralgia were analyzed retrospectively. All of patients underwent the microvascular decompression(MVD) during April 2016 to December 2017. There were 21 males and 19 females, between37-86 years old, with an average age of 59.6±2.2 years. All patients conducted three-dimensional(3D) high-resolution MR imaging, including fast imaging employing steady-state acquisition with phase cycling(FIESTA-c) and time-of-flight magnetic resonance angiography(TOF-MRA) in a 3.0 T MRI system, and data were reconstructed using MRVE. The χ~2 test was used to compare the positive rate of the responsible vessels judged on 3D high-resolution imaging and 3D high-resolution imaging + MRVE, using operation results as the golden standard. Results The positive rate on 3D high-resolution imaging sequence + MRVE(95%, 38/40) was significantly higher than on the pure 3D high-resolution imaging sequence(85%,34/40)(χ~2=1.826, P =0.04). The responsible vessels were identified in all 40 patients during operation,including compression by artery in 33 patients(82.5%), simple venous in 3 patients(7.5%), and both artery and venous in 4 cases(10%). The detection rate of arterial compression by two imaging methods was 100%. The detection rate of venous and arteriovenous compression by 3D high resolution-imaging + MRVE(71.4%, 5/7) was higher than by the pure 3D high-resolution imaging(14.3%, 1/7). Conclusion MR 3D high-resolution imaging sequence combined with MRVE technology may effectively display the 3D space between responsible vessels and nerves, and provide important value for the etiological diagnosis of trigeminal neuralgia.
引文
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[10]金军,汤小俐,香辉,等.3.0 T MRI 3D-TOF序列联合3D-FIES-TA序列结合多平面重建在三叉神经微血管减压术术前评估中的应用价值[J].磁共振成像,2015,6:277-282.
[11]Xiang H,Wu G,Ouyang J,et al.Prospective study of neuroendoscopy versus microscopy:213 cases of microvascular decompression for trigeminal neuralgia performed by one neurosurgeon[J].World Neurosurg,2017,111:335-339.
[12]Cheng J,Liu W,Hui X,et al.Microvascular decompression for trigeminal neuralgia in patients with failed gamma knife surgery:analysis of efficacy and safety[J].Clin Neurol Neurosurg,2017,161:88-92.
[13]苏忠周,沈健,周跃,等.磁共振仿真内窥镜技术在三叉神经痛微血管减压术中的应用[J].中华神经外科杂志,2016,32:1003-1006.
[2]庞惠泽,范国光.原发性三叉神经痛形态学及功能改变的MRI研究现状与进展[J].国际医学放射学杂志,2018,40:35-38.
[3]Mistry AM,Niesner KJ,Lake WB,et al.Neurovascular compression at the root entry zone correlates with trigeminal neuralgia and early microvascular decompression outcome[J].World Neurosurg,2016,95:208-213.
[4]Tomasello F,Esposito F,Abbritti RV,et al.Microvascular decompression for trigeminal neuralgia:technical refinement for complication avoidance[J].World Neurosurg,2016,94:26-31.
[5]Docampo J,Gonzalez N,Munoz A,et al.Neurovascular study of the trigeminal nerve at 3 T MRI[J].Neuroradiol J,2015,28:22-35.
[6]Arbab AS,Nishiyama Y,Aoki S,et al.Simultaneous display of MRAand MPR in detecting vascular compression for trigeminal neuralgia or hemifaeial spasm:comparison with oblique sagittal views of MRI[J].Eur Radiol,2000,10:1056-1060.
[7]刘厚强,于如同,丁允波,等.3D-FIESTA联合3D-TOF MRA对三叉神经微血管减压术的指导价值[J].临床神经外科杂志,2017,14:212-215.
[8]Suzuki M,Yoshino N,Shimada M,et al.Trigeminal neuralgia:differences in magnetic resonance imaging characteristics of neurovascular compression between symptomatic and asymptomatic nerves[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2015,119:113-118.
[9]沈健.磁共振成像技术在原发性三叉神经痛患者神经血管压迫评估及治疗中的价值[D].浙江大学,2017.
[10]金军,汤小俐,香辉,等.3.0 T MRI 3D-TOF序列联合3D-FIES-TA序列结合多平面重建在三叉神经微血管减压术术前评估中的应用价值[J].磁共振成像,2015,6:277-282.
[11]Xiang H,Wu G,Ouyang J,et al.Prospective study of neuroendoscopy versus microscopy:213 cases of microvascular decompression for trigeminal neuralgia performed by one neurosurgeon[J].World Neurosurg,2017,111:335-339.
[12]Cheng J,Liu W,Hui X,et al.Microvascular decompression for trigeminal neuralgia in patients with failed gamma knife surgery:analysis of efficacy and safety[J].Clin Neurol Neurosurg,2017,161:88-92.
[13]苏忠周,沈健,周跃,等.磁共振仿真内窥镜技术在三叉神经痛微血管减压术中的应用[J].中华神经外科杂志,2016,32:1003-1006.