磁共振断层血管成像对三叉神经痛病因的诊断价值  

MR Tomographic Angiography in the Etiological Diagnosis of Trigeminal Neuralgia

作　　者：林青[1] 童绥君[1] 曲红丽[1] 刘希尧[2] 庄雄杰[3] 

机构地区：[1]福建医科大学附属厦门市第一医院神经内科,厦门361003 [2]福建医科大学附属厦门市第一医院神经外科,厦门361003 [3]福建医科大学附属厦门市第一医院放射科,厦门361003

出　　处：《福建医科大学学报》2008年第4期341-343,共3页Journal of Fujian Medical University

基　　金：厦门市科技局科研基金项目(3502220064016)

摘　　要：目的探讨磁共振断层血管成像(MRTA)对三叉神经痛(TN)病因诊断的临床应用价值。方法TN患者45例及健康成人(对照组)20例,行MRTA检查,观察3D-TOF成像序列结合3D-CISS序列中脑桥小脑角池内三叉神经与周围血管的关系,并与手术结果进行盲法对照。结果TN组患侧神经血管存在接触或压迫41例,健侧存在血管接触或压迫9例,对照组40侧有10侧显示神经血管接触或压迫。TN组患侧神经血管接触或压迫的阳性率与健侧及对照组比较差别有统计学意义(P<0.05),健侧和对照组的差别无统计学意义(P>0.05)。MRTA对神经血管接触或压迫的敏感度、特异度、准确度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、约登指数分别为93.75%,81.82%,88.89%,88.24%,90%,5.16,0.077,0.76。结论MRTA诊断CPA池内血管接触或压迫敏感度和真实性高,为尽早合理治疗提供客观的影像学依据。Objective To explore the value of MR tomographic angiography（MRTA） in the etiological diagnosis of trigeminal neuralgia（TN）. Methods Forty-five patients with TN and 20 healthy controis underwent MRTA. The relationship of the fifth cranial nerve to adjacent vessels was best visualized on the three-dimensional time-of-flight magnetic resonance angiography（3D-TOF MRA）, and constructive interference at steady state（CISS-MR） sequences. The results from MRTA were compared with the outcome of MVD. Results Neurovascular contact/compress（NVC） was verified in 41 of 45 symptomatic sides, in 9 of 45 opposite sides and 10 of 40 control sides. The positive rate of NVC in symptomatic sides were significant higher than that in the opposite sides and the control group（P〈0.05）, no significant difference was found between the opposite sides and the control group（P〉0.05）. Evaluating the MRTA diagnosis of NVC： the sensitivity rate was 93.75%, the specificity rate was 81.82%, the accuracy rate was 88. 89%, the positive predictive value was 88.24%, the negative predictive value was 90%, the positive likelihood ratio was 5. 16, the negative likelihood ratio was 0. 077, Youden S index was 0. 76. Conclusion MRTA demonstrates that neurovascular contact/compress at the root entry zones in cases of TN. These findings were verified at surgery. The specificity and accuracy in diagnosis of NVC by MRTA are high. MRTA can show the anatomical relationship accurately, which is beneficial for clinic treatment.

关 键 词：三叉神经痛 磁共振血管血管造影术 诊断 

分 类 号：R745.11[医药卫生—神经病学与精神病学]