高分辨磁共振成像对原发性三叉神经痛的诊断价值  

Diagnostic value of high-resolution MRI for essential trigeminal neuralgia

作　　者：尤超[1] 柴维敏[1] 张卫峰[2] 谭令[1] 陈克敏[1] 赵卫国[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院放射科,上海200025 [2]上海交通大学医学院附属瑞金医院神经外科,上海200025

出　　处：《诊断学理论与实践》2011年第4期340-345,共6页Journal of Diagnostics Concepts & Practice

基　　金：上海市重点学科建设项目资助(S30203)

摘　　要：目的:利用高分辨磁共振成像(high-resolution magnetic resonance imaging,HR-MRI)观察原发性三叉神经痛患者的三叉神经脑池段与周围血管间的空间关系。方法:收集2008年8月至2009年12月行神经根微血管减压的80例原发性三叉神经痛患者。采用HR-MRI,包括三维时间飞跃(3D-TOF)序列及三维快速稳态自由进动成像(3D-FIESTA)序列采集原始横断面三维数据,分别重建平行于神经脑池段的斜矢状面及垂直于神经的冠状面,从多角度共同观察研究其患侧三叉神经脑池段及邻近脑干与周围血管间的空间关系,并与手术结果行双盲对照。结果:78例(97.50%)患者显示一支或多支神经血管接触和(或)压迫(neurovascular contact/compression,NVC)患侧三叉神经脑池段或其邻近脑干,其中54例(67.50%)显示责任血管为小脑上动脉,其他血管包括小脑前下动脉、椎动脉、基底动脉及某些静脉。NVC点距神经出脑干平均距离为(2.80±0.73)mm,其中42例(52.50%)NVC发生在近端(NVC点距神经出脑干根部距离≤3mm),27例(33.75%)发生在远端(NVC点距神经出脑干根部距离>3mm),9例(11.25%)仅存在血管与三叉神经邻近脑干接触。联合应用3D-TOF和3D-FIESTA,其诊断灵敏度达97.44%,特异度为100%,准确率达97.50%。结论:HR-MRI检查不仅有利于原发性三叉神经痛患者的临床诊断及手术方案制定,且有助于更好地理解原发性三叉神经痛的发病机制。Objective To demonstrate the spatial relationship between cisternal segment of trigeminal nerve and adjacent vessel in patients with essential trigeminal neuralgia（TN） and to investigate the pathogenesis of essential TN with the use of high-resolution magnetic resonance imaging（HR-MRI）.Methods Eighty consecutive essential TN patients treated with nerve rootlet microvascular decompression（MVD） between August 2008 and December 2009 were enrolled in this study.High-resolution MRI with axial 3D acquisition sequences was performed,including three-dimensional time-of-flight （3D-TOF） and three-dimensional fast imaging employing steady state acquisition（3D-FIESTA）,to reconstract the sagittal and coronal images parallel and perpendicular to trigeminal nerves,respectively.The spatial relationship between cisternal segment of affected trigeminal nerve and adjacent brain stem and the adjacent peripheral vessels was assessed and analyzed with the result of MVD surgery.Results In 78 patients（97.50%）,there was one or multiple neurovascular contact/compression（NVC） points on cisternal segment of trigeminal nerve or adjacent brain stem.The responsible vessel was superior cerebellar artery（SCA） in 54 cases（67.50%）,others including antero-inferior cerebellar artery（AICA）,basilar artery（BA）,vertebral artery（VA）,and some venous vessel.The mean distance between NVC point and nerve outlet from brainstem was（2.80±0.73） mm.In 42 patients（52.50%）,the NVC was located proximally（the distance between NVC point and nerve outlet from brain stem was less than 3mm）,in 27（33.75%） the NVC was located distally（the distance was more than 3mm） and in 9（11.25%）NVC was only located adjacent to pons.Combining 3D-TOF with 3D-FIESTA,the diagnostic sensitivity was 97.44%,the specificity was 100%,and the accuracy was 97.50%.Conclusions High-resolution MRI could be used for the diagnosis and therapeutic decision of essential TN,and it is also helpful for understanding the pathogenesis o

关 键 词：原发性三叉神经痛 血管神经接触/压迫 磁共振成像 诊断 

分 类 号：R445.2[医药卫生—影像医学与核医学]