原发性及创伤后脑神经病变磁共振检查序列的对比研究  

Comparative research on the techniques for screening patients with primary or posttraumatic cranial nerve disorders

作　　者：苏家威[1] 俞顺[1,2] 罗敏[1,2] 包强[1,2] 

机构地区：[1]福建省立医院放射科,福州350001 [2]福建医科大学省立临床医学院,福州350001

出　　处：《创伤与急诊电子杂志》2015年第3期11-17,共7页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的探讨Philips 1.5T磁共振三维时间飞跃稳态梯度回波序列(Threedimensional time of flight spoiled gradient echo,3D-TOP-SPGR,3D-TOF)与三维平衡式稳态自由进动梯度回波序列(Three-dimensional Balance fast field echo,3D-BFFE)对脑干区脑神经及毗邻血管的显示对比,优化原发性及创伤后脑神经病变的患者磁共振检查的扫描方法。方法对50例可疑原发性或创伤后脑神经病变的患者(排除颅内占位、炎症性及脑实质挫裂伤病变)的脑干区同时行3D-TOF及3D-BFFE序列扫描,经2名磁共振主治医师采用双盲法分别阅片,评价3D-TOF、3D-BFFE以及两种序列图像联合对相应脑神经形态及毗邻血管关系的显示情况,其中重点观察第Ⅲ、Ⅴ、Ⅶ、Ⅷ对颅神经及与其毗邻的血管关系,并进行临床治疗回访,评价上述磁共振扫描方法诊断的准确性。结果评分统计后显示3D-TOF和3D-BFFE两种序列图像联合不论是观察神经还是血管的评分均值均高于单选序列;在观察神经方面单选3D-BFFE或两种序列图像联合观察的效果评分均较高,与单选3D-TOF序列观察效果差异均显著(P<0.05),单选3D-BFFE与两种序列图像联合观察效果差异不明显(P>0.05);在观察血管方面单选3D-TOF或两种序列图像联合观察的效果评分均较高,与单选3D-BFFE序列观察效果差异均显著(P<0.05),单选3D-TOF与两种序列图像联合观察效果差异不明显(P>0.05)。且2名医师观察后诊断为脑神经血管压迫或高度可疑压迫的患者有9例,其中单选3D-TOF序列观察即可诊断并判定责任血管的1例,单选3D-BFFE序列观察可诊断并判定责任血管的有4例,另外有4例需要两种序列图像联合观察、对比才可诊断并判定责任血管。后续随访这9例患者中有7例临床拟诊为脑神经血管压迫并在本院接受手术治疗,并最终被临床确诊。结论在应用Philips 1.5T磁共振仪进行脑干区脑神经检查中,联合应用3D-TOF、3D-BFFE序列扫Objective To investigate the use of three-dimensional time of flight spoiled gradient echo （3d-Tof） sequence and three-dimensional balance fast field echo （3d-BffE） sequence for the imaging of the cranial nerves in brain stem and the adjacent vessels by Philips 1.5T mri scanner and to optimize the techniques for screening patients with primary and post-traumatic cranial nerve disorders.Method 3d-Tof sequence and 3d-BffE sequence wereused to visualize the brain stem region in 50 patients who were found to have no intracranial mass lesions or intracranial inflammation. The imaging appearance of the cranial nerves and the adjacent vessels with solely 3d-Tof sequence, solely 3d-BffE sequence, and both sequences were evaluated by two attending physicians experienced in mri diagnosis using a double-blind method. The emphasis was put on the observation of the relation between theⅢ、Ⅴ、Ⅶ andⅧcranial nerves and their adjacent vessels, the follow-up conducted with the clinical treatment, and the evaluation of the accuracy of the above three diagnostic methods.Result The score results given by both physicians were as follows： There was a significant superiority in the qualities of images of nerves and vessels with both sequences, compared with 3d-BffE sequence or 3d-Tof sequence alone. There was a significant superiority in the qualities of images of nerves with 3d-BffE sequence alone or with both sequences, compared with 3d-Tof sequence （P〈0.05）. There was no significant superiority in the quality of images of nerves with 3d-BffE sequence alone and with both sequences （P〉0.05）. There was also a significant superiority in the quality of images of vessels with 3d-Tof sequence alone and with both sequences, compared with 3d-BffE sequence （P〈0.05）. There was no significant superiority in the quality of images of vessels with 3d-Tof sequence alone and with both sequences （P〉0.05）. There were 9 patients diagnosed as having cranial nerve neurovascular compression or highly suspicious of

关 键 词：原发性 创伤后 脑神经病变 3D-TOF 3D-BFFE 磁共振成像 

分 类 号：R741[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]