磁共振仿真内镜技术在三叉神经痛显微血管减压术中的应用  

Application of magnetic resonance virtual endoscopy in microvascular decompression of trigeminal neuralgia

作　　者：苏忠周[1] 沈健[2] 周跃[1] 闫仁福[1] 徐杰[1] 邱晟[1] 陈钟樑[1] 

机构地区：[1]湖州市中心医院神经外科,浙江省313000 [2]湖州市中心医院放射影像科,浙江省313000

出　　处：《中华神经外科杂志》2016年第10期1003-1006,共4页Chinese Journal of Neurosurgery

摘　　要：目的 探讨磁共振仿真内镜（MRVE）技术联合三维时间飞跃法成像（3D-TOF）序列、三维稳态进动快速成像（3D-FIESTA）序列在三叉神经痛显微血管减压术（MVD）中的应用价值.方法 回顾性纳入2012年8月至2015年4月湖州市中心医院神经外科采用MVD治疗的76例原发性三叉神经痛患者,所有患者均于术中确认病因.术前患者均采用3.0T磁共振行3D-TOF、3D-FIESTA序列扫描,并行MRVE后处理,评估MRVE技术联合3D-TOF、3 D-FIESTA序列的诊断及术中的价值.结果 76例患者中,术前3D-TOF＋ FIESTA序列诊断有责任血管压迫者63例,与手术确认的符合率为83％,漏诊13例（17％）;3D-TOF＋ FIESTA＋ MRVE序列诊断有责任血管压迫者72例,符合率为95％,漏诊4例（5％）,P =0.04.2种联合序列诊断符合者均主要为责任血管是动脉的患者,漏诊者均主要为责任血管是静脉的患者,其中1例蛛网膜粘连增厚者2种方法均漏诊.结论 MRVE技术联合3D-TOF、3D-FIESTA序列能清晰显示责任血管与神经的三维空间关系,提高责任血管判断的准确率.Objective To investigate the application value of magnetic resonance virtual endoscopy （MRVE） combined with three-dimensional time-of-flight （3D-TOF） and three-dimensional fast imaging employing steady-state acquisition （3D FIESTA） sequence in the microvascular decompression of trigeminal neuralgia.Methods Seventy-six patients with primary trigeminal neuralgia treated with microvascular decompression （MVD） at the Department of Neurosurgery,Huzhou Central Hospital from August 2012 to April 2015 were enrolled retrospectively.All the causes of disease in the patients were identified during the operations.All patients conducted imaging examinations of 3.0T MRI for 3D-TOF,3D-FIESTA,and MRVE.The diagnostic and intraoperative values of MRVE combined with 3D-TOF and 3D-FIESTA sequences were evaluated.Results In 76 patients,the preoperative 3D-TOF ＋ 3D-FIESTA sequences diagnosed 63 patients with offending vascular compression.The coincidence rate with the surgery confirmation was 83% and 13 patients （17%） were missed diagnosis;3D-TOF ＋ FIESTA ＋ MRVE sequences diagnosed 72 patients with offending vascular compression,the coincidence rate was 95%,and 4 were missed diagnosis （5%）,P =0.04.The patients of diagnostic coincidence of the 2 kinds of sequences were mainly the arteries as offending vessels.The patients of missed diagnosis were mainly in patients with offending vessels as veins,one of the patients with subarachnoid adhesions and thickening was missed diagnosis.Conclusion MRVE technique combined with 3D-TOF and 3D-FIESTA sequences may clearly reveal the relationship of three-dimensional space between offending vessels and nerves,and improve the accurate rate for identification of offending vessels.

关 键 词：三叉神经痛 磁共振成像 显微血管减压术 磁共振仿真内镜 

分 类 号：R651.3[医药卫生—外科学]