磁共振3D-TOF联合3D-FIESTA对原发性三叉神经痛病因的诊断价值  

Magnetic resonance 3D-TOF sequence combined with 3D-FIESTA sequence in diagnosis of primary trigeminal neuralgia

作　　者：喻雯[1] 胡兴越[2] 倪建芳[1] 金珏[1] 陈颖[1] 

机构地区：[1]浙江省人民医院老干部科,杭州310024 [2]浙江大学医学院附属邵逸夫医院神经内科

出　　处：《浙江医学》2016年第18期1487-1490,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技项目(2015KYB031)

摘　　要：目的探讨磁共振成像的三维时间飞跃序列(3D-TOF)联合三维稳态自由进动梯度回波序列(3D-FIESTA)对原发性三叉神经痛病因的诊断价值,以及责任血管构成和易诱发三叉神经痛的血管类型。方法回顾性分析105例三叉神经痛患者和80例非三叉神经痛患者3D-TOF和3D-FIESTA磁共振图像。将三叉神经痛患者患侧106侧作为患侧组,健侧104侧作为健侧组,非三叉神经痛患者双侧160侧作为对照组;针对三叉神经脑池段与周围血管的关系分为5个型(无血管、远离、接近、接触、压迫);比较各组间三叉神经与周围血管的关系、责任血管构成等差异。结果健侧组与对照组神经与血管关系分型构成差异无统计学意义(P>0.05)。患侧组神经与血管关系阳性率(接触+受压变形)为75.47%,明显高于健侧组15.38%和对照组16.25%(P<0.05)。责任血管为小脑上动脉(SCA)占71.25%,小脑前下动脉(AICA)占20.00%,单纯基底动脉(BA)占2.50%,BA联合SCA占3.75%,SCA联合AICA占1.25%,静脉占1.25%。结论磁共振3D-TOF联合3D-FIESTA能清晰显示三叉神经脑池段与周围血管的空间关系;血管压迫是原发性三叉神经痛的重要病因,主要责任血管为SCA。Objective To assess the diagnostic value of MRI 3D-TOF sequence combined with 3D-FIESTA sequence for primary trigeminal neuralgia. Methods The imagines of MRI 3D-TOF and 3D-FIESTA in 105 patients with trigeminal neuralgia and 80 non-neuralgia patients were retrospectively analyzed. The 106 affected sides of trigeminal neuralgia patients were assigned to affected group, 104 non-affected sides were contralateral group, and 160 sides of non-neuralgia patients were control group. Relationship between trigeminal nerve and surrounding vascular structures was classified as type 1（no surrounding artery, type 2（apart from surrounding artery）, type 3 （close to surrounding artery）, type 4 （contacting surrounding artery） and type 5 （compressing surrounding artery）. Results There were no significant differences in relationship of nerves to vessels between contralateral group and control group （P 〉0.05）. The rate of positive nerves to vessels relationship （contacting or compressing） was 75.47% in case group, which was significantly higher than that of contralateral group and control group（15.38% and 16.25%, respectively, P〈0.05）. The responsible vessels were SCA（71.25%）, AICA（20.00%）, BA（2.50%）, BA joint SCA（3.75%）, SCA joint AICA （1.25%）, and veins （1.25%）. Conclusion The combined application of 3D-FIESTA sequence with 3D-TOF sequence may be an optimal method to investigate the structure relationship between the trigeminal nerve cisternal segment and the responsible vessels. The study also shows that major responsible vessel is SCA and vascular compression is main cause for trigeminal neuralgia.

关 键 词：三叉神经痛 血管压迫 3D-TOF 3D-FIESTA 

分 类 号：R745.11[医药卫生—神经病学与精神病学]