3D-FIESTA联合3D-TOFMRA对三叉神经微血管减压术的指导价值  

The value of 3D-FIESTA combined with 3D-TOF MRA sequence to the operation of microvascular decompression

作　　者：刘厚强 于如同 丁允波 谷佳 王子德 李祥 

机构地区：[1]徐州医科大学附属医院脑科医院神经外科,徐州221002

出　　处：《临床神经外科杂志》2017年第3期212-215,219,共5页Journal of Clinical Neurosurgery

基　　金：江苏省卫生厅重大科研项目基金(H200818)

摘　　要：目的探究三维稳态进动快速成像(3D-FIESTA)及三维时间飞跃法血管成像(3D-TOF MRA)对三叉神经微血管减压术的指导价值。方法分析2012年2月~2015年12月徐州医科大学附属医院脑科医院神经外科行微血管减压术的121例三叉神经痛患者的临床表现、影像资料、术中所见、手术疗效。使用3.0 T磁共振机行3D-FIESTA及3D-TOF MRA序列扫描,重点从轴位、冠状位、矢状位上观察两种序列中患侧三叉神经脑池段与周围血管的位置关系,与手术结果进行对照分析。结果本组119例患者手术中探查到三叉神经REZ区有血管压迫或接触。3D-FIESTA、3D-TOF MRA及3D-FIESTA联合3D-TOF MRA对于判断有无血管压迫或接触的总符合率分别为82.6%、74.4%、98.3%。术前3D-FIESTA联合3D-TOF MRA检查与术中所见结果的差异无统计学意义(P>0.05)。3D-FIESTA联合3D-TOF MRA对判断血管类型的准确性明显高于单独3D-FIESTA及3D-TOF MRA,差异有统计学意义(均P<0.001)。结论 3D-FIESTA联合3D-TOF MRA可准确判断患侧三叉神经是否有血管接触,明确责任血管及其血管的类型(动脉或静脉),有助于制定手术方案,提高手术疗效;对于三叉神经微血管减压术具有十分重要的意义。Objective To invetigate the clinical value of 3D-FIESTA and 3D-TOF MRA in the microvascular decompression for trigeminal neuralgia.Methods Using the retrospective analysis to study the clinical manifestation, the medical imaging information, the surgical findings and the effect of the operation of the 121 cases which have had the microvascular decompression from February 2012 to December 2015.Preoperative 3.0T MRI with axial time of-flight（TOF） and 3D-FIESTA sequence were performed.The point is to use the two sequences to observe the relationship between the trigeminal nerve root in the cistern and blood vessels around from axial view,coronal view and sagittal view of the affected side and the unaffected side,and compare the result with the surgical findings.Results The surgical findings is that：compression or contact vessels in trigeminal nerve REZ have been found in 119 cases of the 121 samples.The total consistent rate of FIESTA,TOF,and FIESTA＋TOF to for the diagnosis of the existence of contact vessels on the neuralgia sides were 82.4%,74.4%,98.3%,respectively.The difference between vascular contact manifested by MRI and vascular contact manifested by operation was not statistically significant （P〉0.05）.The difference among FIESTA,TOF and FIESTA ＋TOF were statistically significant（all P〈0.001）.Concilusion 3D-FIESTA combined with 3D-TOF is effective to diagnose the existence of contact vessels on the neuralgia sides and the types of contact vessels.3D-FIESTA combined with 3D-TOF,which assists in preperative planning and improve the operation effect,is very impotant for the microvascular decompression.

关 键 词：三叉神经痛 MRI 微血管减压术 

分 类 号：R445.2[医药卫生—影像医学与核医学] R651.3[医药卫生—诊断学]