3D-TOF-MRA联合3D-FIESTA-C在血管压迫性三叉神经痛术前评估中的诊断价值  

The diagnostic value of 3D-TOF-MRA in combination with 3D-FIESTA-C in preoperative evaluation of vascular compressive trigeminal neuralgia

作　　者：朱传清[1] 于泽峰[1] 郭春锋 

机构地区：[1]佳木斯市妇幼保健院放射线科,黑龙江佳木斯154002 [2]驻马店市第一人民医院磁共振室,河南驻马店463000

出　　处：《实用放射学杂志》2018年第2期180-183,共4页Journal of Practical Radiology

摘　　要：目的 探讨三维时间飞跃法磁共振血管成像（3D-TOF-MRA）联合三维双激发平衡式稳态自由进动序列（3D-FIESTA-C）结合多平面重建（MPR）及图像融合技术在血管压迫性三叉神经痛（TN）术前评估中的特点，以提高诊断准确率。方法 回顾性分析70例经神经外科手术证实的血管压迫性TN患者的影像资料，将3D-TOF-MRA联合3D-FIESTA-C与术中所见及3D-TOF-MRA、3D-FIESTA-C分别对比，评价两者联合结合MPR及图像融合技术对TN诊断的优越性。结果 70例患者均行微血管减压术（MVD），与手术结果对照3D-TOF-MRA显示55例三叉神经脑池段周围存在责任血管，阳性率为79%，3D-FIESTA-C显示60例存在责任血管，阳性率为85%，两者联合显示65例，阳性率为93%。5例未见明确显示，而术中证实3例为迂曲的小动脉，2例为岩静脉。而责任血管的种类以小脑上动脉、基底动脉为主。结论 3D-TOF-MRA联合3D-FIESTA-C结合MPR及图像融合技术能清晰显示血管与三叉神经之间的关系，准确评估血管压迫性TN患者的责任血管性质和神经血管压迫征象，能为低位脑神经压迫症状患者行外科MVD提供指导。在小静脉的显示上还存在不足，需结合MRI其他序列（如 CE-3D-FIESTA序列）。Objective To investigate the diagnostic value of three-dimensional time-of-flight magnetic resonance angiography （31〉 TOF MRA） in combination with three-dimensional fast imaging employing steady state acquisition with phase cycling （3D-FIESTA C）, using multiplanar reconstruction and image fusion technology in preoperative evaluation of vascular compressive trigeminal neuralgia （TN） and to improve the diagnostic accuracy.Methods 3I）-TOF-MRA and 3D-FIESTA-C images using MPR and image fusion technology of 70 patients with TN confirmed by surgery were reviewed retrospectively,and compared with intraoperative findings separately and together.Results Microvascular decompression （MVD} surgery was performed in all 70 patients. Compared with surgical results, 3D-TOF MRA showed presence of the offending vessel around the cisternal segment of trigeminal nerve in 55 cases with a positive rate of 79%. 3D-FIESTA-C showed the presence of the offending vessel in 60 cases with a positive rate of 85%. 65 cases were found when combining both 3D-TOF-MRA and 3D-FIESTA C images, with a positive rate of 93%. No positive imaging findings were seen in 5 cases. Operation showed that offending vessels were small arteries in 3 cases and were petrosal veins in 2 cases. The main offending vessels were superior cerebellar artery and basilar artery.Conclusion Combining images of 3D-TOF MRA and 3D-FIESTA-C using MPR and image fusion technology can show the relationship between offending vessels and the trigeminal nerve clearly in patients, and provide guidance for MVD surgery.There are still some deficiencies in the display of venules, and other sequences of MRI （ such as CE-3D-FIESTA sequences） may be helpful.

关 键 词：三叉神经痛 三维时间飞跃法磁共振血管成像 三维双激发平衡式稳态自由进动序列 多平面重建 

分 类 号：R745.11[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]