3D-FIESTA联合3D-TOF-MRA成像技术对三叉神经血管压迫的诊断价值

汪红梅; 吕洋; 邱俊; 罗艺; 刘畅; 陈传玉; 季学兵

doi:10.13898/j.cnki.issn.1000-2200.2018.06.026

3D-FIESTA联合3D-TOF-MRA成像技术对三叉神经血管压迫的诊断价值

The diagnostic value of 3D-FIESTA combined with 3D-TOF-MRA imaging in trigeminal nerve vascular compression

摘要

摘要: 目的：分析高场3T磁共振三维循环相位稳态采集快速成像（3D-FIESTA）技术联合三维时间飞跃磁共振血管成像（3D-TOF-MRA）对三叉神经血管压迫的临床诊断价值。方法：收集63例经临床手术证实的三叉神经痛病人资料纳入研究，术前均行3D-FIESTA联合3D-TOF-MRA磁共振成像检查，对图像进行三叉神经和血管关系分析，并与手术结果进行对比研究。结果：63例中术前MRI诊断和术中金标准诊断动脉血管压迫阳性分别是52例（82.5%）和55例（87.30%），差异无统计学意义（χ²=0.56，P>0.05）。其中术前MRI判读压迫40例，接触9例，可疑接触3例，责任血管包括来自小脑上动脉的21例（40.38%），小脑前下动脉的12例（23.07%），小脑后下动脉6例（11.53%），椎-基底动脉的8例（13.56%），三叉神经周围有明确的血管影但来源不明的5例（9.61%）。术中发现， 23例（41.82%）责任血管来自小脑上动脉，14例（25.46%）来自小脑前下动脉，5例（9.09%）来自小脑后下动脉，9例（16.36%）来自椎-基底动脉的， 4例（7.27%）来自无名血管的压迫。对照手术结果，63例中，术前MRI结果（责任血管判定错误或阴性）与术中诊断不符15例（23.81%），术前无压迫而术中表现为小脑上动脉压迫3例（4.76%），小脑后下动脉1例（1.59%），椎-基底动脉2例（2.17%），静脉压迫或蛛网膜粘连4例（6.35%），其余5例（7.94%）为责任血管判定不符。结论：利用高场3T磁共振的3D-FIESTA技术联合3D-TOF-MRA成像结合多方位重组技术可以清晰分辨三叉神经与周围血管的位置关系，帮助微创手术治疗提供精准的影像学依据，但是受部分容积效应等因素的影响，对于责任血管的认定仍存在一定的差异。

Abstract: Objective:To evaluate the application value of 3.0 MRI 3D-FIESTA sequence combined with 3D-TOF-MRA imaging in the diagnosis of trigeminal nerve vascular compression.Methods:Sixty-three patients with trigeminal neuralgia were detected using 3.0 MRI 3D-FIESTA sequence combined with 3D-TOF-MRA scan,the responsibility blood vessel was analyzed using the relationship between trigeminal nerve and blood vessels,and which was compared with surgical results.Results:The positive diagnosis rates of vascular compression using MRI before operation and good standard diagnosis during operation in 63 cases were 82.5% and 87.30%,respectively,the difference of which was not statistically significant(χ²=0.558,P=0.558).In MRI imaging,the vascular compression in 40 cases,contact in 9 cases and suspected contact in 3 cases were found.Among the offending blood vessels,21 cases(40.38%) from superior cerebellar artery blood vessels,12 cases(23.07%) from anterior inferior cerebellar artery,6 cases(11.53%) from posterior inferior cerebellar artery,8 cases from vertebral-basilar artery and 5 cases(9.61%)from unknown artery around trigeminal nerve were identified.Among the offending blood vessels,23 cases(41.82%) from superior cerebellar artery,14 cases(25.46%) from anterior inferior cerebellar artery,5 cases(9.09%) from posterior inferior cerebellar artery,9 cases(16.36%) from vertebral-basilar artery and 4 case(7.27%) from unknown vascular compression were found during operation.Among 63 cases compared with the operation results,the preoperative MRI diagnosis in 15 cases(23.81%) was not in accord with intraoperative diagnosis.The diagnosis of preoperative free of oppression and intraoperative oppression showed 3 cases(4.76%) of superior cerebellar artery,1 case(1.59%) of posterior inferior cerebellar artery,2 cases(2.17%) of vertebral-basilar artery,4 cases(6.35%) of venous compression or arachnoid adhesion.The preoperative MRI diagnosis in 5 cases(7.94%) was not in accord with the offending blood vessel.Conclusions:The 3.0 MRI 3D-FIESTA sequence combined with 3D-TOF-MRA imaging technology can display the trigeminal nerve vascular compression,provide the accurate imaging basis in minimally invasive surgery.The diagnosis of offending blood vessel is still different because of the partial volume influence.

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