磁共振成像技术在原发性三叉神经痛患者神经血管压迫评估及治疗中的价值

发布时间：2018-08-06 18:58

【摘要】：目的:探讨磁共振三维稳态进动快速成像序列(three-dimensional fast imaging employing steady state acquisition,3D-FIESTA)联合三维时间飞跃序列(three-dimensional time of flight,3D-TOF)对原发性三叉神经痛患者神经血管压迫(neurovascular compression,NVC)的评估价值。同时评价基于 3D-FIESTA 的脑池磁共振仿真内窥镜技术(megnatic resonance virtual endoscopy,MRVE)对原发性三叉神经痛手术治疗的指导价值。方法:回顾分析72例单侧原发性三叉神经痛患者的临床及影像学资料,所有患者均经神经外科微血管减压术(microvascular decompression,MVD)治疗确诊,分别对比有症状侧与无症状侧之间的神经血管压迫(NVC)发生率、NVC评分、责任血管与三叉神经出脑干区(root entry zone,REZ)的最短距离、以及责任血管(responsible vessel,RV)的性质与来源等。利用磁共振仿真内窥镜(MRVE)技术进行脑池仿真内镜成像,重建三维图像模拟手术路径,并与术中录像进行对照,评价MRVE技术的可靠性以及对手术的指导价值。结果:有症状侧NVC发生率约为94.44%(68/72),其中动脉参与比例约95.59%(65/68),责任血管中最常见为小脑上动脉(superior cerebellar artery,SCA),占比约75%(51/68),NVC评分为6.63±2.18,责任血管与REZ区最短距离为1.04±1.55mm;无症状侧的NVC发生率约45.83%(33/72),其中动脉参与比例约66.67%,责任血管中最常见亦为小脑上动脉(SCA),占比约57.58%(19/33),NVC评分为2.91±0.95,责任血管与REZ区最短距离为5.28±2.33mm;两组数据之间差异均具有统计学意义。有症状侧68例NVC阳性患者的FIESTA图像,经MRVE三维后处理获得模拟手术路径图像,与手术录像对比高度一致。结论:原发性三叉神经痛与患侧神经血管压迫程度及部位密切相关,3D-FIESTA联合3D-TOF序列对神经血管压迫的诊断及评估具有重要价值。基于3D-FIESTA的脑池仿真内窥镜技术可以高度模拟手术路径及视野,对外科治疗具有重要的指导价值。
[Abstract]:Objective: to evaluate the value of three-dimensional fast imaging employing steady state acquisition 3D-FIESTA combined with three-dimensional time of flight3D-TOF in the evaluation of neurovascular compression in patients with primary trigeminal neuralgia. To evaluate the guiding value of 3D-FIESTA based magnetic resonance virtual endoscopy (megnatic resonance virtual endoscopy MRVE) in the surgical treatment of primary trigeminal neuralgia. Methods: the clinical and imaging data of 72 patients with unilateral primary trigeminal neuralgia were retrospectively analyzed. All patients were diagnosed by microvascular decompression. The incidence of neurovascular compression (NVC) in the symptomatic side and the asymptomatic side were compared. The (NVC) score, the shortest distance between the responsible vessel and the trigeminal nerve (root entry Z, and the nature and origin of the responsible vessel were compared between the symptomatic side and the asymptomatic side. Magnetic resonance virtual endoscopy (MRVE) was used to simulate the operation path of the brain cisterns, and to evaluate the reliability of the MRVE technique and its guiding value. Results: the incidence of symptomatic NVC was 94.44% (68 / 72), in which arterial involvement was 95.59% (65 / 68), and the most common responsible vessel was the superior cerebellar artery (superior cerebellar arteriae SCA), with a score of 6.63 卤2.18, and the shortest distance between the responsible vessel and the REZ area was 1.04 卤1.55 mm, and the asymptomatic NVC occurred in the asymptomatic side. The rate was about 45.83% (33 / 72), in which the proportion of arterial involvement was about 66.677.The (SCA), score of the cerebellar artery was about 57.58% (19 / 33), and the shortest distance between the responsible vessel and the REZ area was 5.28 卤2.33mm. the difference between the two groups was statistically significant. The FIESTA images of 68 patients with positive NVC on the symptomatic side were obtained by MRVE 3D post-processing, which were in good agreement with the operation video. Conclusion: the primary trigeminal neuralgia is closely related to the degree and location of neurovascular compression in the affected side. The combination of 3D-FIESTA and 3D-TOF sequence is of great value in the diagnosis and evaluation of neurovascular compression. Cisterna virtual endoscopy based on 3D-FIESTA can simulate the operation path and visual field highly, and has important guiding value for surgical treatment.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R745.11;R445.2

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