磁共振断层血管成像对三叉神经痛病因诊断的价值

Evaluation of MRTA in the diagnosis of trigeminal neuralgia

目的:评价磁共振断层血管成像(MRTA)对三叉神经痛患者病因诊断的价值,并为制定血管-神经压迫的影像学诊断标准提供建议。方法:对45例(47侧)临床明确诊断为三叉神经痛的患者进行MRTA检查,2位影像学专业人员在不告知诊断的情况下独立读片,其间的差异采用成组设计两样本比较的u检验。设立有症状侧为实验组,无症状侧为对照组,组间差异采用X2检验。对其中2例进行了微血管减压术。结果:2位影像学专业人员的评分在统计学上无差异(双尾,P>0.05)。45例病例中,6例为肿瘤压迫引起,占13.3％。其余41侧有症状侧MRTA明确诊断为压迫者占58.5％(24／41),可疑压迫者占17.1％(7／41),责任血管依次为小脑上动脉(SCA)61.3％、小脑下前动脉(AICA)19.4％、SCA+AICA为12.9％、椎动脉(VA)为6.4％,血管压迫的部位于近脑干1／3者占61.30%(19／31),其余占38.7％。37侧无症状侧MRTA无明确诊断为压迫者,可疑压迫者占18.9％(7／37)。经X2检验,两组有显著差异(P<0.005),2例行微血管减压术的患者,MRTA诊断与术中发现符合,术后患者疼痛即刻缓解,且无明显麻木。结论:多平面-MRTA方法可作为三叉神经痛初诊患者的常规检查手段,并为微血管减压术提供一定的参考。

PURPOSE:To evaluate magnetic resonance tomographic angiography (MRTA) findings and etiological diagnostic value in patients with trigeminal neuralgia (TN), and to establish the radiological diagnostic standard of the neurovascular compression (NVC). METHODES: MRTA was performed in 45 cases(47 sides) with TN. Contralateral asymptomatic nerves were evaluated as a control. The images were independently reviewed by two radiologists, who were blinded to the clinical details. Two of the 45 patients underwent microvascular decompression (MVD). The results were analyzed by using SPSS 11.0. RESULTS: 6 out of 45 patients(13.3%) were suffered from the tumors at cerebellopontine angle(CPA). NVC was identified on MRTA in 24 out of 41 symptomatic nerves(58.5%), uncertain NVC were occurred in 17.1% (7/41 ).The offending vessels were superior cerebellar artery (SCA) in 61.3% ,anterior inferior cerebellar artery (AICA) in 19.4%,SCA+AICA in 12.9% ,vertebral artery (VA) in 6.4%. The locations of the compression were 61.3%(19/ 31) at the root of entry zone(REZ) and 38.7% at the distal part. 18.9%(7/37) asymptomatic nerves were showed uncertain NVC on MRTA, and no identified NVC. There was a high degree of agreement between the two observer(P>0.05). The difference between symptomatic and asymptomatic nerves was statistically significant (x2=33.884, P<0.005). For the twopatients who underwent MVD, MRTA findings corresponded with the operative findings. They had complete pain relief and no sensory loss postoperatively. CONCLUSION: MRTA can be used as a routine preoperative work-up in patients with TN. The identified NVC is the indication of MVD.