3D-FIESTA及MRVE在血管压迫性三叉神经痛及面肌痉挛的应用价值

Application of high-resolution 3D-FIESTA and MR virtual endoscopy in vascular compressive trigeminal neuralgia and hemifacial spasm

目的评价高分辨3D-FIESTA成像及MRVE后处理技术显示桥小脑角的脑神经与血管的三维空间关系的能力及对血管压迫性三叉神经痛和面肌痉挛病因诊断中的价值。方法回顾性分析17例三叉神经痛及22例面肌痉挛患者。利用高分辨3D-FIESTA原始图像作MRVE重建,从不同的视角观察神经与血管的空间关系,判断有无血管压迫神经。其中6例与手术结果对照。结果①高分辨3D-FIESTA图像上,脑脊液呈高信号,神经与血管呈中等信号,对比良好;②MRVE重建可以直观地显示神经与血管的三维立体的图像,再现局部解剖结构;③面肌痉挛症状侧的血管压迫阳性率为77.3%(17/22)。三叉神经痛的症状侧血管压迫阳性率为70.6%(12/17);④6例经外科手术证实有血管受压,术后随访有5例痊愈,1例三叉神经痛患者症状明显改善。结论高分辨3D-FIESTA成像结合MRVE后处理重建能三维立体地显示桥小脑角脑神经与周围血管的空间关系,对明确三叉神经痛或面肌痉挛的病因诊断有重要价值,对神经外科医师设计和优化微血管减压手术是一种重要的影像手段。

Objective To evaluate the ability in displaying the relationship between cranial nerves and blood vessels within the cerebellopontine angle （CPA） using MR virtual endoscopy （MRVE） post-processing after high-resolution 3D-fast imaging employing steady-state acquisition （3D-FIESTA） acquisition, furthermore, estimate the effectiveness of these MR techniques in the etiopathogenisis diagnosis of vascular compressive trigeminal neuralgia and hemifacial spasm. Methods Retrospective analysis was required on 17 patients with vascular compressive trigeminal neuralgia and 22 cases with hemifacial spasm. MRVE through the CPA was performed using 3D-FIESTA images （source images） suitable for 3D reconstructions. The complex spatial relationships between cranial nerves and blood vessels were overviewed from different visual angle. And make a decision whether there was compression from blood vessels on cranial nerves. Six cases of them were compared with microvacular decompression surgery. Results （1）Cerebrospinal fluid （CSF） appearance hyperintensity signal on 3D-FIESTA images, nevertheless, blood vessels and cranial nerves are isointensity signal. There is excellent contrast between CSF and vessels or nerves. （2）The technique improves the understanding of the complex spatial relationships between blood vessels and cranial nerves under the background of CSF, and the regional anatomic structure in the CPA were reappeared well. （3） The positive of vessels compression is 77.3% （17/22） in the patients with facial spasm lateral and 70. 6% （12/17） in the patients with trigeminal neuralgia. （4）Six cases of them were compared With microvacular decompression surgery. Five cases healed and 1 case improved from the disorders in the follow-up. Conclusion High-resolution 3D-FIESTA acquisition combines with MRVE post-processing can provide the excellent spatial structure between the vessels and nerves within the CPA cisterna. There is important value in the etiological diagnosis of vascular compressive trigeminal neuralgia and hemifacial spasm. Furthermore, the technique is an important tool for neurosurgeons in planning and optimizing microvascular decompression in the CPA.