磁共振断层血管成像在颅神经血管压迫综合征的应用

Magnetic resonance tomographic angiography in cranial neurovascular compression syndrome

目的 探讨磁共振断层血管成像（MRTA）对颅神经血管压迫综合征病因诊断的临床应用价值,评价3D-FIESTA及3D-TOF-SPGR序列显示颅神经与血管的三维空间关系的能力.方法 湖北省恩施自治州中心医院神经外科白2007年5月至2009年5月共收治行微血管减压术（MVD）治疗的颅神经血管压迫综合征患者41例,术前行MRTA及其3D-FIESTA和3D-TOF-SPGR 序列扫描,观察颅神经与周围血管的空间关系,并与术中探查结果进行对照,评价MRTA及其3D-FIESTA和3D-TOF-SPGR序列在术前评估颅神经与周围血管关系的能力.结果MRTA能清晰且同时显示三叉神经、面神经、舌咽神经等颅神经和责任血管,在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;在3D-TOF-SPGR图像上,脑脊液为低信号,脑实质和颅神经为等信号,血管为高信号;3D-FIESTA序列扫描显示病变侧神经与血管有密切关系34例（82.9%）,3D-TOF-SPGR序列扫描显示病变侧神经与血管有密切关系35例（85.4%）,二者差异无统计学意义（χ2=0.091.P=0.762）.结论 MRTA技术能清楚显示颅神经及责任血管,3D-FIESTA结合3D-TOF-SPGR对颅神经血管压迫综合征的术前病因诊断及手术适应证的选择具有重要价值.

Objective To investigate the clinical diagnostic value of magnetic resonance tomographic angiography （MRTA） on cranial neurovascular compression syndrome,and evaluate the ability of 3D-FIESTA and 3D-TOF-SPGR sequences in demonstrating the relation of three-dimensional space between cranial nerves and blood vessels.Methods The data of 41 patients with cranial neurovascular compression syndrome,admitted to our hospital from May 2007 to May 2009,were analyzed.These patients were planed to perform micro vasular decompression （MVD）.Before the operation,MRTA,3D-FIESTA and 3D-TOF-SPGR sequence scanning were performed to observe the relation of three-dimensional space between cranial nerves and blood vessels;these results were compared with the intraoperative results to evaluate the advantages and disadvantages of 3D-FIESTA and 3D-TOF-SPGR sequence scanning.Results MRTA could demonstrate such cranial nerves as trigeminal nerve,facial nerve and glossopharyngeal nerve,and responsible blood vessels clearly and simultaneously.The 3D-FIESTA imaging showed high signal in the cerebrospinal fluid and moderate signal in the nerves and blood vessels.The 3D-TOF-SPGR imaging showed low signal in the cerebrospinai fluid,moderate signal in the nerves and brain parenchyma,and high signal in the blood vessels.Closed relation between the nerves and the blood vessels in the lesion side were found in 34 patients （82.9%） by 3D-FIESTA sequence scanning,and that was found in 35 patients by 3D-TOF-SPGR sequence scanning; no significant difference between 3D-FIESTA and 3D-TOF-SPGR sequence scanning was found in displaying the relation of nerves and blood vessels （P〉0.05）.Conclusion MRTA technology may clearly show the relation of cranial nerves and responsible blood vessels;combined application of 3D-FIESTA and 3D-TOF-SPGR sequence scanning can help making the preoperative diagnosis and determining the surgical indications in patients with cranial neurovaseular compression syndrome.