3．0T磁共振成像在血管压迫性三叉神经痛中的应用

Application of 3.0T MRI for vascular compressive trigeminal neuralgia

目的探讨3.0T MRI在血管压迫性三叉神经痛中的应用。方法对32例三叉神经痛患者行轴位3D-TOF MRA及3D-FIESTA-C,并分别进行MPR、CMPR及仿真内镜重建(MRVE),分析患侧血管与神经的关系。结果 32例中,5例(5/32,15.63%)患侧血管与神经无接触,4例(4/32,12.50%)可疑接触,5例(5/32,15.63%)明确接触;18例(18/32,56.25%)存在压迫,其中14例(14/18,77.78%)责任血管为小脑上动脉,2例(2/18,11.11%)为岩静脉,另外分别为小脑前下动脉、基底动脉各1例(1/18,5.56%)。对其中15例行微血管减压术(MVD),MRI所示责任血管与术中所见相吻合;术后11例疼痛消失,4例疼痛较前明显减轻。结论 3.0T MRI可有效区分导致血管压迫性三叉神经痛的责任动脉及静脉与神经的关系;3D-FIESTA-C的CMPR及MRVE可提高判断接触与压迫的敏感度与准确率,对显示责任静脉具有优势,MRVE三维空间立体定位可作为MVD术前评估的有力补充。

Objective To explore the value of 3.0T MRI for vascular compressive trigeminal neuralgia. Methods Totally 32 patients with trigeminal neuralgia underwent transverse 3D-TOF MRA scanning and 3D-FIESTA-C scanning. The source images of 3D-TOF MRA were reconstructed with MPR, of 3D-FIESTA-C were managed with CMPR and MR virtu- al endoscopy （MRVE）. The relationship between vessels and nerves in the symptomatic side was overviewed. Results Among 32 patients, no neurovascular contact was detected in 5 cases （5/32, 15.63 %）, while uncertain contact was found in 4 （4/32, 12.50%） and certain contact was noticed in 5 cases （5/32, 15.63%）, whereas compression was proved in 18 cases （18/32, 56.25 %）. Among 18 cases of compression, the offending vessels included superior cerebellar artery （14/18, 77.78%）, the petrosal vein （2/18, 11.11%）, as well as anterior inferior cerebellar artery and vertebra basilar artery （1/18, 5.56 %）. Among 15 patients with compression and underwent microvacular decompression （MVD）, the responsi- ble vessels showed by MRI were consistent .to postoperative results, and symptoms of 11 patients disappeared, of 4 patients relieved. Conclusion The relationship between responsible artery, vein and nerve can be validly distinguished with 3. 0T MRI. 3D- FIESTA-C CMPR can improve the sensitivity and accuracy of judging contact and compression, having advanta- ges on displaying responsible veins. 3D spatial stereotaxis of MRVE can be used as complement evidences for preoperative evaluation of MVD.