28例前庭阵发症的MRI表现分析

Analysis on MRI Manifestations in 28 Patients with Vestibular Paroxysmia

目的探讨前庭阵发症的磁共振表现。方法应用三维-磁共振血管成像技术对28例前庭阵发症(vestibular paroxysmia,VP)患者(VP组)及28例其他眩晕病患者(对照组)进行扫描,评判所见前庭蜗神经周围有无神经血管交互压迫(neurovascular cross-compression,NVCC)现象,并记录责任血管和责任血管压迫神经部位至脑干的距离。分别进行卡方检验和t检验以明确两组差异之间有无统计学意义。结果 VP组56耳中存在NVCC现象有35耳,其中血管接触关系28耳,推移关系7耳,对照组56耳中存在NVCC现象有16耳,均为接触关系,未发现前庭蜗神经受血管推移现象,两组比较差异有统计学意义(χ2=16.191,P<0.001)。VP组中责任血管为小脑前下动脉25耳(71.4%),小脑后下动脉7耳(20%),椎动脉3耳(8.6%),对照组中责任血管为小脑前下动脉9耳(56.3%),小脑后下动脉6耳(37.5%),椎动脉1耳(6.3%),VP组与对照组压迫责任血管来源差异无统计学意义(χ2=1.774,P>0.05)。NVCC距脑干距离VP组为8.57±5.08 mm,对照组为8.93±4.64 mm,两组差异无统计学意义(t=-0.237,P>0.05)。VP组NVCC压迫位置距脑干距离<15 mm者为29耳(82.9%),对照组NVCC压迫位置距脑干距离<15 mm者为12耳(75%),两组差异无统计学意义(P=0.705,P>0.05)。结论 NVCC在VP患者中发生率高,压迫血管以小脑前下动脉多见,NVCC多发生在前庭蜗神经中枢髓鞘部。

Objective To explore the MRI manifestations of vestibular paroxysmia（ VP）. Methods The cerebellopontine angle area were scaned by MRI with three-dimensional magnetic resonance angiography in 28 VP patients（ VP group） and 28 other vertiginous patients（ control group）,and to judge if there was neurovascular cross-compression（ NVCC）,the offending vessels and the distance from the site of NVCC to the brainstem were recorded at the same time. Results 35 ears existed NVCC in VP group,including 28 ears of contact relation between nerve and vessel and 7ears of distortion between those. 16 ears existed NVCC in control group,it was all contact relation between nerve and vessel. The difference of two groups was significant（ χ2= 16. 191,P 0. 001）. In VP group the main offending vessel was anterior inferior cerebellar artery,accounted for 25 ears（ 71. 4%）,posterior inferior cerebellar artery accounted for 7 ears（ 20%） and vertebral artery for 3 ears（ 8. 6%）. In contral group anterior inferior cerebellar artery accounted for 9 ears（ 56. 3%）,posterior inferior cerebellar artery accounted for 6 ears（ 37. 5%） and vertebral artery for 1 ears（ 6. 3%）. There was no statistical significance of the difference between the two groups＇ offerring vessels（ χ2 = 1. 774,P 0. 05）. The distance from the site of NVCC to the brainstem in VP group was 8. 57 ± 5. 08 mm,in control was 8. 93 ± 4. 64 mm. There was no statistical significance of the difference between VP group and control group（ t =- 0. 237, P 0. 05）. The total of ears that the distance was less than 15mm was 29 ears（ 82. 9%） in VP group,in control group was 12 ears（ 75%）,the difference was not significant between VP group and control group（ P = 0. 705,P 0. 05）. Conclusions The incidence of NVCC in VP patients is higher; anterior inferior cerebellar artery was the most common offending vessels; NVCC tends to occur in the central myelin portion of vestibulocochlear nerve.