双激发平衡式稳态自由进动序列曲面重建在血管压迫性三叉神经痛及面肌痉挛的应用价值

Application value of doubly excited Balance-SSFP sequence curvature plane reconstruction in vascular compressive trigeminal neuralgia and hemifacial spasm

目的评价双激发平衡式稳态自由进动(3D-FIESTA-C)序列曲面重建(curvature plane reconstruction,CPR)在血管压迫性三叉神经痛(trigeminal neuralgia,TN)及面肌痉挛(hemifacial spasm,HFS)的应用价值。材料与方法对临床诊断的48例TN及33例HFS患者进行3D-FIESTA-C扫描,经后处理工作站进行CPR,分析判断症状侧血管神经关系,81例患者中65例与手术结果对照,并对结果的一致性采用Kappa分析。结果 81例经CPR判断血管神经无接触8例,接触25例,压迫48例,在接触及压迫病例中患侧脑池间距较对侧窄小者33例,脑干变形12例,2名医师对65例3D-FIESTA-C以及联合曲面重建结果与微血管减压术(microvascular decopression,MVD)术后的Kappa一致性检验结果(K值分别为0.790、0.622、0.755),3D-FIESTA-C及联合CPR检测责任血管的灵敏度分别为83.08%、96.92%,特异度分别为93.00%、75%,阳性预测值分别为98.10%、94.02%,阴性预测值分别为57.69%、85.71%。结论 3D-FIESTA-C CPR能够对血管神经解剖关系提供更为全面准确的观察视角,可为术前评估及病因诊断提供重要依据。

Objective： To evaluate the application value of doubly excited BalanceSSFP sequence Curvature Plane Reconstruction（CPR） in vascular compressive Trigeminal Neuralgia（TN） and Hemifacial Spasm（HFS）. Materials and Methods： Forty-eight cases with Trigeminal Neuralgia（TN） and thirty-three cases with Hemifacial Spasm（HFS） were accepted 3D-FIESTA-C scanning. The origin images were post-processed with Curvature Plane Reconstruction（CPR） on workstation. Relationship between vessels and nerves was analyzed in symptomatic side. Sixtyfive out of 81 cases were compared with surgery result, and 2 magnetic resonance physicians evaluated consistency test of result through Kappa analysis. Results： Eighty-one cases through Curvature Plane Reconstruction（CPR） show that contactless of vessels and nerves were found in 8 patients, contact of vessels and nerves were found in 25 patients and oppression were found in 48 patients. In the cases of contact and oppression, 33 cases indicated that the spacing of side cistern was narrow compared with contralateral ones, and 12 cases of brain stem showed deformation. The Kappa consistency test result between CPR result and post-operation of MVD result for 65 cases done by 2 physicians was that（K values were 0.837 and 0.787 respectively）, 3D-FIESTA-C combined with CPR showed source of responsible vessels, oppression position and level of nerve oppression. The sensitivity was 96.92%, specificity was 75%, PPV was 94.02% and NPV was 85.71%. Conclusion： Doubly excited BalanceSSFP sequence CPR can provide a more comprehensive and accurate viewing angle for vessels and nerves anatomy relations, and offer important evidence for pre-surgery evaluation and etiological diagnosis.