椎基底动脉延长扩张症引发颅底神经改变的MRI诊断

The MRI Diagnosis of Skull Base nerves Changes Caused by Vertebrobasilar Dolichoectasia

目的探讨MRI在椎基底动脉延长扩张症(VBD)引发颅底神经改变中的应用价值。方法搜集本院2012年3月至2015年1月期间经临床证实的VBD患者28例,男20例,女8例。所有患者均行脑MRA、MRI及3D-Fiesta-c序列扫描,VBD的纳入及分级标准分别参照Ubogu等提出的VBD的MRA半定量标准及Smoker的VBD的MRI分级标准。结果本组28例VBD中,1例脑干神经未见明显异常,余27例均伴有单侧一支或多支神经异常。其中22例单侧面神经受压,占81.48%;25例单侧发生移位,占92.59%;2例未见明显异常,占7.41%。15例单侧三叉神经受压,发生率占55.56%;24例单侧发生移位,占88.89%;3例未见明显异常,占11.11%。9例单侧舌咽神经受压,占33.33%;15例单侧发生移位,占55.57%;9例未见明显异常,占33.33%;3例一侧或双侧神经显示不清,占11.11%。8例单侧前庭蜗神经受压,发生率26.63%;25例单侧发生移位,占92.59%;2例未见明显异常,占7.41%。4例单侧外展神经受压,发生率14.81%;4例单侧发生移位,占14.81%;10例未见明显异常,占37.03%;12例一侧或双侧神经显示不清,占44.44%。结论 VBD对颅底神经的影响较大,脑MRI、MRA、3D-Fiesta-c序列相结合为VBD的诊断、颅底神经与延长扩张的椎基底动脉之间关系的显示提供有价值的影像学资料。

Objective To investigate the application value of MRI in the neurological changes on skull base caused by vertebrobasilar dolichoectasia （VBD）. Methods collection of 28 cases of VBD, which were proved clinically, in our hospital between March 2012 and January 2015, 20 males and 8 females. All patients underwent brain MRA, MRI scans and 3D-Fiesta-c sequence. Semi-quantitative criteria of VBD in MRA proposed by Ubogu＇s and criteria of VBD in MRI by Smoker were used in grading and classification standards of VBD. Results One case showed no abnormal brainstem in the group of 28 cases of VBD. 27 cases had unilateral one or multiple neurological abnormalities, including 22 cases of unilat- eral facial nerve compression, accounting for 81.48% ; 25 cases of unilateral displacement occurred, accounting for 92.59% ; 2 cases of no obvious abnormalities, accounting for 7.40%. 15 cases of unilateral trigeminal nerve compression, accounting for 55.56% incidence ;24 cases of unilateral displacement, accounting for 88.89% ; 3 cases of no obvious ab- normalities, accounting for 11.11%. 9 cases of unilateral glossopharyngeal nerve compression, accounting for 33.33 % ; 15 cases of unilateral displacement, accounting for 55. 56% ; 9 cases showed no obvious abnormalities, accounting for 33.33 % ; three cases of unilateral or bilateral nerve unseen, accounting for 11.11%. 8 cases of unilateral Vestibulocochlear nerve compression, accounting for 26.63% ;25 cases of unilateral displacement, accounting for 92.59% ;2 cases of no obvious abnormalities, accounting for 7.4% o 4 cases of unilateral exceptional exhibition nerve compression, accounting for 14.81% ; 4 cases of unilateral displacement, accounting for 14.81% ; 10 cases of no obvious abnormalities, accounting for 37.03% ; 12 cases of unilateral or bilateral nerve unseen, accounting for 44.44%. Conclusion VBD impact on nerves of skull base is higher, brain MRI, MRA, 3D-Fiesta-e sequence combination for VBD diagnosis, to shown the relationship between nerves of skull base and vertebrobasilar dolichoectasia to provide a certain image value.