3.0T MR三维时间飞跃与三维稳态采集快速成像序列融合图像术前评估三叉神经、面神经与邻近血管关系

3.0T MR three-dimensional time-of-flight and fast imaging employing steady state acquisition sequences in pre-operative evaluation on spatial relationship among trigeminal nerve,facial nerve and peripheral vessels

目的探讨3.0T MR三维时间飞跃(3D-TOF)与三维稳态采集快速成像(3D-FIESTA)序列融合图像在三叉神经及面神经显微血管减压术(MVD)术前评估三叉神经、面神经与邻近血管关系的价值。方法回顾性分析经MVD治疗的36例三叉神经痛(TN)及31例面肌痉挛(HFS)患者的影像学资料。分析2名医师评判三叉神经、面神经与邻近血管关系的一致性,分别比较TN及HFS症状侧及无症状侧神经血管压迫(NVC)征象出现率的差异;以手术结果为金标准,计算3D-TOF与3D-FIESTA序列融合图像对症状侧神经与血管关系的诊断效能。结果2名医师评价症状侧及无症状侧三叉神经及面神经与血管关系的一致性均好(P均<0.001)。TN及HFS患者症状侧NVC征象出现率均明显高于无症状侧(χ~2=26.13、20.81,P均<0.001)。3D-TOF与3D-FIESTA序列融合图像诊断三叉神经与血管关系的准确率、敏感度、特异度、阳性预测值和阴性预测值分别为97.22%(35/36)、97.06%(33/34)、100%(2/2)、100%(33/33)和66.67%(2/3);诊断面神经与血管关系的准确率、敏感度、特异度、阳性预测值和阴性预测值分别为93.55%(29/31)、96.55%(28/29)、50.00%(1/2)、96.55%(28/29)和50.00%(1/2)。结论3D-TOF与3D-FIESTA序列融合图像能清晰显示神经与血管的空间关系,可为MVD提供可靠的影像学依据。

Objective To investigate the value of three-dimensional time-of-flight（3D-TOF）and three-dimensional fast imaging employing steady state acquisition（3D-FIESTA）sequences in evaluation on spatial relationship among trigeminal nerve,facial nerve and peripheral vessels before microvascular decompression（MVD）with 3.0T MR.Methods Data of MRI of 36 patients with trigeminal neuralgia（TN）and 31 with hemifacial spasm（HFS）before MVD were analyzed retrospectively.The intra-observer agreement for the spatial relationship among trigeminal nerve,facial nerve and adjacent blood vessels were observed.The differences of occurrence rates of neurovascular compression（NVC）of symptomatic side and asymptomatic side in TN and HFS patients were compared.Taking surgical results as the gold standards,the diagnostic efficacy for neurovascular relationships of symptomatic side with 3D-TOF and 3D-FIESTA sequences were calculated.Results The consistency between two observers in assessing relationship of trigeminal nerve,facial nerve and adjacent blood vessels of symptomatic and asymptomatic was good（all Kappa≥0.75,all P〈0.001）.In both of TN and HFS patients,the occurrence rates of NVC of symptomatic side were significantly higher than those of asymptomatic side（χ~2=26.13,20.81,both P〈0.001）.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of 3D-TOF and 3D-FIESTA sequences in displaying relationship of trigeminal nerve and vascular was97.22%（35/36）,97.06%（33/34）,100%（2/2）,100%（33/33）and 66.67%（2/3）,respectively,of relationship between facial nerve and vascular was 93.55%（29/31）,96.55%（28/29）,50.00%（1/2）,96.55%（28/29）and 50.00%（1/2）,respectively.Conclusion 3D-TOF and 3D-FIESTA sequences can clearly display the spatial relationship of nerve and adjacent vessels,therefore providing imaging evidences for MVD.