磁共振成像在面肌痉挛中的应用价值

Application value of magnetic resonance imaging in hemifacial spasm

目的探讨面肌痉挛的磁共振成像(MRI)评价指标,为诊断面神经脑池段受其周围血管压迫导致的原发性面肌痉挛提供形态学依据。方法选择采用MRI 3D-FIESTA序列扫描的单侧面肌痉挛患者70例(面肌痉挛组)和非面肌痉挛患者140例(对照组)为研究对象,在多平面重组重建影像上观测面神经脑池段与其周围血管相交处的血管直径、神经血管相交处与脑干的距离和面神经周围血管的自身角度及其与面肌痉挛之间的关系。结果面肌痉挛组患者健侧面神经脑池段与其周围血管相交处的血管直径、神经血管相交处与脑干的距离及面神经周围血管的自身角度与对照组比较差异均无统计学意义(P>0.05)。面肌痉挛组患者患侧面神经脑池段与其周围血管相交处的血管直径与面肌痉挛组患者健侧及对照组比较显著增大(P<0.05),神经血管相交处与脑干的距离及面神经周围血管的自身角度与面肌痉挛组患者健侧及对照组比较显著减小(P<0.05)。面神经脑池段与其周围血管相交处的血管直径与面肌痉挛的发生呈正相关(r=0.45,P<0.05)。神经血管相交处与脑干的距离与面肌痉挛的发生呈负相关(r=-0.53,P<0.05)。面神经周围血管的自身角度与面肌痉挛的发生呈负相关(r=-0.79,P<0.05)。结论面神经脑池段与其周围血管相交处评价指标的变化对诊断面肌痉挛有重要的参考价值,血管的自身角度越小、直径越粗、神经血管相交处距离脑干越近,越易出现面肌痉挛病变。

Objective To investigate the evaluating index of magnetic resonance imaging（ MRI） in facial spasm,and to provide morphological basis for the diagnosis of primary facial spasm induced by the compression of the surrounding blood vessels at the cisternal segment of facial nerve. Methods A total of 70 patients with hemifacial spasm（ facial spasm group）and 140 subjects without hemifacial spasm（ control group） were examined by MRI 3 D-FIESTA sequence scanning. The relationship between the vascular diameter at the intersection of peripheral vessel and the cisternal segment of facial nerve,the distance between the intersection and the brain stem,the self angle of the peripheral vessels and facial spasm was observed by multiplanar reconstruction image. Results There was no significant difference in the vascular diameter at the intersection of peripheral vessel and the cisternal segment of facial nerve,the distance between the intersection and the brain stem and the self angle of the peripheral vessels in the healthy side of facial nerve between the facial spasm group and control group（ P 〉 0. 05）.The vascular diameter at the intersection of peripheral vessel and the cisternal segment of facial nerve in the facial spasm side of patients in the facial spasm group was significantly more than that in the control group（ P 〈 0. 05）. The distance between the intersection and the brain stem,the self angle of the peripheral vessels and facial spasm in the facial spasm side were significantly less than those in the healthy side and control group（ P 〈 0. 05）. The vascular diameter at the intersection of peripheral vessel and the cisternal segment of facial nerve was positively correlated with the occurrence of facial spasm（ r = 0. 45,P 〈0. 05）. The distance between the intersection and the brain stem was negatively correlated with the occurrence of facial spasm（ r =-0. 53,P 〈 0. 05）. The self angle of the peripheral vessel was negatively correlated with the occurrence of facial spasm（ r =-0. 79,P 〈 0. 05）. Conclusion The changes in evaluation indexes of the intersection of peripheral vessel and the cisternal segment of facial nerve have important reference value for the diagnosis of hemifacial spasm. With the decreasing of self angle of the peripheral vessel and the distance between the intersection and the brain stem,and the increasing of vascular diameter,the probability of facial spasm is more.