三维双激发平衡式稳态自由进动序列和三维时间飞跃MRA序列在原发性三叉神经痛中的诊断价值

Diagnostic value of three-dimensional fast imaging employing steady-state acquisition with phase cycling and three-dimensional time-of-flight MRA in patients with primary trigeminal neuralgia

目的探讨三维双激发平衡式稳态自由进动序列(3D-FIESTA-c)和三维时间飞跃MRA序列(3D-TOF-MRA)评估原发性三叉神经痛患者神经血管关系的准确性和诊断价值。方法对130例原发性三叉神经痛患者行3D-FIESTA-c和3D-TOF-MRA扫描,对获取的影像资料进行分析,判断患者患侧三叉神经与周围血管关系,以微血管减压术(MVD)为金标准,对比分析3D-FIESTA-c、3D-TOF-MRA以及3D-FIESTA-c联合3D-TOF-MRA显示责任血管的情况。结果 130例三叉神经痛患者中均行MVD术,证实128例存在责任血管(98.5%), 2例未见明确责任血管(1.5%)。与MVD手术结果对照,3D-TOF-MRA、3D-FIESTA-c和3D-FIESTA-c联合3D-TOF-MRA显示责任血管阳性率分别为86.9%(113/130)、87.7%(114/130)、95.4%(124/130),准确率分别为80.8%(105/130)、84.6%(110/130)、93.8%(122/130),3D-FIESTA-c联合3D-TOF-MRA评估责任血管阳性率和准确率均高于3D-TOF-MRA或3D-FIESTA-c单独评估(均P<0.05);3D-FIESTA-c联合3D-TOF-MRA评估责任血管阳性率与MVD术结果的差异无统计学意义(P>0.05)。3D-FIESTA-c评估责任静脉伴或不伴有其他血管阳性率(7.7%,10/130)高于3D-TOF-MRA(0%)(P<0.01)。结论 3D-FIESTA-c联合3D-TOF-MRA在诊断神经血管关系中起到互补作用,能够明确责任血管的存在以及血管类型,尤其评估静脉时,3D-FIESTA-c优于3D-TOF-MRA,对制定MVD手术方案具有指导意义。

Objective To investigate and evaluate the accuracy and the diagnostic value of three-dimensional fast imaging employing steady-state acquisition with phase cycling(3 D-FIESTA-c) and three-dimensional time-of-flight MRA(3 D-TOF-MRA) in patients with primary trigeminal neuralgia(PTN). Methods One hundred and thirty patients with PTN were scanned with 3 D-FIESTA-c and 3 D-TOF-MRA. The acquired imaging data were analyzed to judge the relationship between the trigeminal nerve and adjacent vessels in symptomatic side. The images seen in microvascular decompression(MVD) were golden standards for comparative analysis of different results between 3 D-FIESTA-c, 3 D-TOF-MRA and 3 D-FIESTA-c combined with 3 D-TOF-MRA. Results MVD surgeries were performed in all 130 patients, and it was confirmed that 128 cases found responsible vessels(98.5%), and no responsible vessels in 2 cases(1.5%). Compared with MVD results, the positive rates of 3 D-TOF-MRA, 3 D-FIESTA-c, and 3 D-FIESTA-c combined with 3 D-TOF-MRA for the diagnosis of the responsible vessels were 86.9%(113/130), 87.7%(114/130), 95.4%(124/130), the accuracy rates were 80.8%(105/130), 84.6%(110/130), 93.8%(122/130), respectively. The positive and accuracy rates for 3 D-FIESTA-c combined with 3 D-TOF-MRA assessment were higher then those for the 3 D-FIESTA-c or 3 D-TOF-MRA assessment(all P<0.05). The difference of positive rate by 3 D-FIESTA-c combined with 3 D-TOF-MRA and MVD was not statistically significant(P>0.05). The positive rate of 3 D-FIESTA-c for the assessment of responsible veins with or without other blood vessels(7.7%, 10/130) was higher than the 3 D-TOF-MRA sequence(0%)(P<0.01). Conclusions 3 D-FIESTA-c combined with 3 D-TOF-MRA plays a complementary role in diagnosing neurovascular relationships,and can accurately determine the existence of responsible vessels and vessel types. 3 D-FIESTA-c is superior to 3 D-TOFMRA for veins. It has guiding significance for the formulation of MVD surgery plan.