3.0 T时间飞跃法磁共振血管成像用于三叉神经微血管减压术的意义与价值分析

Significance and value analysis of 3.0 T time-leaps magnetic resonance angiography for trigeminal microvascular decompression

目的分析3.0 T时间飞跃法磁共振血管成像(3D-TOF-MRA)指导三叉神经痛(TN)患者行微血管减压术(MVD)的临床指导价值。方法回顾性分析2019年1—12月在浙江省金华市人民医院就诊行MVD治疗的60例TN患者的临床及影像学资料,患者均在术前行3D-TOF-MRA检查,观察三叉神经与周围血管之间的关系和走向,判定术前压迫神经的责任血管,并明确是否存在血管神经压迫(NVC)。结果60例TN患者中,术后52例(86.67%)患者疼痛症状完全消失,8例(13.33%)疼痛症状明显缓解;3D-TOF-MRA检查与MVD在责任血管的判定结果上比较差异无统计学意义(P>0.05);MVD诊断TN的阳性率为98.33%(59/60),3D-TOF-MRA检查诊断TN的阳性率为91.67%(55/60),二者比较差异无统计学意义(P>0.05),并经Kappa检验具有高度一致性(Kappa值=0.867);受试者工作特征曲线分析结果表明3D-TOF-MRA诊断TN的曲线下面积为0.730(95%CI 0.526~0.934);3D-TOF-MRA检查诊断NVC发生率为63.33%(38/60),MVD手术所见NVC发生率为61.67%(37/60),两者比较差异无统计学意义(P>0.05)。结论3D-TOF-MRA检查可较为准确地获知TN患者责任血管位置、走向、形态及压迫程度等方面的信息,对TN的临床诊断及MVD术前评估具有重要的指导价值。

Objective To analyze the clinical guidance value of 3.0 T three-dimensional time of fly magnetic resonance angiography(3D-TOF-MRA)in patients with trigeminal neuralgia(TN)who underwent microvascular decompression(MVD)treatment.Methods The clinical and imaging data of 60 TN patients who underwent MVD treatment in Jinhua People′s Hospital from January 2019 to December 2019 were retrospectively analyzed.All patients underwent 3D-TOF-MRA examination before the surgery.The relationship and direction of the trigeminal neuralgia and surrounding blood vessels were observed,the responsible blood vessels that compressed the nerves before the surgery were determined,and vascular nerve compression(NVC)was clarified.Results Among the 60 TN patients,pain symptoms of 52 patients(86.67%)completely disappeared after the surgery,and the pain symptoms of the remaining 8 patients(13.33%)were also significantly relieved.There was no statistically significant difference between 3D-TOF-MRA examination and MVD surgery in the judgment of the responsible vessel(P>0.05).The positive rate of TN diagnosed by MVD surgery was 98.33%(59/60),and the positive rate of TN diagnosed by 3D-TOF-MRA was 91.67%(55/60),with no statistically significant difference(P>0.05),and with highly consistency by Kappa test(Kappa value=0.867).The area under the curve(AUC)of TN diagnosed by 3D-TOF-MRA through receiver operating characteristic(ROC)curve analysis was 0.730(95%CI 0.526~0.934).The incidence of NVC diagnosed by 3D-TOF-MRA was 63.33%(38/60),and the incidence of NVC seen by MVD surgery was 61.67%(37/60).There was no statistically significant difference in the diagnosis of NVC between 3D-TOF-MRA and MVD surgery.(P>0.05).Conclusions The 3D-TOF-MRA examination can more accurately know the position,orientation,shape and compression degree of the responsible blood vessel in TN patients,which has important guiding value for the clinical diagnosis of TN and preoperative evaluation of MVD.