3D Slicer三维重建影像在微血管减压术治疗原发性三叉神经痛中的应用

Application of three-dimensional reconstruction of MRI images using 3D Slicer software in microvascular decompression for patients with primary trigeminal neuralgia

目的探讨基于磁共振3D-TOF-MRA及3D-FIESTA序列的3D Slicer三维重建影像在微血管减压术(MVD)治疗原发性三叉神经痛(PTN)中的应用价值。方法回顾性分析2019年1月至2020年10月MVD治疗的58例PTN的临床资料。术前均行3.0 T颅脑磁共振3D-TOF-MRA及3D-FIESTA扫描,利用3D Slicer软件进行三维影像重建,以评估神经与血管的关系,并制定手术方案。以术中所见为判断神经与血管关系的金标准。结果3D-TOF-MRA和3D-FIESTA判断责任血管的准确率分别为77.59%(45/58),81.03%(47/58),与术中发现的一致性Kappa值分别为0.753、0.762。三维重建影像判断责任血管的准确率为93.10%(54/58),与术中发现的一致性Kappa值为0.882。三维重建影像判断责任血管的准确率明显优于3D-TOF-MRA和3DFIESTA(P<0.05)。ROC曲线分析显示,术前三维重建影像评估神经受压程度的曲线下面积为0.94(P<0.05)。术后47例疼痛缓解,总有效率为81%(47/58);11例症状未见明显改善,但无加重。出院后随访3~6个月,11例无改善病人中,2例出院1个月有改善,9例无改善、无加重;其余47例无复发。结论基于3D-TOF-MRA及3D-FIESTA的3D Slicer三维重建影像,可以在术前很好地判断神经与血管的关系及神经受压程度,和术中观察具有很好的一致性,对MVD治疗PTN的术前规划具有重要价值。

Objective To explore the application value of three-dimensional reconstruction of MRI images using 3D Slicer software in microvascular decompression(MVD)for the patients with primary trigeminal neuralgia(PTN).Methods The clinical data of58 patients with PTN who underwent MVD from January 2019 to October 2020 were retrospectively analyzed.Before the operation,3.0 T magnetic resonance 3D-TOF-MRA and 3D-FIESTA scans were performed on all the patients,and 3D slicer software was used for three-dimensional reconstruction to evaluate the relationship between the trifacial nerves and their offending vessels and to formulate the surgical plans.Intraoperative findings were served as the gold standard for judging the relationship between the trifacial nerves and their offending vessels.Results The accuracy rates of 3D-TOF-MRA and 3D-FIESTA in judging the offending vessels were 77.59%(45/58)and 81.03%(47/58),respectively.The Kappa values of 3D-TOF-MRA and 3D-FIESTA consistent with those found during the operation were 0.753 and 0.762,respectively.The accuracy of the three-dimensional reconstructed images to determine the offending vessels was 93.10%(54/58),and the Kappa value was 0.882.The accuracy rate of the three-dimensional reconstruction image to judge the offending vessel was significantly higher than those of 3D-TOF-MRA and 3D-FIESTA(P<0.05).ROC curve analysis showed that the area under the curve for preoperative three-dimensional reconstruction images to assess the degree of nerve compression was 0.94(P<0.05).After the operation,pain relief was achieved in 47 patients(81%,47/58)and no significant improvement in 11.Follow-up(3~6 months)showed that 2 of 11 patients with no improvement had improvement within 1 month after the discharge,9 of 11 patients had no improvement or aggravation;the other 47 patients had no recurrence.Conclusions Three-dimensional reconstruction of MRI images using 3D Slicer software can fully differentiate the relationship between the trifacial nerves and their offending vessels,which is of great value in the preoperative planning of MVD for PTN patients.