MRI融合技术提高三叉神经痛伽马刀治疗术前定位的准确性探讨

Exploring MRI fusion technology to improve the accuracy of preoperative positioning of gamma knife for trigeminal neuralgia

目的分析三维可变翻转角快速自旋回波序列(3D-sampling perfection with application-optimized contrasts by using different flip angle evolutions,3D-SPACE)联合三维时间飞跃法磁共振血管成像(3D-time of flight magnetic resonance angiography,3D-TOF-MRA)融合技术在行伽马刀治疗前对三叉神经显示、定位的精准性。方法选取西安大兴医院临床诊断为三叉神经痛拟行伽马刀治疗的患者28例,均行3D-SPACE及3D-TOF-MRA成像,观察三叉神经颅内段与邻近神经血管的关系,评估术前两种序列融合技术对三叉神经血管压迫的检出率及精准性。结果28例患者中,3D-SPACE联合3D-TOF-MRA序列融合技术检出有症状侧三叉神经血管压迫28例,其中右侧17例(2级2例,3级8例,4级7例),左侧11例(3级3例,4级8例),检出率为100%。结论3D-SPACE联合3D-TOF-MRA序列融合技术可以清晰显示三叉神经颅内段与周围神经血管的位置关系,为伽马刀治疗靶区勾画可提供精准的定位信息。

Objective Analysis of 3D-sampling perfection with application-optimized contrasts by using different flip angle evolutions(3D-SPACE)combined with three-dimensional time-of-flight magnetic resonance angiography(3D-TOF-MRA)fusion technology to display and locate the trigeminal nerve before gamma knife treatment.Methods A collection of 28 patients who were clinically diagnosed with trigeminal neuralgia and planned to be treated with gamma knife therapy on the head were collected in Xi'an Daxing Hospital.All of them underwent 3D-SPACE and 3D-TOF-MRA imaging.The relationship between the intracranial segment of the trigeminal nerve and the adjacent nerve and blood vessels were observed.The detection rate and accuracy of the two sequences for trigeminal nerve vascular compression were evaluated.Result Among 28 patients,28 cases of symptomatic side trigeminal nerve vascular compression were detected by the combination of 3D-SPACE and 3D-TOF-MRA sequences,of which 17 cases were on the right side(2 cases in grade 2,8 cases in grade 3,and 7 cases in grade 4),and 11 cases on the left side(3 cases in grade 3,8 cases in grade 4).The detection rate of the sequence was about 100%.Conclusion The fusion technology of 3D-SPACE sequence and 3D-TOF-MRA sequences can clearly display the positional relationship between the intracranial segment of the trigeminal nerve and peripheral nerves,blood vessels,and can provide accurate positioning information for the delineation of the target area of gamma knife treatment.