3D-TOF MRA联合3D-FIESTA序列对原发性面肌痉挛微血管减压术术前评估的价值

Value of 3D-TOF MRA combined with 3D-FIESTA sequence in preoperative assessment of microvascular decompression to primary hemifacial spasm

目的:探讨3D-TOF MRA联合三维双激发平衡式稳态自由进动(3D-FIESTA)序列对原发性面肌痉挛(HFS)微血管减压术(MVD)术前评估的价值。方法:回顾性分析49例行面神经MVD的面肌痉挛患者的临床资料,术前3D-TOF MRA联合3D-FIESTA序列图像重建分析面神经与邻近血管关系,比较患侧与健侧的差异,并与MVD结果对比。结果:49例中,41例(83.67%)患侧术前3D-TOF MRA及3D-FIESTA序列重建图像显示神经血管关系密切,明显高于健侧[2例(4.08%)],差异有统计学意义(χ2=59.84,P=0.000)。MVD术中发现43例神经血管关系密切,其中小脑前下动脉20例(46.51%),小脑后下动脉13例(30.23%),椎基底动脉8例(18.60%),小动脉及静脉2例(4.65%)。以面神经MVD术中所见为金标准,3D-TOF MRA序列联合3D-FIESTA序列诊断HFS的敏感度为90.70%,特异度为66.67%,阳性预测值为95.12%,阴性预测值为50.00%。结论:3D-TOF MRA联合3D-FIESTA序列图像重建能清晰地显示面神经与血管之间的关系,对原发性HFS术前诊断及手术方案的制订有重要意义。

Objective:To explore the value of 3D-TOF MRA and 3D fast imaging employing steadystate acquisition(3D-FIESTA)sequence in preoperative assessment of microvascular decompression(MVD)to primary hemifacial spasm(HFS).Methods:The clinical data of 49 HFS patients who underwent MVD were retrospectively analyzed.Before MVD,3D-TOF MRA and 3D-FIESTA sequence image reconstruction were used to analyze the relationship between the facial nerve and adjacent vessels.The differences between the affected side and the healthy side were compared and then compared with the MVD results.Results:The reconstruction images of preoperative 3D-TOF MRA and 3D-FIESTA sequences showed that 41(83.67%)patients had close neurovascular relationships in the affected side,which was more than 2(4.08%)patients in the healthy side,and the difference was statistically significant(χ2=59.84,P=0.000).MVD found that 43 patients had the close neurovascular relationships,20(46.51%)cases occurred with anterior inferior cerebellar artery,13(30.23%)cases with posterior inferior cerebellar artery,8(18.60%)cases with vertebrobasilar artery,and 2(4.65%)cases with small artery and vein.With MVD results as the golden standard,the sensitivity,specificity,positive predictive value and negative predictive value of the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence were 90.70%,66.67%,95.12%and 50.00%,respectively.Conclusions:3D-TOF MRA combined with 3D-FIESTA sequence image reconstruction can clearly show the relationship between the facial nerve and blood vessels,which is of great significance for preoperative diagnosis and surgical planning.