3D-slicer基于3D-FIESTA及3D-TOF序列在面肌痉挛和原发性三叉神经痛责任血管的诊断及术前评估中的应用

Application value of 3D-slicer based on 3D-FIESTA and 3D-TOF sequences in the diagnosis of offending vessels and preoperative evaluation in hemifacial spasm and primary trigeminal neuralgia

目的探讨3D-slicer软件在基于3.0T磁共振3D-FIESTA及3D-TOF序列的影像重建对面肌痉挛和原发性三叉神经痛患者责任血管的诊断及在微血管减压手术术前评估中的应用价值。方法回顾分析2020-06—2023-06于蚌埠医学院第二附属医院神经外科行微血管减压手术患者30例且手术中证实均存在动脉压迫;术前患者行3D-FIESTA及3D-TOF磁共振检查后预判责任血管,再次利用3D-slicer影像处理软件在3D-FIESTA及3D-TOF序列基础上三维重建合成责任血管及走形,比较其诊断的差异及优势。结果其中面肌痉挛24例,三叉神经痛6例,术中证实24例动脉压迫性面肌痉挛责任血管18例为同侧小脑前下动脉压迫,6例为同侧小脑后下动脉或其分支血管压迫;6例动脉压迫性三叉神经痛患者术中证实责任血管均为同侧小脑上动脉;3D-FIESTA联合3D-TOF对责任血管的诊断率73.3%(22/30),3D-slicer基于3D-FIESTA-C及3D-TOF-MRA序列经三维重建后对责任血管的诊断率96.67%(29/30),差异有统计学意义(χ^(2)=6.405,P<0.05)。结论3D-slicer基于磁共振3D-FIESTA及3D-TOF序列的影像重建可提高面肌痉挛和三叉神经痛患者责任血管的诊断率,可以清晰地重建责任血管形态及走形并为微血管减压手术提供指导价值。

Objective To explore the application value of 3D-slicer software in imaging reconstruction based on 3.0T magnetic resonance 3D-FIESTA and 3D-TOF sequences in the diagnosis of offending vessels in patients with hemifacial spasm and primary trigeminal neuralgia,and preoperative evaluation of microvascular decompression.Methods From Jun 2020 to Jun 2023,30 patients who underwent microvascular decompression in Neurosurgery Department of the Second Affiliated Hospital of Bengbu Medical College were analyzed retrospectively,and all of them were confirmed to have arterial compression during the operation.Before operation,the patient underwent 3D-FIESTA and 3D-TOF magnetic resonance examination and predicted the offending vessels.Then,3D-slicer image processing software was used to reconstruct and synthesize the offending vessels and their shapes on the basis of 3D-FIESTA and 3D-TOF sequences,and the differences and advantages of their diagnosis were compared.Results There were 24 patients with hemifacial spasm and 6 patients with trigeminal neuralgia.During the operation,it was confirmed that 18 cases were caused by ipsilateral anterior inferior cerebellar artery compression,and 6 cases were caused by ipsilateral posterior inferior cerebellar artery or its branches.Six patients with arterial compression trigeminal neuralgia confirmed that the offending vessels were ipsilateral superior cerebellar artery.The diagnostic rate of 3D-FIESTA combined with 3D-TOF was 73.3%(22/30),and the diagnostic rate of 3D-slicer based on 3D-FIESTA-C and 3D-TOF-MRA sequences was 96.67%(29/30),and the difference between them was statistically significant(χ^(2)=6.405,P<0.05).Conclusion 3D-slicer reconstruction based on 3D-FIESTA and 3D-TOF sequences can improve the diagnostic rate of offending vessels in patients with hemifacial spasm and trigeminal neuralgia,and can clearly reconstruct the shape and shape characteristics of offending vessels and provide guidance for microvascular decompression.