3D-TOF-MRA联合MRI检测对原发性三叉神经痛的诊断价值

Diagnostic value of 3D-TOF-MRA combined with MRI detection for primary trigeminal neuralgia

目的探究三维时间飞跃法磁共振血管成像(3D-TOF-MRA)联合磁共振成像(MRI)检测对原发性三叉神经痛(PTN)的诊断价值。方法回顾性收集2022年3月至2024年1月于河南省中医院就诊的78例PTN患者临床资料。男36例,女42例;年龄27~76(50.84±10.47)岁;左侧病变31例,右侧病变47例。分析PTN患者3D-TOF-MRA影像学特征,并比较其患侧、健侧MRI参数;比较不同检测方法的诊断结果,并进一步分析诊断效能。采用配对t检验和χ^(2)检验。结果患侧三叉神经根(TR)面积、神经脑桥夹角[(23.86±3.86)mm^(2)、(39.62±6.75)°]均小于健侧[(28.11±3.19)mm^(2)、(44.13±7.31)°](均P<0.05);患侧TR长度及跨岩尖转角与健侧比较,差异均无统计学意义(均P>0.05)。3D-TOF-MRA联合MRI检测的灵敏度为96.15%(75/78),高于3D-TOF-MRA的82.05%(64/78)和MRI的78.21%(61/78),3D-TOF-MRA联合MRI检测的漏诊率为3.85%(3/78),低于3D-TOF-MRA的17.95%(14/78)和MRI的21.79%(17/78)(P<0.05)。3D-TOF-MRA、MRI及3D-TOF-MRA联合MRI检测诊断不同分级PTN的Kappa值均>0.6,但3D-TOF-MRA联合MRI检测的Kappa值最高,为0.826(均P<0.05)。结论3D-TOF-MRA联合MRI检测可显著提高PTN的诊断灵敏度,降低漏诊率,且具有较高的一致性,有利于临床选择治疗方案、改善患者生活质量。

Objective To explore the diagnostic value of three dimensional time of flight magnetic resonance angiography(3D-TOF-MRA)combined with magnetic resonance imaging(MRI)for primary trigeminal neuralgia(PTN).Methods A total of 78 PTN patients who visited Henan Provincial Hospital of Traditional Chinese Medicine from March 2022 to January 2024 were collected.There were 36 males and 42 females,the age was 27-76(50.84±10.47)years old,and there were 31 left side lesions and 47 right side lesions.The 3D-TOF-MRA imaging features were analyzed,and MRI parameters of the affected and healthy sides of the PTN patients were compared.The diagnostic results of different examination methods were statistically compared,and the diagnostic efficacy was further analyzed.Paired t test andχ^(2) test were used.Results The trigeminal root(TR)area and nerve pontine angle[(23.86±3.86)mm^(2) and(39.62±6.75)°]on the affected side were smaller than those on the healthy side[(28.11±3.19)mm^(2) and(44.13±7.31)°](both P<0.05).There were no statistically significant differences in the TR length or the angle across the apex of the rock between the affected side and the healthy side(both P>0.05).The diagnostic sensitivity of 3D-TOF-MRA combined with MRI was 96.15%(75/78),which was higher than those of 3D-TOF-MRA[82.05%(64/78)]and MRI[78.21%(61/78)],and the missed diagnosis rate of 3D-TOF-MRA combined with MRI was 3.85%(3/78),which was lower than those of 3D-TOF-MRA[17.95%(14/78)]and MRI[21.79%(17/78)](P<0.05).The Kappa values of 3D-TOF-MRA,MRI,and 3D-TOF-MRA combined with MRI in the diagnosis of PTN of different grades were all>0.6,but the Kappa value of 3D-TOF-MRA combined with MRI was the highest,which was 0.826(all P<0.05).Conclusion The combined diagnosis of 3D-TOF-MRA and MRI can significantly improve the diagnostic sensitivity of PTN,reduce the missed diagnosis rate,and has high consistency,which is beneficial for clinical selection of treatment plans and improvement of quality of life.