三维时间飞跃法磁共振血管成像和三维稳态进动快速成像序列在原发性舌咽神经痛显微血管减压术的应用价值

Application value of magnetic resonance 3D-TOF-MRA and 3D-FIESTA sequences in microvascular decompression for primary glossopharyngeal neuralgia

目的探讨磁共振(magnetic resonance imaging,MRI)3D-TOF-MRA和3D-FIESTA高分辨序列成像在原发性舌咽神经痛(primary glossopharyngeal neuralgia,pGN)显微血管减压术(microvascular decompression,MVD)术前评估的价值。方法回顾性分析MVD治疗25例pGN患者资料。术前均行3.0T MRI 3D-TOF-MRA和3D-FIESTA序列扫描,观察舌咽神经和相邻血管关系,可分为:无接触、接触、压迫,其中接触或压迫神经的血管被认为是责任血管。均采用MVD治疗,以术中观察到的责任血管作为“金标准”。结果25例患者MVD术中均可见症状侧神经血管接触或压迫,MRI成像分析结果与术中观察结果相一致23例,不一致2例(1例责任血管术前MRI认定为椎动脉,术中发现为椎动脉核小脑后下动脉;另1例术前MRI未发现责任血管,术中发现责任血管为小脑后下动脉分支血管)。MRI 3D-TOF-MRA和3D-FIESTA序列成像检查显示症状侧血管压迫准确率为92%(23/25),与术中观察具有良好的一致性(κ=0.855,P<0.05)。结论MRI 3D-TOF-MRA和3D-FIESTA序列成像可清晰显示pGN患者舌咽神经和邻近血管关系,有助于判断责任血管,可作为MVD术前评估重要的辅助检查。

Objective To investigate the utility of combining magnetic resonance imaging(MRI)with 3D-TOF-MRA and 3DFIESTA high-resolution sequences in preoperative assessment for microvascular decompression(MVD)in patients with primary glossopharyngeal neuralgia(pGN).Methods The clinical data of 25 patients with pGN were analyzed retrospectively.Preoperative evaluation included 3.0T MRI 3D-TOF-MRA and 3D-FIESTA sequence scans to assess the relationship between the glossopharyngeal nerve and adjacent vessels,which were categorized as no contact,contact,or compression.Vessels that contacted or compressed the nerve were considered responsible vessels.All the patients were treated with MVD,and the responsible vessels observed during surgery were used as the"gold standard".Results Nerve-vessel contact or compression was observed in all 25 patients during the MVD procedure.MRI imaging analysis results were consistent with intraoperative observations in 23 cases and inconsistent in 2 cases(in one case,the responsible vessel was identified as the vertebral artery preoperatively by MRI,but it was found to be the vertebral artery and posterior inferior cerebellar artery during the operation;in another case,no responsible vessel was detected preoperatively by MRI,but it was found to be a branch of the posterior inferior cerebellar artery during the operation).The combined 3D-TOF-MRA and 3D-FIESTA sequence examinations demonstrated an accuracy rate of 92%(23/25)in identifying offending vessels on the symptomatic side,with good consistency with intraoperative observations(κ=0.855,P<0.05).Conclusions The combination of 3D-TOF-MRA and 3D-FIESTA sequences can clearly demonstrate the relationship between the glossopharyngeal nerve and adjacent vessels in pGN patients.This capability aids in identifying responsible vessels,guiding the MVD procedure,and positions it as a crucial adjunctive assessment for preoperative MVD evaluation.