面肌抽搐与三叉神经痛的MRI诊断

MR diagnosis of hemifacial spasm and trigeminal neuralgia

目的 探讨面肌抽搐及三叉神经痛患者血管压迫病因的MR表现及其诊断价值。方法 回顾性分析了 12 0例面肌抽搐及三叉神经痛患者MR表现及手术结果。结果 (1) 6 3例面肌抽搐患者MR显示 12 6侧面听神经共发现 5 8侧存在神经血管压迫或接触 ,17侧可疑接触 ;5 7例三叉神经痛患者MR显示 114侧三叉神经共发现 4 5侧存在神经血管压迫或接触 ,12侧可疑接触。 (2 )统计学分析结果 :面肌抽搐患者症状侧和无症状侧差异有非常显著性意义 (χ2 =31 6 6 ,P <0 0 0 1) ;三叉神经痛患者症状侧和无症状侧差异有非常显著性意义 (χ2 =4 2 98,P <0 0 0 1)。 (3)根据手术结果 ,MR诊断面肌抽搐及三叉神经痛患者神经血管压迫或接触的敏感度为 94 % ,准确度为 83% ,阳性似然比为1 88。结论 MRI能清晰显示三叉神经脑池段与毗邻血管之间的关系 ,对面听神经及三叉神经血管压迫或接触的正确诊断具有较高的敏感度和准确度 ,为临床医师提供术前评估和指导治疗有极其重要的意义。

Objective To evaluate the MR findings and diagnostic value of neurovascular compression in patients with hemifacial spasm (HFS) and trigeminal neuralgia (TN). Methods MR manifestations and operative results of 120 patients with hemifacial spasm and trigeminal neuralgia were reviewed retrospectively. Results (1) 58 sides had vascular compression or contact at MR imaging in 126 sides of the facial nerves of 63 patients with hemifacial spasm, and 17 sides had uncertain vascular contact. 45 sides had vascular compression or contact at MR imaging in 114 sides of the trigeminal nerves of 57 patients with trigeminal neuralgia, and 12 sides had uncertain vascular contact. (2) Statistical results: The difference between the symptomatic sides and asymptomatic sides in HFS patients was statistically significant (χ 2=31.66, P <0.001). The difference between the symptomatic sides and asymptomatic sides in TN patients was statistically significant (χ 2=42.98, P <0.001). (3) The sensitivity, accuracy, and positive likelihood ratio of MR diagnosis of vascular compression or contact was 94%, 83%, and 1.88, respectively. Conclusion MR had higher specificity and sensitivity in diagnosing neurovascular compression or contact, and it played an important role in demonstrating the relationship between the cisternal portion of the seventh and fifth cranial nerve and surrounding vascular structures.