核磁共振成像诊断三叉神经痛的价值分析与研究

doi:10.16150/j.1671-2870.2018.05.015

摘要/Abstract

摘要： 目的：研究探讨MRI检查在三叉神经痛诊断中的价值。方法：100例拟行微血管减压术的原发性三叉神经痛患者,于术前行MRI检查,分别采集三维快速稳态自由梯度（three dimensional- fast imaging employing steady state acquisition,3D-FIESTA）、三维时间飞跃（three dimensional-time of flight,3D-TOF）序列图像,判断神经血管接触压迫情况。以手术诊断结果为参照,计算和比较3D-FIESTA、3D-TOF术前诊断三叉神经痛患者神经血管接触压迫的灵敏度、特异度、准确率,分析2种序列成像诊断结果与手术诊断结果之间的一致性,并计算和比较3D-FIESTA、3D-TOF对不同责任血管的显示率。结果：100例三叉神经痛患者中,有75例经手术诊断证实存在神经血管接触压迫患侧三叉神经脑池段及邻近脑干组织的情况。以手术诊断结果为参照,3D-FIESTA、3D-TOF诊断三叉神经痛患者神经血管接触压迫的灵敏度（97.33%比94.67%）、特异度（92.00%比96.00%）、准确率（96.00%比95.00%）比较,差异均无统计学意义（P>0.05）。一致性分析显示,3D-FIESTA、3D-TOF对三叉神经痛患者神经血管接触压迫的诊断结果与手术诊断结果之间的一致性均保持在良好水平（Kappa值均>0.7）。3D-FIESTA、3D-TOF对1级、2级、3级、4级、5级神经血管压迫程度的诊断符合率比较,差异均无统计学意义（P>0.05）。3D-FIESTA、3D-TOF对小脑上动脉、小脑前下动脉、椎动脉、基底动脉等责任血管的显示率均为100.00%,二者对2支以上动脉、动脉+静脉的显示率未达到100.00%,3D-FIESTA分别为94.74%、75.00%,3D-TOF分别为89.47%、50.00% ,但二者比较差异无统计学意义（P>0.05）。结论：术前行MRI检查可对原发性三叉神经痛患者的神经血管接触压迫情况予以清晰显示,尤其是采用3D-FIESTA、3D-TOF这2种序列成像 ,不仅可作为三叉神经痛的主要诊断手段,还可作为三叉神经痛手术定位的辅助手段。

关键词: 三叉神经痛, 诊断, 核磁共振成像, 三维快速稳态自由梯度, 三维时间飞跃

Abstract: Objective: To study the diagnostic value of MRI in trigeminal neuralgia. Methods: From January 2016 to May 2018, 100 patients with primary trigeminal neuralgia were treated in our hospital. Before operation, the patients were examined by MRI. The images of three dimensional fast imaging employing steady state acquisition 3D-FIESTA and three dimensionaltime of flight 3D-TOF were collected. The neurovascular contact compression was evaluated by two radiologists who are experienced in MRI diagnosis. The sensitivity, specificity and accuracy of 3D-FIESTA and 3D-TOF in the diagnosis of neurovascular contact compression in trigeminal neuralgia were calculated and compared. The display rate of 3D-FIESTA and 3D-TOF for different responsible blood vessels was calculated and compared. Results: Of the 100 cases of trigeminal neuralgia, 75 cases were confirmed by surgery having nerovascular contact compression in cisternal segment of the trigeminal nerve and adjacent brain stem tissue. The diagnostic sensitivity, specificity and accuracy of 3D-FIESTA and 3D-TOF in patients with trigeminal neuralgia were not different significantly(97.33% vs 94.67%, 92.00% vs 96.00%, 96.00% vs 95.00%, respectively) (P>0.05). The results of 3D-FIESTA and 3D-TOF in diagnosis of neurovascular contact compression in patients with trigeminal neuralgia were consistent with that found surgically. The Kappa values were higher than 0.7. The display rates of 3D-FIESTAST and 3D-TOF in superior cerebellar artery, anterior inferior cerebellar artery and vertebral artery were 100.00%.The display rates of two or more arteries and artery + vein were not 100.00%. However, the difference was not statistically significant (P>0.05). Conclusions: Preoperative MRI can clearly display the neurovascular contact compression in patients with primary trigeminal neuralgia, especially 3D-FIESTA and 3D-TOF imaging, which can be used not only as the main diagnostic method of trigeminal neuralgia, but also as an auxiliary means of localization for surgery in patients with trigeminal neuralgia.

Key words: Trigeminal neuralgia, Diagnosis, Magnetic Resonance Imaging, Three-dimensional fast imaging employing steady-state acquisition, Three-dimensional time of flight

中图分类号:

R741.04

李云峰, 江泓, 李宁, 孙青芳. 核磁共振成像诊断三叉神经痛的价值分析与研究[J]. 诊断学理论与实践, 2018, 17(05): 562-565.

LI Yunfeng, JIANG Hong, LI Ning, SUN Qingfang. Analysis and study on value of MRI in diagnosis of trigeminal neuralgia[J]. Journal of Diagnostics Concepts & Practice, 2018, 17(05): 562-565.

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