术前3D-CISS联合3D-TOF序列MRI判断原发性三叉神经痛责任血管的效果

目的探讨术前三维稳态构成干扰(3D-CISS)序列和三维时间飞跃(3D-TOF)序列MRI在原发性三叉神经痛责任血管判断中价值。方法回顾性分析2016年1~12月首次行微血管减压术(MVD)治疗的79例原发性三叉神经痛的临床资料。术前均行3D-CISS和3D-TOF序列MRI检查。以术中发现为判断责任血管的标准。结果术中发现单一责任血管56例(70.8%),2支及以上责任血管19例(24.1%),无责任血管4例(5.1%);责任血管中包含至少一条动脉73例(92.4%),单纯静脉2例(2.5%)。术前影像学检查阳性75例,阴性4例。75例阳性中,术中发现责任血管73例,未发现责任血管2例;4例阴性中,术中发现责任血管2例,2例未发现责任血管。术前3D-CISS和3D-TOF序列MRI判断责任血管的灵敏性为97.3%(73/75),特异性为50.0%(2/4),准确率为94.9%(73+2)/79];判断责任血管包含动脉的灵敏性为98.6%(72/73),特异性为50.0%(3/6),准确率为94.9%(72+3)/79]。结论术前3D-CISS联合3D-TOF序列MRI可用于判断原发性三叉神经痛责任血管,尤其对于包含动脉的责任病变,准确率较高,为MVD提供参考信息。

Values of 3D-CISS combined with 3D-TOF sequences MRI to diagnosis of vessels responsible for primary trigeminal neuralgia

Objective To explore the values of 3-dimensional constructive inference in steady state (3D-CISS) combined with 3-dimensional time of flight (3D-TOF) sequences MRI to the diagnosis of the vessels responsible for primary trigeminal neuralgia (PTN). Methods The clinical data of 79 patients with PTN, who underwent the first microvascular decompression (MVD) in Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from January, 2016 to December, 2016, were analyzed retrospectively. By comparing the offending vessels preoperatively identified by 3D-CISS combined with 3D-TOF sequences MRI with the offending vessels intraoperatively detected by the operators, the accuracy of 3D-CISS combined with 3D-TOF sequences MRI in diagnosis of offending vessels was evaluated. Results The preoperative 3D-CISS combined with 3D-TOF sequences MRI found that there were offending vessels in 75 patients and there were no offending vessels in 4 patients. The operators intraoperatively found that there was at least 1 offending artery in each of 73 patients with PTN and there were no offending vessels in 4 patients. The sensitivity and specificity of 3D-CISS combined with 3D-TOF sequences MRI for detecting the offending vessels were 98.6％ and 50.0％ respectively and its accuracy for diagnosing the offending vessel was 94.9％ before the operation. Conclusion The pre-operative 3D-CISS combined with 3D-TOF sequences MRI can provide the important information of the offending vessels for MVD surgery in the patients with PTN.