MR血管成像Hosoya评分对面肌痉挛病因诊断中血管压迫程度的量化研究

目的对面肌痉挛（hemifacial spasm，HFS）患者面神经根部血管压迫的程度进行量化研究，评价Hosoya评分在面肌痉挛病因诊断中的价值并对其进行改良。方法对20例正常人及36例偏侧面肌痉挛患者进行脑十部位三维时间飞跃法MR血管成像（3D—TOFMRA）检查，采用Hosoya评分及改良Hosoya评分对轴面、冠状面原始图像面神经根部的血管压迫进行量化评分，对改良Hosoya评分≥1．5分的27例患者进行血管减压治疗。术后复查MR血管成像（MRA），并重新进行改良Hosoya评分。结果20例正常人Hosoya评分，仅有3例为1．0分，无一例≥1．5分，判断为无血管压迫；36例HFS患者中，患侧Hosoya评分≥1．5分者27例，阳性率81．8％，按改良Hosoya评分，患侧≥1．5分者33例，阳性率91．7％；有6例小血管骑跨在面神经根部，Hosoya评分无法评价，通过改良的Hosoya评分方可确定量化；患者手术前后改良Hosoya评分经秩和（等级分组）检验，差异有统计学意义（H=27．192，P〈0．001）。结论Hosoya评分能对面肌痉挛患者面神经出脑干处的血管压迫情况进行量化，但对小血管压迫有一定局限性，改良Hosoya评分可以弥补这一缺陷。

A quantitative study on the severity of neurovascular compression in etiologic diagnosis of hemifacial spasm using Hosoya grading system of MR angiography

Objective To quantitate the severity of neurovascular compression of facial nerve in patients with hemifacial spasm (HFS) and evaluate the value of Hosoya grading system in diagnosis of HFS. Methods Three-dimensional time of flight magnetic resonance angiography (3D-TOF MRA) was performed in 36 patients with HFS and 20 healthy controls, the standard and verified Hosoya grading system were employed to quantitate the severity of neurovascular compression in axis and coronal plane of head, 21 patients whose verified scores were above 1.5 undergo vascular decompression. After operation, MRA and Hosoya grading were reperformed. Results The scores of 20 healthy controls was all less than 1 except of 3 cases, their scores were 1. The scores were above 1.5 in 27 of 36 patients using standard Hosoya system and in 33 of 36 patients using verified system. The positive rates were 81.8% and 91.7%, respectively.Conclusion Hosoya grading system is effective in diagnosis of neurovascular compression in patients with HFS, but its value in evaluating microvascular compression is limited, and verified Hosoya grading system can do it well.