周围性面瘫的MRI增强扫描检查和损伤节段观察及预后相关性分析

目的 探究周围性面瘫的MRI检查和损伤节段观察及预后相关性。方法 周围性面瘫患者15例，用Siemens Magnet V1.5 T超导型磁共振，头线圈，扫描双侧颞骨，单侧面瘫扫描双侧面神经，健侧为阴性对照。常规T1WI、T2WI轴面及冠状面薄层扫描后，行T1WI-vibe横断位、T2WI-TSE冠状位、T2WI-SPACE横断位、增强后T1WI-Vibe横断位及T1WI-TSE冠状位扫描及钆喷替酸葡甲胺(Gd-DTPA)增强扫描(对比剂剂量0.1mmol/kg)，延时30min对病变进行MRI扫描及图像多平面重建。结果 ①与手术相关者3例,面神经MRI重建显示面神经全程完整1例，没有中断、水肿。3个月后恢复,为H-B 1级。术前就发生面瘫的岩部巨大胆脂瘤患者1例，显示全程水肿，但没有中断，术后恢复十分缓慢，为H-B 3级。第3例巨大听神经瘤患者，MRI重建显示面神经仍连续，与术中观察一致。术前面瘫H-B 6级，术后仍为6级；②Bell氏面瘫者6例中，显示内听道段至鼓室段均有强化1例，强化在膝状神经节至乳突段2例，只在内听道段2例，在内听道段、迷路段、膝状神经节及鼓室段1例，术后均痊愈，H-B分级全部达到1级；③HUNT综合征患者6例中，未见面神经异常1例，强化在内听道2例，另膝状神经节强化3例，其中2例伴内听道内强化，只有1例还涉及乳突段，伴有耳蜗增强改变5例，治疗后H-B分级全部达到1级。结论 MRI增强和重建，可以很好地显示面神经损伤的节段和范围，也能为预后判定提供一些信息。

Correlation of segment of lesion with prognosis in peripheral facial palsy by MRI study

Objective To recognize the correlation of segment of lesion and prognosis in the patients with peripheral facial palsy by Gd-enhanced MRI. Methods The patients were scanned by Siemens Magnet V1.5 T, while contralateral as control. The conventional T1WI, T2WI axial and coronal thin layer scanning, Gd-DTPA-enhanced, delayed 30min re-imaging and multi-plane reconstruction were performed. Results ① In 3 patients who underwent operation, 1 displayed in reconstruction full-distance normal nerve without interruption and edema. She recovered completely to the H-B 1 grading in 3 months. Another patient had facial palsy before the operation due to huge cholesteatoma. Entire facial nerve showed edema but no discontinuity. The patient recovered to H-B 3 grading after the operation. MRI reconstruction of the last huge vestibular schwannoma patient demonstrated facial nerve continuous as same as before the operation. H-B grading remained at 6 before and after the operation. ② Among six Bell′s palsy patients, enhancement were noted from inner ear to tympanic segment in one case, inner ear to labyrinth segment in one case, geniculate ganglion and tympanic segment in one case, geniculate ganglion to mastoid segment in two cases, and only inner ear segment in two cases. All six patients were cured after the treatment with H-B grading 1. ③ Among six Ramsay Hunt syndrome patients, facial nerves showed normal in one case and enhancement in inner ear segment in two cases. Of the 3 remaining cases, 2 showed enhancement in inner ear segment, while 1 in mastoid segment. After the treatment, 5 patients showed enhancement in cochlea, but all six recovered to H-B grading 1. Conclusion MRI enhancement and reconstruction can clearly reveal segment and extent of facial nerve lesion, in addition to prognostic information.