【摘要】：目的:探討磁共振三維穩(wěn)態(tài)進(jìn)動快速成像序列(three-dimensional fast imaging employing steady state acquisition,3D-FIESTA)聯(lián)合三維時間飛躍序列(three-dimensional time of flight,3D-TOF)對原發(fā)性三叉神經(jīng)痛患者神經(jīng)血管壓迫(neurovascular compression,NVC)的評估價值。同時評價基于 3D-FIESTA 的腦池磁共振仿真內(nèi)窺鏡技術(shù)(megnatic resonance virtual endoscopy,MRVE)對原發(fā)性三叉神經(jīng)痛手術(shù)治療的指導(dǎo)價值。方法:回顧分析72例單側(cè)原發(fā)性三叉神經(jīng)痛患者的臨床及影像學(xué)資料,所有患者均經(jīng)神經(jīng)外科微血管減壓術(shù)(microvascular decompression,MVD)治療確診,分別對比有癥狀側(cè)與無癥狀側(cè)之間的神經(jīng)血管壓迫(NVC)發(fā)生率、NVC評分、責(zé)任血管與三叉神經(jīng)出腦干區(qū)(root entry zone,REZ)的最短距離、以及責(zé)任血管(responsible vessel,RV)的性質(zhì)與來源等。利用磁共振仿真內(nèi)窺鏡(MRVE)技術(shù)進(jìn)行腦池仿真內(nèi)鏡成像,重建三維圖像模擬手術(shù)路徑,并與術(shù)中錄像進(jìn)行對照,評價MRVE技術(shù)的可靠性以及對手術(shù)的指導(dǎo)價值。結(jié)果:有癥狀側(cè)NVC發(fā)生率約為94.44%(68/72),其中動脈參與比例約95.59%(65/68),責(zé)任血管中最常見為小腦上動脈(superior cerebellar artery,SCA),占比約75%(51/68),NVC評分為6.63±2.18,責(zé)任血管與REZ區(qū)最短距離為1.04±1.55mm;無癥狀側(cè)的NVC發(fā)生率約45.83%(33/72),其中動脈參與比例約66.67%,責(zé)任血管中最常見亦為小腦上動脈(SCA),占比約57.58%(19/33),NVC評分為2.91±0.95,責(zé)任血管與REZ區(qū)最短距離為5.28±2.33mm;兩組數(shù)據(jù)之間差異均具有統(tǒng)計學(xué)意義。有癥狀側(cè)68例NVC陽性患者的FIESTA圖像,經(jīng)MRVE三維后處理獲得模擬手術(shù)路徑圖像,與手術(shù)錄像對比高度一致。結(jié)論:原發(fā)性三叉神經(jīng)痛與患側(cè)神經(jīng)血管壓迫程度及部位密切相關(guān),3D-FIESTA聯(lián)合3D-TOF序列對神經(jīng)血管壓迫的診斷及評估具有重要價值�；�3D-FIESTA的腦池仿真內(nèi)窺鏡技術(shù)可以高度模擬手術(shù)路徑及視野,對外科治療具有重要的指導(dǎo)價值。
[Abstract]:Objective: to evaluate the value of three-dimensional fast imaging employing steady state acquisition 3D-FIESTA combined with three-dimensional time of flight3D-TOF in the evaluation of neurovascular compression in patients with primary trigeminal neuralgia. To evaluate the guiding value of 3D-FIESTA based magnetic resonance virtual endoscopy (megnatic resonance virtual endoscopy MRVE) in the surgical treatment of primary trigeminal neuralgia. Methods: the clinical and imaging data of 72 patients with unilateral primary trigeminal neuralgia were retrospectively analyzed. All patients were diagnosed by microvascular decompression. The incidence of neurovascular compression (NVC) in the symptomatic side and the asymptomatic side were compared. The (NVC) score, the shortest distance between the responsible vessel and the trigeminal nerve (root entry Z, and the nature and origin of the responsible vessel were compared between the symptomatic side and the asymptomatic side. Magnetic resonance virtual endoscopy (MRVE) was used to simulate the operation path of the brain cisterns, and to evaluate the reliability of the MRVE technique and its guiding value. Results: the incidence of symptomatic NVC was 94.44% (68 / 72), in which arterial involvement was 95.59% (65 / 68), and the most common responsible vessel was the superior cerebellar artery (superior cerebellar arteriae SCA), with a score of 6.63 鹵2.18, and the shortest distance between the responsible vessel and the REZ area was 1.04 鹵1.55 mm, and the asymptomatic NVC occurred in the asymptomatic side. The rate was about 45.83% (33 / 72), in which the proportion of arterial involvement was about 66.677.The (SCA), score of the cerebellar artery was about 57.58% (19 / 33), and the shortest distance between the responsible vessel and the REZ area was 5.28 鹵2.33mm. the difference between the two groups was statistically significant. The FIESTA images of 68 patients with positive NVC on the symptomatic side were obtained by MRVE 3D post-processing, which were in good agreement with the operation video. Conclusion: the primary trigeminal neuralgia is closely related to the degree and location of neurovascular compression in the affected side. The combination of 3D-FIESTA and 3D-TOF sequence is of great value in the diagnosis and evaluation of neurovascular compression. Cisterna virtual endoscopy based on 3D-FIESTA can simulate the operation path and visual field highly, and has important guiding value for surgical treatment.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R745.11;R445.2

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