MRI增强3D FLASH联合3D CISS评估原发性三叉神经痛三叉神经形态学改变及与疼痛程度相关性

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1385 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

文章导读

摘要目的：探讨MRI增强三维快速小角度激发（3D FLASH）序列联合三维稳态构成干扰（3D CISS）序列在原发性三叉神经痛（TN）三叉神经形态学改变及与疼痛程度相关性研究中的应用价值。方法：回顾性分析单侧48例原发性TN患者MRI影像，采用高分辨率MRI扫描，测量三叉神经脑池段长度及面积、三叉神经脑桥角及桥小脑角池截面积。将血管神经压迫程度进行分级：1级为无接触；2级为接触或可疑接触；3级为压迫。应用VAS评分进行疼痛程度评分，并评估血管神经压迫程度与VAS评分的相关性。结果：患侧三叉神经脑池段血管1级8例，2级28例，3级12例；患侧三叉神经脑池段长度为（9.17±3.30）mm，健侧长度为（9.53±2.50）mm，两者比较差异无统计学意义（P＞0.05）；患侧三叉神经脑池段面积为（19.78±6.95）mm2，健侧面积为（26.37±13.20）mm2，两者比较差异有统计学意义（P＜0.05）；患侧三叉神经脑桥角为40.02°± 14.43°，健侧角度为52.57°±16.10°，两者比较差异有统计学意义（P＜0.05）；患侧桥小脑角截面积为（191.75±68.75）mm2，健侧面积为（236.74±64.79）mm2，两者比较差异有统计学意义（P＜0.05）。血管神经压迫程度与VAS评分具有相关性（r=0.309，P=0.033）。结论：MRI增强3D FLASH联合3D CISS序列对原发性TN患者三叉神经形态学改变能定性、定量地诊断；三叉神经脑桥角锐利、桥小脑角池的狭小易导致神经血管冲突，血管神经压迫程度与VAS评分具有相关性。

	服务
	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	杨登法
	王林友
	杨铁军
	李军苗
	沈剑敏
	吴亮
	金涌
	周开宇
	李又成

关键词 ：磁共振成像, 三叉神经, 形态学, 疼痛

Abstract：Objective: To assess the morphologic changes in the primary trigeminal neuralgia with the high-resolution MR imaging, and to evaluate the correlation between the degrees of neurovascular compression and the extent of pain. Methods: Forty-eight patients with trigeminal neuralgia undergoing the enhanced three-dimensional fast low angle shot (3D-FLASH) and three-dimensional constructive interference in steady-state (3D-CISS) sequence were retrospectively analyzed. The length and area of the cisternal segment of the trigeminal nerve, the trigeminal-pontine angle and the cross-sectional area of cerebellopontine angle cistern were measured. The vascular compression was classified into three degrees: degree I, no contact; degree II, contact or suspicious; degree III, compression. The extent of pain was measured by visual analog score. Results: There were 8 cases in degree I, 28 cases in degree II, and 12 cases in degree III. The length of the cisternal segment of the affected side and the healthy side was (9.17±3.30) mm and (9.53±2.50) mm respectively, showing no statistical difference (P>0.05). The area of the cisternal segment of the affected side and the healthy side was (19.78±6.95) mm2 and (26.37±13.20) mm2 respectively, showing significant difference (P<0.05). The trigeminal-pontine angle of the affected side and the healthy side was 40.02°±14.43° and 52.57°±16.10° respectively, showing statistical difference (P<0.05). The cross-sectional area of cerebellopontine angle cistern of the affected side and the healthy side was (191.75±68.75) mm2 and (236.74±64.79) mm2 respectively, showing statistical difference (P<0.05). Positive correlation could be found between the degrees of NVC and the extent of pain in the patients with TN (P=0.033, r=0.309). Conclusion: The morphologic changes can be diagnosed qualitatively and quantitatively with the high-resolution MR imaging. Sharp trigeminal-pontine angle, narrow area of the cerebellopontine angle cistern increase the chance of neurovascular contact, and cause TN easily. There is correlation between the degrees of NVC and the extent of pain in the patients with TN.

Key words： magnetic resonance imaging trigeminal neuralgia morphology pain

收稿日期: 2018-02-06

PACS:

基金资助:台州市椒江区科技计划项目（132062）。

通讯作者: 吴亮，副主任医师，Email：william_hy@sina.com

作者简介: 杨登法（1983-），男，浙江台州人，主治医师，硕士

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I9/662

[1] DE SOUZA D D, HODAIE M, DAVIS K D. Structural magnetic resonance imaging can identify trigeminal system abnormalities in classical trigeminal neuralgia[J]. Front Neuroanat, 2016, 10(19): 95-109.
[2] 杨登法, 沈剑敏, 夏贤武, 等. 强化3D FLASH序列联合3D CISS序列在血管压迫性三叉神经痛中的应用价值[J]. 现代实用医学杂志, 2016, 5(28): 573-574.
[3] HUGHES M A, FREDERICKSON A M, BRANSTETTER B F, et a1. MRI of the trigeminal nerve in patients with trigeminal neuralgia secondary to vascular compression[J]. Am J Roentgenol, 2016, 206(3): 595-600.
[4] SEEBURG D P, NORTHCUTT B, AYGUN N, et a1. The role of imaging for trigeminal neuralgia: A segmental approach to high-resolution MRI[J]. Neurosurg Clin N Am, 2016, 27(3): 315-326.
[5] CHENG J, MENG J, LIU W, et a1. Nerve atrophy and a small trigeminal pontine angle in primary trigeminal neuralgia: A morphometric magnetic resonance imaging study[J]. World Neurosurg, 2017, 104: 575-580.
[6] 贺芸芸, 戚喜勋, 张苏雅, 等. 三叉神经痛患者三叉神经脑池段MR形态测量研究[J]. 中国临床医学影像杂志, 2017, 28(4): 233-239.
[7] Kawano Y, Maehara T, Ohno K. Validation and evaluation of the volumetric measurement of cerebellopontine angle cistern as a prognostic factor of microvascular decompression for primary trigeminal neuralgia[J]. Acta Neurochir (Wien), 2014, 156(6): 1173-1179.
[8] PARK S H, HWANG S K, LEE S H, et al. Nerve atrophy and a small cerebellopontine angle cistern in patients with trigeminal neuralgia[J]. J Neurosurg, 2009, 110(4): 633-637.
[9] KRESS B, SCHINDLER M, RASCHE D, et a1. MRI volume try for the preoperative diagnosis of trigeminal neural-gia[J]. Eur Radiol, 2005, 15(7): 1344-1348.
[10] WILCOX S L, GUSTIN S M, EYKMAN E N, et a1. Trigeminal nerve anatomy in neumpathic and non-neuropathic orofacial pain patients[J]. J Pain, 2013, 14(8): 865-872.
[11] 周勇智, 邹元杰, 刘永, 等. 三叉神经根入脑干区MRI形态学研究[J]. 临床神经外科杂志, 2014, 11(1): 29-32.
[12] JAYWANT S S, PAL A V. A comparative study of pain measurement scales in acute burn patients[J]. Indian J Occup Ther, 2010, 35(3): 13-17.