目的：通过对三叉神经痛（Trigeminal neuralgia，TN）患者及对照组进行三叉神经脑池段MR形态测量，研究TN患者患侧三叉神经脑池段形态结构的差别。方法：45例经临床诊断为TN的患者和45例健康志愿者作为对照组纳入本研究。所有受试对象采用GE 3.0T MR扫描，采用3D-TOF-SPGR及3D-FIESTA序列，分别以两侧三叉神经脑池段为中心进行轴位扫描。通过reformat软件对扫描图像进行后处理，测量三叉神经脑池段长度及冠状位、轴位、矢状位上三叉神经脑池段最大横截面积，三叉神经与脑桥夹角，三叉神经根岩尖处转角及血管压迫部位距三叉神经根部的距离，然后对测量结果进行统计分析，并根据两组序列上双侧三叉神经各形态学测量值的差异比做ROC曲线，评价两组序列各形态学测值对TN的诊断效能。以P<0.05为具有统计学差异。结果：患侧三叉神经脑池段长度及冠状位、轴位、矢状位三叉神经脑池段最大横截面积均小于健侧及对照组（P<0.05），而患侧三叉神经与脑桥夹角、三叉神经根岩尖处转角与健侧及对照组比较无显著差异（P>0.05）。对照组的双侧三叉神经脑池段形态学测量结果差异均无统计学意义（P>0.05），但对照组三叉神经脑池段长度及冠状位、轴位、矢状位三叉神经脑池段最大横截面积均大于患者健侧（P<0.05），而三叉神经与脑桥夹角及三叉神经根岩尖处转角与健侧比较无差异（P>0.05）。在两组序列各形态学测值的差异比中，SPGR序列上冠状位最大横截面积的差异比对TN诊断的准确度最高。TN患者患侧三叉神经血管压迫部位距根部约为（2.124±1.478） mm，84.4%的患者患侧血管压迫神经都发生在三叉神经脑池段近段。结论：三叉神经MR形态学测量能够更加直观的显示三叉神经形态学改变，增加了临床TN诊断的客观性，为TN的诊断提供了一种新的方法和思路。
Abstract
Objective: To investigate the changes of morphological structures in trigeminal neuralgia(TN) affected trigeminal nerve by using MR to measure the morphology of the cisternal segment of the trigeminal nerve in TN patients and the control group． Methods: Forty-five TN patients and forty-five healthy volunteers were enrolled in this study and scanned by GE 3.0T high resolution MR． Three dimensional time of flight spoiled gradient recalled acquisition(3D-TOF-SPGR) and three dimensional fast imaging employing steady state acquisition(3D-FIESTA) were used to measure morphological structures in cisternal segment of bilateral trigeminal nerve. All images were done postprocessing by reformat software. The length of the cisternal segments of the trigeminal nerve, the maximum cross-sectional areas of the nerves in coronal, axial and sagittal image, the trigeminal-pontine angle, the turn angles of the nerves passing the petrosal bones, and the distance of the neurovascular compression were measured. Then compared and analyzed the measurements and drew the ROC curve by the different ratios of the morphological measurements in the sequence of SPGR and FIESTA between bilateral trigeminal nerve of TN patients and control group. Values with P<0.05 were considered statistically significant. Results: The length of the cisternal segments of the trigeminal nerve, the maximum cross-sectional areas of the nerves in coronal, axial and sagittal image on the symptomatic side were smaller than that on the asymptomatic side and the control group(P<0.05), but the bilateral trigeminal-pontine angle and the turn angles of the nerves passing the petrosal bones had no difference both in patients and the control group(P>0.05). The length of the cisternal segments trigeminal nerve, the maximum cross-sectional areas of the nerves in coronal, axial and sagittal image on the control group were greater than that on the asymptomatic side(P<0.05), the bilateral trigeminal-pontine angle and the turn angles of the nerves passing the petrosal bones in the control group had no difference with the asymptomatic side. In the different ratios of the morphological measurements in these sequence, the different ratios of the maximum cross-sectional areas of the nerves in the coronal of the SPGR sequence had the best diagnosis efficiency. 84.4% of the neurovascular compression point in TN patient was near the nerve root, the mean distance of the neurovascular compression point was (2.124±1.478) mm. Conclusion: Morphometric measurement of MR sequence in the cisternal segment of trigeminal nerve can display the morphology change of trigeminal nerve more intuitively, increase the objectivity of the clinical TN diagnosis and provides a new method and sight for the diagnosis of TN.
关键词
三叉神经痛 /
磁共振成像
Key words
Trigeminal neuralgia /
Magnetic resonance imaging
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