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MR Imaging Analysis of Vascular Compressive Trigeminal Neuralgia

Author: ZhuDaGuang
Tutor: ShenHaiLin
School: Suzhou University
Course: Medical Imaging and Nuclear Medicine
Keywords: Magnetic resonance imaging Trigeminal neuralgia Microvascular decompression The neurovascular contact / oppression
CLC: R445.2
Type: Master's thesis
Year: 2009
Downloads: 123
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Abstract

Objective: To compare 3D-TOF and two 3D-CISS sequence on the trigeminal nerve and surrounding blood vessels as well as the two spatial relations display and judgment to a more reasonable approach to the trigeminal nerve morphology evaluation; 2. Applications 3D symptomatic side and asymptomatic side cisternal segment analysis-TOF and two 3D-CISS sequence of the trigeminal nerve, relatively asymptomatic side of the trigeminal nerve and its peripheral vascular; 3. assessment of trigeminal neuralgia with reference to the surgical results cisternal segment of NVC diagnostic value in patients, and further in-depth analysis of MR evaluation of clinical relationship, to summarize most valuable evaluation to improve the diagnostic accuracy. Materials and methods: (1) use of the German Siemens 1.5T Avanto A tim System superconducting MRI scanner, 3D-TOF and two 3D-CISS sequence trigeminal cisternal segment of 30 normal volunteers were used routinely transected surface scanning and MPR method to obtain cross-sectional images of the both sides of the parallel and perpendicular nerve. Trigeminal cisternal segment and its branches in the two image sequences show. Compare two image sequences trigeminal nerve cisternal segment display adjacent vessels, and the analysis of the spatial relationship with nerves, to observe the signal of the blood vessels in the two image sequences. Measurement of the maximum diameter of the largest cross-section of the cisternal segment of the trigeminal nerve in the 3D-CISS sequence image and trails. (2) of 141 patients with idiopathic trigeminal neuralgia patients undergoing the MRTA checks, were unilateral trigeminal neuralgia, trigeminal nerve totaling 282 side, there are 141 cases of symptomatic side and asymptomatic side. Scanning equipment and the same as the first part, a slightly different method, but is unclear or no responsibility vascular imaging sequences, 3D-TOF cisternal segment of the trigeminal nerve plus sweep the 3D-CISS sequence. By two more experienced radiologists blinded read the piece, the relationship and responsibilities of vascular judge the nerve with responsibility vascular walk the line. Vertical nerve cross-sectional images of the largest cross-section of the cisternal segment of the trigeminal nerve of the asymptomatic side were measured to its maximum diameter and the minimum diameter and records. Statistical analysis was performed on the asymptomatic side MRTA image obtained using SPSS10 Software. Observed the responsibility of the blood vessels and nerve relationship will be divided into four performance: oppression, contact, suspicious contact and non-contact. Responsibility vascular judgment of the direction of travel can be divided into: no responsibility vascular, angle of less than 45o, angle greater than 45o. (3) retrospective study of 56 cases due to unilateral trigeminal neuralgia underwent surgery in the preoperative MRTA images, including 50 cases of primary trigeminal neuralgia and trigeminal images are displayed clearly. The scanning device, sequences, the same as the method and the second portion. Analysis of primary trigeminal neuralgia most common responsibility of blood vessels, and surgical findings as the gold standard for the control patients with preoperative MRTA image using SPSS10 software statistical the MRTA check the sensitivity, specificity, and accuracy, and assessment of the MRTA Display section. Results: (1) 3D-CISS cisternal segment of the trigeminal nerve and its branches, as well as adjacent vessels display capability is better than 3D-TOF sequence (P lt; 0.01); 3D-CISS can clearly show the cross-section of the trigeminal nerve meet the accurate measurement of the maximum diameter and the minimum diameter requirements. (2) A total of 170 cases in all 282 side of the trigeminal nerve MRTA image walk the line can see the responsibility vascular observe responsibilities vascular symptoms side trigeminal nerve responsibility vascular seen walking the line more than the statistics show that the angle between the nerves and blood vessels greater than 45o. This is seen relatively close relationship with the asymptomatic side vascular running a significant difference in thus responsibility to blood vessels and nerves of the angle between the bigger and more prone to disease-causing. The blood vessels and nerves in the ipsilateral trigeminal neuralgia contact rate was significantly higher in patients with contralateral This shows that the the trigeminal neuralgia important because vascular compression. 14.9% of the asymptomatic side trigeminal nerve can be found in the MRTA image blood vessels clear contact and oppression, while 5.7% of the trigeminal nerve in the symptomatic side MRTA images did not show contact with blood vessels and nerves, which can explain the vascular compression trigeminal brainstem segment is not the only cause of primary trigeminal neuralgia incidence. Measurement, cisternal segment of the trigeminal nerve of the asymptomatic side the maximum diameter of the largest cross-section and the most trails that cisternal segment of the trigeminal nerve of the asymptomatic side sectional minimal path difference (P lt; 0.05), suggesting that symptoms side The long-term trigeminal neuralgia can result in the loss or atrophy of the nerve tissue. The MRTA cross-section, oblique sagittal, coronal, and three sections with the differences in the asymptomatic group analysis shows that patients with vascular compression of trigeminal neuralgia, MRTA is a more targeted checks, conducive to the detection of the blood vessel, and have a higher reproducibility. (3) 56 cases due to unilateral trigeminal neuralgia underwent surgery process, six cases of other intracranial lesions caused by the secondary trigeminal neuralgia. 50 cases the MVD surgery results, responsibility vascular cerebellar artery (66%); followed by the joint nerve (14%) of the arteries and veins, a simple intravenous oppression (2%), and found no responsibility vascular (4%). 3D-TOF checks only not found all responsibility vascular, requires a combination of the 3D-CISS exclude cava. Surgical findings as the gold standard for comparison the MRTA, found suspicious vascular attributed to the the vascular contact group to help improve diagnostic sensitivity, specificity and accuracy. Conclusion: MRTA is a more reliable method of imaging studies diagnosis of TN patients NVC, multi-planar imaging will help to improve the the MRI detected NVC sensitivity, specificity, and accuracy. 3D-CISS sequence with high spatial resolution, display of nerves and tiny blood vessels are better than 3D-TOF sequence, favor a combination of both improve responsibility vascular detection rate. Responsibility vascular walk the line, the location, the size of the blood vessels of responsibility is the key to diagnosis.

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