天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (1): 60-64.doi: 10.11958/20171144

• 临床研究 • 上一篇    下一篇

血管压迫性三叉神经痛的扩散张量成像研究

谷鹏1,孙洪涛2,袁飞1,张泉1,李建慧1,袁滨1,沈文3   

  1. 1 天津医科大学第一中心临床学院（邮编 300192）；2 武警后勤学院附属医院磁共振科；3 武警后勤学院附属医院神经外科； 4 天津市第一中心医院天津器官移植临床医学研究中心
  • 收稿日期:2017-10-24 修回日期:2017-11-15 出版日期:2018-01-15 发布日期:2018-01-16
  • 通讯作者: 谷鹏 E-mail:gupeng_19830625@126.com
  • 作者简介:谷鹏（1983），男，硕士在读，主要从事神经影像学研究
  • 基金资助:
    MVD影响三叉神经痛患者脑可塑性的多模态磁共振研究

The study of diffusion tensor imaging of trigeminal neuralgia with vascular compression

GU Peng1,2, SUN Hong-tao3, YUAN Fei2, ZHANG Quan2, LI Jian-hui2, YUAN Bin2, SHEN Wen4△   

  1. 1 Center of the First Clinical College of Tianjin Medical University, Tianjin 300192, China; 2 Department of MRI, 3 Department of Neurosurgery, the Affiliated Hospital of Logistics University of Chinese People’s Armed Police Forces; 4 Tianjin Clinical Research Center for Organ Transplantation of Tianjin First Center Hospital
  • Received:2017-10-24 Revised:2017-11-15 Published:2018-01-15 Online:2018-01-16

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摘要： 目的 研究血管压迫性三叉神经痛（TN）患者三叉神经根部扩散张量成像（DTI）的磁共振表现及临床应 用。方法 49 例经手术证实的血管压迫引起单侧 TN 患者行常规 MRI 检查和横轴面 DTI 成像，根据血管与神经相 互关系分为 A 组（接触，22 例）、B 组（移位，11 例）、C 组（压迫，16 例），分别测量患侧及健侧三叉神经根部的横截面 积（CSA）、平均扩散系数（MD）值、部分各向异性分数（FA）值、轴向扩散系数（AD）值和径向扩散系数（RD）值，比较患 侧及健侧三叉神经以及 TN 患者组间患侧三叉神经各参数值的差异。结果 患侧三叉神经 CSA、FA 值明显低于健 侧，患侧 MD 值及 RD 值明显高于健侧，且差异均有统计学意义（P＜0.05），患侧 AD 值与健侧比较差异无统计学意 义（P＞0.05）。A、B 和 C 组的 CSA、FA 值、RD 值之间差异有统计学意义，其中 A 组 CSA 和 FA 值高于 C 组，RD 值低 于 C 组；B 组 FA 值高于 C 组，差异有统计学意义（P＜0.05）。结论 磁共振 DTI 序列可以反映三叉神经微观结构的 改变，提示三叉神经脱髓鞘是由血管压迫引起的，为揭示 TN 的发病机制以及评估 TN 严重程度提供了可靠的依据。

关键词: 三叉神经痛, 磁共振成像, 血管压迫, 扩散张量成像

Abstract: Objective To study the findings and clinical application of the diffusion tensor imaging (DTI) of the trigeminal nerve root in patients with trigeminal neuralgia (TN). Methods Forty-nine patients with unilateral TN caused by vascular compression and surgically confirmed were collected in this study. The subjects were divided into group A (contact, n=22), group B (displacement, n=11) and group C (atrophy, n=16), according to the relationship between blood vessels and nerves. Conventional MRI and horizontal DTI were performed to measure cross-sectional area (CSA), mean diffusivity (MD) value, fractional anisotropy (FA) value, axial diffusivity (AD) value and radial diffusivity (RD) value in nerve roots of affected side and unaffected side. The trigeminal indexes of both affected and unaffected trigeminal nerves and data of the affected trigeminal indexes of TN patients were compared between the groups. Results The CSA and FA values were significantly lower, MD and RD values of trigeminal nerves were significantly higher in affected side than those of unaffected side (P＜ 0.05). But there was no significant difference in AD value between affected side and unaffected side of TN patients (P＞ 0.05). Values of CSA and FA were significantly higher in group A than those of group C. The value of RD was significantly lower in group A than that of group C. FA value was significantly higher in group B than that of group C (P＜0.05). Conclusion The magnetic resonance DTI sequence can reflect changes in trigeminal nerve microstructure, suggesting that trigeminal demyelination is caused by vascular compression, and altered diffusion indexes of trigeminal nerve are reliable basis for the pathogenesis and the severity evaluation of TN.

Key words: trigeminal neuralgia, magnetic resonance imaging, vascular compression, diffusion tensor imaging