ABSTRACT
Objective To investigate the diagnostic value of three-dimensional time-of-flight magnetic resonance angiography(3D-TOF-MRA)in combination with three-dimensional fast imaging employing steady-state acquisition with phase cycling (3D-FIESTA-C),using multiplanar reconstruction and image fusion technology in preoperative evaluation of vascular compressive trigeminal neuralgia (TN) and to improve the diagnostic accuracy.Methods 3D-TOF-MRA and 3D-FIESTA-C images using MPR and image fusion technology of 70 patients with TN confirmed by surgery were reviewed retrospectively,and compared with intraoperative findings separately and together.Results Microvascular decompression (MVD)surgery was performed in all 70 patients.Compared with surgical results, 3D-TOF-MRA showed presence of the offending vessel around the cisternal segment of trigeminal nerve in 55 cases with a positive rate of 79%.3D-FIESTA-C showed the presence of the offending vessel in 60 cases with a positive rate of 85%.65 cases were found when combining both 3D-TOF-MRA and 3D-FIESTA-C images,with a positive rate of 93%.No positive imaging findings were seen in 5 cases.Operation showed that offending vessels were small arteries in 3 cases and were petrosal veins in 2 cases.The main offending vessels were superior cerebellar artery and basilar artery.Conclusion Combining images of 3D-TOF-MRA and 3D-FIESTA-C using MPR and image fusion technology can show the relationship between offending vessels and the trigeminal nerve clearly in patients,and provide guidance for MVD surgery.There are still some deficiencies in the display of venules,and other sequences of MRI (such as CE-3D-FIESTA sequences)may be helpful.
ABSTRACT
Objective To compare the diagnostic efficiency in showing the responsible blood vessels for neurovascular compression in patients with trigeminal neuralgia by 3D‐FIESTA‐C and 3D‐TOF‐MRA sequences .Methods The imaging data of 60 patients with primary trigeminal neuralgia were analyzed retrospectively .After MRI examination ,all of the patients underwent micro‐vascular de‐compression (MVD) .3D‐TOF‐MRA and 3D‐FIESTA‐C sequences were performed to evaluate the three‐dimensional relationship be‐tween trigeminal nerve and blood vessels through the original and reconstructed image .The intraoperative endoscopic findings were set as the gold standard comparing to the manifestations of 3D‐TOF‐MRA and 3D‐FIESTA‐C .Results The sensitivities of 3D‐TOF‐MRA and 3D‐FIESTA‐C for the diagnosis of the existence of responsible vessels were 85 .7% ,89 .3% ,the specificities were 75 .0% , 100% ,and the accuracies were 85 .0% ,90 .0% ,respectively (P=1 .000) .Furthermore ,the sensitivities of 3D‐TOF‐MRA and 3D‐FIESTA‐C for the diagnosis of the existence of responsible arteries were 94 .1% ,88 .2% (P=0 .244) ,while the sensitivities of the responsible veins were 0 .00% and 88 .2% (P=0 .009) .Conclusion Both the 3D‐FIESTA‐C and 3D‐TOF‐MRA sequences can accurately deter‐mine the existence of responsible vessels in trigeminal neuralgia before surgery .3D‐FIESTA‐C sequence is superior to 3D‐TOF‐MRA for presenting the responsible veins ,which can be used as a supplemental diagnostic tool before operation .