Huang Yu, Huang Ying, Xiao Chaoyong, Huang Qingling, Chai Xue
Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China.
J Pain Res. 2024 Aug 5;17:2561-2570. doi: 10.2147/JPR.S465956. eCollection 2024.
This study aims to evaluate the effectiveness of Magnetic Resonance Virtual Endoscopy combined with 3D-FIESTA-c and 3D-TOF-MRA in preoperative assessment of MVD for PTN, with a focus on accurately detecting neuromuscular contact.
We retrospectively analyzed clinical and imaging data from 240 patients with unilateral primary trigeminal neuralgia undergoing MVD surgery between April 2016 and July 2023. Preoperative scans with 3D-FIESTA-c and 3D-TOF-MRA were performed, and MRVE images were obtained to analyze the relationship between the trigeminal nerve and adjacent vessels. Using the findings during microvascular decompression (MVD) surgery as the gold standard, the diagnostic results of 3D-TOF-MRA + 3D-FIESTA-c were considered as group I, while the combined use of MRVE, 3D-TOF-MRA + 3D-FIESTA-c was considered as group II.
In 240 cases, group I had a positive rate of 96.25% and an accuracy rate of 86.25% for identifying responsible blood vessels, while group II had a positive rate of 98.3% and an accuracy rate of 94.17%. There were no statistically significant differences in positive rates between group I and group II, group I and MVD, or group II and MVD (P > 0.05). However, there were statistically significant differences in accuracy rates (P < 0.05). The accuracy for single and multiple arteries with group I was 99.38% and 80.0%, respectively, while with group II, it was 100% and 95.0%. No statistically significant difference was found in accuracy for single or multiple arteries (P>0.05). The accuracy of evaluating responsibility veins with or without other vessels was 52.73% and 80.0%, respectively, with a statistically significant difference (P<0.05).
MRVE combined with 3D-TOF-MRA + 3D-FIESTA-c significantly improves the accuracy of identifying responsibility vessels, especially veins, in preoperative assessment for MVD. This has important clinical implications for preoperative decision-making and surgical planning.
本研究旨在评估磁共振虚拟内镜联合3D-FIESTA-c和3D-TOF-MRA在原发性三叉神经痛微血管减压术（MVD）术前评估中的有效性，重点是准确检测神经肌肉接触情况。
我们回顾性分析了2016年4月至2023年7月期间接受MVD手术的240例单侧原发性三叉神经痛患者的临床和影像数据。术前行3D-FIESTA-c和3D-TOF-MRA扫描，并获取磁共振虚拟内镜（MRVE）图像，以分析三叉神经与相邻血管的关系。以微血管减压术（MVD）手术中的发现为金标准，将3D-TOF-MRA + 3D-FIESTA-c的诊断结果视为I组，而将MRVE、3D-TOF-MRA + 3D-FIESTA-c联合使用视为II组。
在240例病例中，I组识别责任血管的阳性率为96.25%，准确率为86.25%，而II组的阳性率为98.3%，准确率为94.17%。I组与II组、I组与MVD组或II组与MVD组之间的阳性率无统计学显著差异（P > 0.05）。然而，准确率存在统计学显著差异（P < 0.05）。I组对单支和多支动脉的准确率分别为99.38%和80.0%，而II组分别为100%和95.0%。单支或多支动脉的准确率无统计学显著差异（P>0.05）。评估有无其他血管的责任静脉的准确率分别为52.73%和80.0%，有统计学显著差异（P<0.05）。
MRVE联合3D-TOF-MRA + 3D-FIESTA-c可显著提高MVD术前评估中识别责任血管（尤其是静脉）的准确率。这对术前决策和手术规划具有重要的临床意义。
