CAJ | 학술논문

目的：探讨Philips 1.5T磁共振三维时间飞跃稳态梯度回波序列（Three-dimensional time of flight spoiled gradient echo,3d-ToP-sPgr,3d-Tof)与三维平衡式稳态自由进动梯度回波序列（Three-dimensional Balance fast field echo，3d-BffE）对脑干区脑神经及毗邻血管的显示对比，优化原发性及创伤后脑神经病变的患者磁共振检查的扫描方法。方法对50例可疑原发性或创伤后脑神经病变的患者（排除颅内占位、炎症性及脑实质挫裂伤病变）的脑干区同时行3d-Tof及3d-BffE序列扫描，经2名磁共振主治医师采用双盲法分别阅片，评价3d-Tof、3d-BffE以及两种序列图像联合对相应脑神经形态及毗邻血管关系的显示情况，其中重点观察第Ⅲ、Ⅴ、Ⅶ、Ⅷ对颅神经及与其毗邻的血管关系，并进行临床治疗回访，评价上述磁共振扫描方法诊断的准确性。结果评分统计后显示3d-Tof和3d-BffE两种序列图像联合不论是观察神经还是血管的评分均值均高于单选序列；在观察神经方面单选3d-BffE或两种序列图像联合观察的效果评分均较高，与单选3d-Tof序列观察效果差异均显著（P＜0.05），单选3d-BffE与两种序列图像联合观察效果差异不明显(P＞0.05)；在观察血管方面单选3d-Tof或两种序列图像联合观察的效果评分均较高，与单选3d-BffE序列观察效果差异均显著（P＜0.05），单选3d-Tof与两种序列图像联合观察效果差异不明显(P＞0.05)。且2名医师观察后诊断为脑神经血管压迫或高度可疑压迫的患者有9例，其中单选3d-Tof序列观察即可诊断并判定责任血管的1例，单选3d-BffE序列观察可诊断并判定责任血管的有4例，另外有4例需要两种序列图像联合观察、对比才可诊断并判定责任血管。后续随访这9例患者中有7例临床拟诊为脑神经血管压迫并在本院接受手术治疗，并最终被临床确诊。结论在应用Philips 1.5T磁共振仪进行脑干区脑神经检查中，联合应用3d-Tof、3d-BffE序列扫描所获脑神经脑池段的成像效果、观察毗邻血管走行及有无血管压迫的效果均显著优于单选序列，因此在检查时间允许的条件下应推荐行两种序列联合扫描能取得良好的诊断效果，更好地指导临床诊治。目的：探討Philips 1.5T磁共振三維時間飛躍穩態梯度迴波序列（Three-dimensional time of flight spoiled gradient echo,3d-ToP-sPgr,3d-Tof)與三維平衡式穩態自由進動梯度迴波序列（Three-dimensional Balance fast field echo，3d-BffE）對腦榦區腦神經及毗鄰血管的顯示對比，優化原髮性及創傷後腦神經病變的患者磁共振檢查的掃描方法。方法對50例可疑原髮性或創傷後腦神經病變的患者（排除顱內佔位、炎癥性及腦實質挫裂傷病變）的腦榦區同時行3d-Tof及3d-BffE序列掃描，經2名磁共振主治醫師採用雙盲法分彆閱片，評價3d-Tof、3d-BffE以及兩種序列圖像聯閤對相應腦神經形態及毗鄰血管關繫的顯示情況，其中重點觀察第Ⅲ、Ⅴ、Ⅶ、Ⅷ對顱神經及與其毗鄰的血管關繫，併進行臨床治療迴訪，評價上述磁共振掃描方法診斷的準確性。結果評分統計後顯示3d-Tof和3d-BffE兩種序列圖像聯閤不論是觀察神經還是血管的評分均值均高于單選序列；在觀察神經方麵單選3d-BffE或兩種序列圖像聯閤觀察的效果評分均較高，與單選3d-Tof序列觀察效果差異均顯著（P＜0.05），單選3d-BffE與兩種序列圖像聯閤觀察效果差異不明顯(P＞0.05)；在觀察血管方麵單選3d-Tof或兩種序列圖像聯閤觀察的效果評分均較高，與單選3d-BffE序列觀察效果差異均顯著（P＜0.05），單選3d-Tof與兩種序列圖像聯閤觀察效果差異不明顯(P＞0.05)。且2名醫師觀察後診斷為腦神經血管壓迫或高度可疑壓迫的患者有9例，其中單選3d-Tof序列觀察即可診斷併判定責任血管的1例，單選3d-BffE序列觀察可診斷併判定責任血管的有4例，另外有4例需要兩種序列圖像聯閤觀察、對比纔可診斷併判定責任血管。後續隨訪這9例患者中有7例臨床擬診為腦神經血管壓迫併在本院接受手術治療，併最終被臨床確診。結論在應用Philips 1.5T磁共振儀進行腦榦區腦神經檢查中，聯閤應用3d-Tof、3d-BffE序列掃描所穫腦神經腦池段的成像效果、觀察毗鄰血管走行及有無血管壓迫的效果均顯著優于單選序列，因此在檢查時間允許的條件下應推薦行兩種序列聯閤掃描能取得良好的診斷效果，更好地指導臨床診治。
목적：탐토Philips 1.5T자공진삼유시간비약은태제도회파서렬（Three-dimensional time of flight spoiled gradient echo,3d-ToP-sPgr,3d-Tof)여삼유평형식은태자유진동제도회파서렬（Three-dimensional Balance fast field echo，3d-BffE）대뇌간구뇌신경급비린혈관적현시대비，우화원발성급창상후뇌신경병변적환자자공진검사적소묘방법。방법대50례가의원발성혹창상후뇌신경병변적환자（배제로내점위、염증성급뇌실질좌렬상병변）적뇌간구동시행3d-Tof급3d-BffE서렬소묘，경2명자공진주치의사채용쌍맹법분별열편，평개3d-Tof、3d-BffE이급량충서렬도상연합대상응뇌신경형태급비린혈관관계적현시정황，기중중점관찰제Ⅲ、Ⅴ、Ⅶ、Ⅷ대로신경급여기비린적혈관관계，병진행림상치료회방，평개상술자공진소묘방법진단적준학성。결과평분통계후현시3d-Tof화3d-BffE량충서렬도상연합불론시관찰신경환시혈관적평분균치균고우단선서렬；재관찰신경방면단선3d-BffE혹량충서렬도상연합관찰적효과평분균교고，여단선3d-Tof서렬관찰효과차이균현저（P＜0.05），단선3d-BffE여량충서렬도상연합관찰효과차이불명현(P＞0.05)；재관찰혈관방면단선3d-Tof혹량충서렬도상연합관찰적효과평분균교고，여단선3d-BffE서렬관찰효과차이균현저（P＜0.05），단선3d-Tof여량충서렬도상연합관찰효과차이불명현(P＞0.05)。차2명의사관찰후진단위뇌신경혈관압박혹고도가의압박적환자유9례，기중단선3d-Tof서렬관찰즉가진단병판정책임혈관적1례，단선3d-BffE서렬관찰가진단병판정책임혈관적유4례，령외유4례수요량충서렬도상연합관찰、대비재가진단병판정책임혈관。후속수방저9례환자중유7례림상의진위뇌신경혈관압박병재본원접수수술치료，병최종피림상학진。결론재응용Philips 1.5T자공진의진행뇌간구뇌신경검사중，연합응용3d-Tof、3d-BffE서렬소묘소획뇌신경뇌지단적성상효과、관찰비린혈관주행급유무혈관압박적효과균현저우우단선서렬，인차재검사시간윤허적조건하응추천행량충서렬연합소묘능취득량호적진단효과，경호지지도림상진치。
Objective To investigate the use of three-dimensional time of flight spoiled gradient echo (3d-Tof) sequence and three-dimensional balance fast field echo (3d-BffE) sequence for the imaging of the cranial nerves in brain stem and the adjacent vessels by Philips 1.5T mri scanner and to optimize the techniques for screening patients with primary and post-traumatic cranial nerve disorders.Method 3d-Tof sequence and 3d-BffE sequence wereused to visualize the brain stem region in 50 patients who were found to have no intracranial mass lesions or intracranial inflammation. The imaging appearance of the cranial nerves and the adjacent vessels with solely 3d-Tof sequence, solely 3d-BffE sequence, and both sequences were evaluated by two attending physicians experienced in mri diagnosis using a double-blind method. The emphasis was put on the observation of the relation between theⅢ、Ⅴ、Ⅶ andⅧcranial nerves and their adjacent vessels, the follow-up conducted with the clinical treatment, and the evaluation of the accuracy of the above three diagnostic methods.Result The score results given by both physicians were as follows: There was a significant superiority in the qualities of images of nerves and vessels with both sequences, compared with 3d-BffE sequence or 3d-Tof sequence alone. There was a significant superiority in the qualities of images of nerves with 3d-BffE sequence alone or with both sequences, compared with 3d-Tof sequence (P<0.05). There was no significant superiority in the quality of images of nerves with 3d-BffE sequence alone and with both sequences (P>0.05). There was also a significant superiority in the quality of images of vessels with 3d-Tof sequence alone and with both sequences, compared with 3d-BffE sequence (P<0.05). There was no significant superiority in the quality of images of vessels with 3d-Tof sequence alone and with both sequences (P>0.05). There were 9 patients diagnosed as having cranial nerve neurovascular compression or highly suspicious of oppression by 2 attending physicians. among them, there was 1 patient diagnosed by 3d-Tof sequence alone with the identification of responsible vessels. There were 4 patients diagnosed by 3d-BffE sequence alone with the identification of responsible vessels. The other 4 patients needed the diagnosis by combination and comparison with both sequences and 7 out of 9 follow-up patients who received operations in our hospital were confirmed to have cranial nerve neurovascular compression.Conclusion in the examination performed by Philips 1.5T mri scanner, the quality of the images of cranial nerves in cisternal segment with both 3d-Tof sequence and 3d-BffE sequence are significantly better than those with solely one sequence. Thus, if testing time permits, the combination of both sequences is recommended in order to achieve a more accurate diagnosis and guide the clinical treatment.