CAJ | 학술논문

目的：评价双激发平衡式稳态自由进动(3D-FIESTA-C)序列曲面重建(curvature plane reconstruction，CPR)在血管压迫性三叉神经痛(trigeminal neuralgia，TN)及面肌痉挛(hemifacial spasm，HFS)的应用价值。材料与方法对临床诊断的48例TN及33例HFS患者进行3D-FIESTA-C扫描，经后处理工作站进行CPR，分析判断症状侧血管神经关系，81例患者中65例与手术结果对照，并对结果的一致性采用Kappa分析。结果81例经CPR判断血管神经无接触8例，接触25例，压迫48例，在接触及压迫病例中患侧脑池间距较对侧窄小者33例，脑干变形12例，2名医师对65例3D-FIESTA-C以及联合曲面重建结果与微血管减压术(microvascular decopression，MVD)术后的Kappa一致性检验结果(K值分别为0.790、0.622、0.755)，3D-FIESTA-C及联合CPR检测责任血管的灵敏度分别为83.08%、96.92%，特异度分别为93.00%、75%，阳性预测值分别为98.10%、94.02%，阴性预测值分别为57.69%、85.71%。结论3D-FIESTA-C CPR能够对血管神经解剖关系提供更为全面准确的观察视角，可为术前评估及病因诊断提供重要依据。
목적：평개쌍격발평형식은태자유진동(3D-FIESTA-C)서렬곡면중건(curvature plane reconstruction，CPR)재혈관압박성삼차신경통(trigeminal neuralgia，TN)급면기경련(hemifacial spasm，HFS)적응용개치。재료여방법대림상진단적48례TN급33례HFS환자진행3D-FIESTA-C소묘，경후처리공작참진행CPR，분석판단증상측혈관신경관계，81례환자중65례여수술결과대조，병대결과적일치성채용Kappa분석。결과81례경CPR판단혈관신경무접촉8례，접촉25례，압박48례，재접촉급압박병례중환측뇌지간거교대측착소자33례，뇌간변형12례，2명의사대65례3D-FIESTA-C이급연합곡면중건결과여미혈관감압술(microvascular decopression，MVD)술후적Kappa일치성검험결과(K치분별위0.790、0.622、0.755)，3D-FIESTA-C급연합CPR검측책임혈관적령민도분별위83.08%、96.92%，특이도분별위93.00%、75%，양성예측치분별위98.10%、94.02%，음성예측치분별위57.69%、85.71%。결론3D-FIESTA-C CPR능구대혈관신경해부관계제공경위전면준학적관찰시각，가위술전평고급병인진단제공중요의거。
Objective: To evaluate the application value of doubly excited Balance-SSFP sequence Curvature Plane Reconstruction (CPR) in vascular compressive Trigeminal Neuralgia (TN) and Hemifacial Spasm (HFS).Materials and Methods:Forty-eight cases with Trigeminal Neuralgia (TN) and thirty-three cases with Hemifacial Spasm (HFS) were accepted 3D-FIESTA-C scanning. The origin images were post-processed with Curvature Plane Reconstruction (CPR) on workstation. Relationship between vessels and nerves was analyzed in symptomatic side. Sixty-five out of 81 cases were compared with surgery result, and 2 magnetic resonance physicians evaluated consistency test of result through Kappa analysis.Results: Eighty-one cases through Curvature Plane Reconstruction (CPR) show that contactless of vessels and nerves were found in 8 patients, contact of vessels and nerves were found in 25 patients and oppression were found in 48 patients. In the cases of contact and oppression, 33 cases indicated that the spacing of side cistern was narrow compared with contralateral ones, and 12 cases of brain stem showed deformation. The Kappa consistency test result between CPR result and post-operation of MVD result for 65 cases done by 2 physicians was that (K values were 0.837 and 0.787 respectively), 3D-FIESTA-C combined with CPR showed source of responsible vessels, oppression position and level of nerve oppression. The sensitivity was 96.92%, specificity was 75%, PPV was 94.02% and NPV was 85.71%.Conclusion: Doubly excited Balance-SSFP sequence CPR can provide a more comprehensive and accurate viewing angle for vessels and nerves anatomy relations, and offer important evidence for pre-surgery evaluation and etiological diagnosis.