血管压迫性面肌痉挛的磁共振断层血管成像(MRTA)表现及其诊断价值.doc

血管压迫性面肌痉挛的磁共振断层血管成像（MRTA）表现及其诊断价值 杨柳青，张磊，张冬，文利（400037 重庆，第三军医大学新桥医院放射科） [摘要] 目的 分析原发性面肌痉挛（hemifacial spasm，HFSmagnetic resonance tomographic angiography，MRTAMRTA显示面听神经与周围血管的三维空间关系的能力，探讨MRTA对血管压迫性面肌痉挛的诊断价值。 方法 回顾分析210例临床诊断HFS者的临床及MR资料，并与80例手术结果进行对照分析。结果 210例患者中，单侧症状205例，双侧症状5例，共计症状侧215侧，MRTA显示204侧有阳性表现，其中血管压迫面神经109侧，血管与面神经接触86侧，9侧为可疑接触，阳性率为94.9%；非症状侧205侧，MRTA显示血管压迫12侧，血管与神经接触23侧，可疑接触6侧，共41侧，阳性率为20%。症状侧与非症状侧在血管与面神经解剖关系上，差异有统计学意义(P0.05)。手术患者80例,均为单侧发病，其中76例术前MRTA 显示为血管压迫或接触，其中72例责任血管为动脉（单支63例，两支7例，多支2例），2例为静脉，2例为动静脉双重责任血管，未见责任血管4例；手术中发现78例血管压迫或接触者，其中68例责任血管为动脉（单支57例，两支9例，多支2例），5例为静脉，5例为动静脉双重责任血管，未见责任血管2例，其中71例术前MRTA与术中所见完全相符。MRTA诊断神经血管压迫、接触的灵敏度为96.2% (75/78)，诊断符合率95% (76/80)，HFS患者症状与血管是否压迫或接触面神经有显著相关性（P＜0．01）。4例MRTA阴性患者，手术中证实3例存在静脉责任血管。结论 MRTA是一种无创、有效术前诊断HFS病因的影像学检查方法，可清楚显示面神经与周围血管的空间关系，为术前筛选、术中探查责任血管，提高手术疗效等提供了可靠的影像学依据。 [关键词] 面肌痉挛；MRI；磁共振断层血管成像；血管压迫；血管减压术 MRTA imaging of vascular compressive hemifacial spasm and its diagnostic value Yang Liuqing，Zhang Lei，Zhang Dong，Wen Li（Department of Radiology，Xinqiao Hospital,Third Military Medical University，Chongqing，400037，china） [Abstract] Objective To analyze MRTA imaging of Idiopathic hemifacial Spasm, to evaluate the ability of displaying three dimensional relationship between facial nerve and the adjacent blood vessels by using MRTA and to discuss the diagnostic value of MRTA in vascular compressive hemifacial Spasm. Methods Clinical and MR data of 210 HFS patients were reviewed retrospectively and then were compared with 80 operation results. Results 205 of the 210 patients presented unilateral symptoms, 5 with bilateral symptoms. A total of 215 symptomatic sides were found, among which 204 sides expressed positive phenotype as MRTA displays, positive rates reaching 94.9% (109 with vascular compression on facial nerve, 86 with vascular and facial nerve contacts and 9 sides with dubious contacts). Meanwhile, the non-symptomatic sides were 205. Under MRTA imaging, 12 sides