三叉神经形态学定量评价对原发性三叉神经痛的诊断价值

Diagnostic value of quantitative evaluation of trigeminal nerve morphology in primary trigeminal neuralgia

摘要:

目的：比较原发性三叉神经痛患者与健康人群双侧桥前池段三叉神经形态学参数（体积和横截面积）的差异，分析上述形态学指标与患者疼痛程度及病程的相关性。方法：本研究共纳入43例三叉神经痛患者和年龄、性别匹配的健康受试者，采用三维稳态采集快速成像和三维时间飞跃血管成像扫描序列获取桥前池段颅神经和血管图像，并使用医学影像处理、分析与可视化软件（medical image processing，analysis，and visualization，MIPAV）测定三叉神经的体积和横截面积，将上述形态学参数与视觉模拟评分（visual analog scale，VAS）和病程进行相关分析。结果：三叉神经痛患者组疼痛侧三叉神经体积[（62.15±8.92） mm3]和横截面积[（3.90±0.57） mm2]明显小于非疼痛侧[体积：（80.93±10.01） mm3，横截面积：（5.05±0.63） mm2]和健康对照组[体积：（78.10±6.47）mm3，横截面积：（4.91±0.39） mm2；F体积=53.920，P=0.001；F横截面积=52.519，P=0.001]，而非疼痛侧神经形态学参数与对照组没有统计学差异。同时，疼痛侧三叉神经横截面积（r=-0.643，P=0.001）和体积（r=-0.608，P=0.001）与VAS呈线性负相关，与病程仅有相关趋势。结论：三叉神经痛患者组疼痛侧三叉神经的萎缩程度可能成为评价患者临床症状的一项影像学指标。

Abstract:

Objective：To compare the volume（V） and cross-sectional area（CSA） of the trigeminal nerves（TGNs） of the symptomatic side and the asymptomatic side in patients with and without primary trigeminal neuralgia（PTN），and to analyze the correlation between the above morphological parameters and the degree of facial pain and disease duration in PTN patients. Methods：43 PTN patients and 43 age- and gender-matched healthy volunteers were recruited in the study，all of the participants underwent three-di－mensional fast imaging employing steady state acquisition（3D-FIESTA） and time-of-flight magnetic resonance angiography（TOF-MRA）. CSA and V of the TGNs were calculated using medical image processing，analysis，and visualization（MIPAV） software. Correlation of the above morphological parameters and visual analog scale（VAS） with disease duration in PTN group was analyzed. Results：V[（62.15±8.92） mm3] and CSA[（3.90±0.57） mm2] of the symptomatic TGN were signi cantly smaller than in the asymp－tomatic TGN in patients[V：80.93±10.01） mm3，CSA：（5.05±0.63） mm2] and bilateral sides in controls[V：（78.10±6.47） mm3，（4.91±0.39） mm2；FV=53.920，P=0.001；FCSA=52.519，P=0.001]. No statistical differences were detected between morphological data of the asymptomatic TGN and control TGNs. CSA（r=-0.643，P=0.001） and V（r=-0.608，P=0.001） of the symptomatic TGN had nega－tive correlation with VAS scores and showed a tendency（al－though not statistically signi cant） to have correlation with dis－ease duration in PTN patients. Conclusion：Degree of atrophy in the symptomatic TGN may become one of the imaging indicators for evaluating facial pain in PTN.