| Object The pathogenesis of primary trigeminal neuralgia is neurovascular contact,and the relationship between neurovascular and primary trigeminal neuralgia is closely related,and it is also an important indication for microvascular decompression.This study was to investigate the application of multimodal image fusion technology in the diagnosis of primary trigeminal neuralgia and the preoperative visualization of microvascular decompression for primary trigeminal neuralgia.The imaging methods used to diagnose neurovascular contact relationships are mainly 3D-TOF-MRA and 3D-FIESTA/CISS sequence MRI.In the study,3D-slicer was used to perform multimodal image fusion and 3D stereoscopic image reconstruction on 3D-TOF-MRA and 3D-FIESTA/CISS images.The degree of neurovascular contact in microvascular decompression was the gold standard,and The specificity and sensitivity of 3D-TOF-MRA images,3D-FIESTA/CISS images and 3D-slicer multimodal image fusion and three-dimensional reconstruction images for the diagnosis of primary trigeminal neuralgia were analysed.At the same time,through a retrospective study,a logistic multivariate analysis of the incidence of plasma low-density lipoprotein cholesterol,total cholesterol,fasting blood glucose and blood pressure,and vertebral-basal artery tortuous in primary trigeminal neuralgia was analysed to explore the risk factors for primary trigeminal neuralgia and to provide a theoretical basis for preventing and reducing the recurrence rate of trigeminal neuralgia after microvascular decompression.These risk factors may cause neurovascular contact.Methods In the first part,we reviewed the medical records of 45 cases of primary trigeminal neuralgia firstly.All patients had complete case data and underwent microvascular decompression.The original cranial magnetic resonance DICOM files,surgical records,surgical videos,and intraoperative photographs of all subjects were collected.Secondly,multimodal image fusion and 3D reconstruction of 3D-FIESTA/CISS and 3D-TOF-MRA sequence MRI images of 45 subjects with primary trigeminal neuralgia were performed using 3D-slicer.The specific method is to extract the information of pons and trigeminal nerve from the 3D-FIESTA/CISS image,extract the vertebral-basal artery vascular information from the 3D-TOF-MRA image,and use 3D-slicer for image fusion and reconstruction into three-dimensional Visualize the image.Then,according to the criteria of neurovascular relationship,3D-TOF-MRA,3D-FIESTA/CISS,3D-slicer multimodal images three-dimensional stereoscopic reconstruction and intraoperative videos were read by senior radiologists and senior neurosurgeons respectively.The neurovascular relationships were analyzed and determined,and the degree of neurovascular contact was recorded.Finally,with the degree of intraoperative neurovascular contact as the state variable,with positive contact as the tangent point,3D-TOF-MRA,3D-FIESTA/CISS and 3D-slicer multimodal image fusion reconstructed three-dimensional image was used as a test variable,and the ROC curve analysis was performed on the three diagnostic methods.The specificity and sensitivity of the three methods in the diagnosis of primary trigeminal neuralgia were compared.In the second part,218 cases of primary trigeminal neuralgia and 228 control subjects were retrieved.General conditions of age,gender,and characteristics of primary trigeminal neuralgia in all subjects were reviewed,and volue of plasma low-density lipoprotein cholesterol,total cholesterol,and fasting blood glucose,blood pressure,and vertebral-basal artery tortuosity in all subjects were extracted.Secondly,chi-square test was performed on the plasma low-density lipoprotein cholesterol,total cholesterol,fasting blood glucose and blood pressure ratios in the two groups.Logistic multivariate analysis of plasma low-density lipoprotein cholesterol,total cholesterol,fasting blood glucose,and blood pressure was performed.Combined with magnetic resonance angiography,the chi-square decompression and rank sum test were performed on the primary trigeminal neuralgia and the vertebral-basal artery tortuosity ratio and the degree of tortuosity in the control group.The degree of vertebral-basal artery distortion was analyzed between the control group and the control group.Finally,according to the results of Logistic multivariate analysis,chi-square test and rank sum test,the risk factors of primary trigeminal neuralgia were determined.Result In the first part,Kappa analysis shows that senior radiologists and senior neurosurgeons had a consistent agreement on neurovascular relationships in 3D-TOF-MRA,3D-FIESTA/CISS,3D-slicer multimodal three-dimensional stereoscopic reconstruction images and intraioperative videos.The judgment of the neurovascular relationship was consistent.The Kappa values for the neurovascular relationship in the 3D-TOF-MRA image were 0.937 on the left side and 0.740 on the right side.The Kappa values for the neurovascular relationship in the 3D-FIESTA/CISS images were 0.773 on the left and 0.845 on the right.The Kappa values for the neurovascular relationship in the 3D stereo images reconstructed from the 3D-slicer multimodal image were 0.850 on the left side and 0.757 on the right side,both higher than 0.7.The Kappa value of the two senior neurosurgeons for the determination of intraoperative neurovascular relationships was 0.556,which was determined by the degree of neurovascular contact determined by two senior neurosurgeons.The above determination results are built into a database for ROC curve analysis.With positive contact as the tangent point,3D-TOF-MRA,3D-FIESTA/CISS,3D-slicer multimodal three-dimensional stereoscopic reconstruction images used as a test variable,the neurovascular relationship in microvascular decompression as a state variable,plot the ROC curve,and calculate the area under the curve to determine the specificity and sensitivity of the three imaging diagnostic methods.The results show that the area under the 3D-TOF-MRA ROC curve is 0.518,the area under the curve of 3D-FIESTA/CISS is 0.584,and the area under the curve of the 3D-slicer image reconstruction is 0.649.In the ROC curve,the area under the curve of the 3D-slicer multimodal image fusion reconstructed image is the largest.In the diagnosis of primary trigeminal neuralgia,3D-slicer multimodal image fusion reconstruction images have better specificity and sensitivity.The study also found that,in combination with 3D printing,3D-slicer multimodal image fusion reconstruction images can be used to simulate microvascular decompression.The 3D-slicer multimodal image fusion reconstruction image combined with the diffusion tensor fiber bundle imaging can show the compression of the fiber bundle,which can directly reflect the degree of neurovascular contact,and provide a basis for the diagnosis of primary trigeminal neuralgia.In the second part,there were no significant differences in age and gender between the two groups in 218 patients with primary trigeminal neuralgia and 228 control subjects(P values of 0.073 and 0.248,respectively).An independent sample t-test of low-density lipoprotein cholesterol,total cholesterol,fasting blood glucose,systolic blood pressure,and diastolic blood pressure in the primary trigeminal neuralgia group and the control group showed significant statistical differences between the two groups(P values are 0.001,0.006,0.000,0.014,and 0.004 respectively.In the primary trigeminal neuralgia group and the control group,the chi-square test for high-low-density lipoprotein cholesterol was suggested to be statistically significant(X2 = 0.248,P = 0.015),high-low-density lipoprotein cholesterol.Hemorrhage is a risk factor for primary trigeminal neuralgia(OR = 1.480,95% CI 1.013 to 2.163).The chi-square test for hypercholesterolemia showed a statistically significant difference between the two groups(X2 = 7.347,P = 0.007).Hypercholesterolemia was a risk factor for PTN(OR = 1.700,95% CI 1.157~)2.497).A chi-square test for hyperglycemia showed a statistically significant difference between the two groups(X2 = 23.445,P = 0.000).Hyperglycemia was a risk factor for primary trigeminal neuralgia(OR = 3.841,95)% CI 2.170 to 6.801).A chi-square test was performed on the rate of hypertension.The results showed a statistically significant difference between the two groups(X2 = 6.415,P = 0.011).Hypertension was a risk factor for PTN(OR = 1.721,95% CI 1.129 to 2.624).Statistical results suggest that high and low-density lipoprotein cholesterol,high total cholesterol,high fasting blood glucose and high blood pressure are risk factors for primary trigeminal neuralgia.In the magnetic resonance imaging of the primary trigeminal neuralgia group and the control group,the chi-square test was performed on the ratio of vertebral-basal artery tortuosity.The results showed statistical differences between the two groups.The rate of vertebral-basal artery tortuosity in the primary trigeminal neuralgia group was higher than that in the control group.A rank-sum test was performed on the degree of vertebral-basal artery tortuosity.The results showed statistical differences between the two groups.The degree of vertebral-basal artery distortion in the primary trigeminal neuralgia group was higher than that in the control group(P = 0.001).Conclusion 1.Multi-modal image fusion three-dimensional reconstruction of 3D-FIEASTA/CISS and 3D-TOF-MRA images using 3D slicer can improve the diagnosis of neurovascular contact in primary trigeminal neuralgia;2.Multi-modal image fusion three-dimensional reconstruction of 3D-FIEASTA/CISS and 3D-TOF-MRA images using 3D slicer combined with 3D printing technology can be used for preoperative simulation and preoperative planning in microvascular decompression of primary trigeminal neuralgia;3.Multi-modal image fusion three-dimensional reconstruction of 3D-FIEASTA/CISS and 3D-TOF-MRA images using 3D slicer have broad prospects in the treatment of primary trigeminal neuralgia with microvascular decompression;4.The incidence of primary trigeminal neuralgia is associated with high and low-density lipoprotein cholesterol,high total cholesterol,high fasting blood glucose and high blood pressure.High and low-density lipoprotein cholesterol,high total cholesterol,high fasting blood glucose and high blood pressure are primary.Risk factors for the onset of sexual trigeminal neuralgia;5.The proportion and extent of vertebral-basal artery tortuosity in primary trigeminal neuralgia are higher than those in the control group,which is one of the causes of neurovascular contact. |
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