Anatomical Imaging Of Vessels And Nerves And Brain Functional Study In Patients With Trigeminal Neuralgia

Part ?: Evaluation of vascular nerve compression degreepatients with trigeminal nueralgia based on MRI subtraction andObjective To explore the clinical value of Magnetic Resonance Subtraction and Virtual endoscope imaging in patients with trigeminal neuralgia.Materials and Methods 55 cases of trigeminal neuralgia were collected and the 3D-TOF-MRA sequence and 3D-B-FFE sequence of cranial nerve were collected.MR subtraction was performed on EWS workstation.According to the formula "the result of subtraction = B sequence(3D-TOF-MRA sequence)-A sequence(3D-B-FFE sequence)* weight",the weight value was 0.8.The 3D-B-FFE sequence was imported into GE CT adw4.4 workstation to perform virtual endoscopy imaging.The method of judging the relationship between neurovascular compression according to the "3D-TOF-MRA+3D-B-FFE sequence" is recorded as "routine method",and a "subtraction method" is recorded according to the method of "MR subtraction sequence",and the method of "endoscopy" is recorded according to the method of "virtual endoscopy".2 experienced radiologists evaluated the relationship of neurovascular compression according to these 3 methods,and the compression relationship was divided into(1)non contact;(2)contact without deformation;(3)contact deformation.Then 1 statisticians compared the image evaluation results with the operation conditions(gold standard)to calculate the sensitivity and specificity of each method,and then compared the differences between the sensitivity and the difference between the conventional method and the subtraction method,the conventional method and the endoscope method,and then judged the two kinds of differences.The clinical application value of the method.Results This study found that the sensitivity and specificity of "conventional method" and "gold standard" were 62.9%/88.1%,and the sensitivity and specificity of judging "oppression without deformation" and "oppression and deformation" were 81.8%/81.8% and 100%/97.8% respectively.There was no significant difference in the sensitivity and specificity between the "subtraction" and "golden standard" in assessing the relationship between the three kinds of oppression.55 cases were reconstructed by virtual endoscopy,and 29 cases were successfully reconstructed.In the 29 successful reconstruction cases,the results of evaluation of the relationship between nerve and blood vessels were recorded as "endoscopy".In contrast to "endoscopy" and "gold standard",the sensitivity and specificity of "no oppression","oppression and no deformation" and "oppression and deformation" were 62.5%/85.7%,82.3%/66.7% and 75%/100%,respectively.There was no significant difference in the sensitivity and specificity between the "endoscopic method" and "conventional method" in assessing the relationship between the three kinds of compression.Conclusion In assessing the relationship between neurovascular compression,the MR subtraction sequence has the same diagnostic value as "3D-B-FFE sequence +3D-TOF-MRA sequence",which has the advantages of 3D-B-FFE sequence and 3D-TOF-MRA sequence.The large artery is high signal,the nerve is in the same signal and the cerebrospinal fluid is low signal.The contrast of the image and the background are significantly improved.The interference is small.Endoscopic reconstruction has the same diagnostic value as "3D-B-FFE sequence".Endoscopy images can help neurosurgeons to understand the spatial position of nerve vessels before operation,make surgical procedures and save the time of intraoperative exploration,but the success rate of virtual endoscopic reconstruction is low,and the technical difficulty is great.Part ? The study of Resting-state Functional Magnetic Resonance Imaging in patients with trigeminal neuralgia.Objective To study the changes of resting state activity and pain network in functional brain regions of patients with TN,and further explore the mechanism of central pathogenesis.Materials and Methods The difference between Amplitude of Low Frequency Fluctuations of the TN patients and the normal control group was compared,and the brain functional connection was carried out in the differential brain region,and the 18 seed points in the ALFF and FC differential brain regions were extracted,and the 18 seed points were analyzed by the Multivariable Granger causality analysis(GCA),to study the central pain transduction pathway of TN,and further explore the pathogenesis of armature disease.Results In group TN,compared with group NC,ALFF analysis showed that the function of left superior side gyrus and right posterior central gyrus in TN patients were inhibited.FC analysis mainly found that the connection between the seeds of the right posterior central gyrus and the bilateral central posterior gyrus was reduced,the connection between the right thalamus increased,the FC between the seed point of the left top and the right posterior central gyrus was reduced,the FC between the bilateral thalamus increased,and the FC between the left superior frontal gyrus increased,and the left upper gyrus,the upper gyrus,and the left upper gyrus,FC increased between the left anterior lobe and increased FC between the left hippocampus.The Granger causality analysis between the 18 seed points found that the FC of the left hippocampus increased,the FC of the left anterior lobe to the posterior central gyrus increased,the FC decreased to the ipsilateral thalamus,and the functional connection of the left thalamus to the left Parietal_Sup was increased.Conclusion By ALFF,FC,and Granger causality analysis,TN patients were associated with pain related brain area activity / functional connections in TN patients,including thalamus,primary somatosensory,marginal system and joint region,and the complex mechanism of pain regulation,involving memory,information processing,and cognitive activities.There is a cross regulation in the multi brain regions.The core brain areas of neuropathic pain include S1,S2,ACC,thalamus,and the anterior part of IC.The "default network" responsible for emotion and cognition is also involved,such as the frontal and marginal systems.TN is similar to other brain regions with activation / inhibition of neuropathic pain,but the difference in functional connectivity between brain regions is unclear.