【作者】 程玉书；

【导师】 周正荣； 丁建辉； 谭德炎； 胡超苏；

【作者基本信息】 复旦大学 ， 影像医学与核医学， 2008， 硕士

【摘要】 【第一部分】多序列MR成像技术在显示正常Ⅲ-Ⅻ对脑神经中的比较研究目的:比较3D-FIESTA(three-dimensional fast imaging employing steady-stateacquisition,三维快速稳态进动成像)序列(有效层厚1mm)、2D-FSE序列(层厚2mm)、3D-FSE序列(有效层厚1mm)T2WI及2D-SE序列T1WI(层厚2mm)在显示正常Ⅲ-Ⅻ对脑神经脑池段中的应用价值,探讨适于显示脑神经的MR成像方法。材料和方法:选择26例健康志愿者应用GE公司1.5T超导双梯度MR成像仪分别进行3D-FIESTA,3D-FSE序列(有效层厚1mm)和2mm层厚2D-FSE序列T2加权相及2D-SE序列T1加权像横断面扫描。由两名资深放射科医生分别对所得4种序列图像中的52侧(26对)Ⅲ-Ⅻ对脑神经在脑池段的显示情况进行分析。结果:本组26位志愿者在4种扫描序列(3D-FIESTA,3D-FSET2WI,2D-FSE T2WI,2D-SE TIWI)方法中,三叉神经主干、面神经及前庭蜗神经均能100%显示。仅3D-FIESTA序列能显示部分滑车神经(23%)。在动眼神经,三叉神经上颌支、下颌支及展神经的显示中,3D-FIESTA=3D-FSE＞2D-FSE＞2D-SE,P＜α’=0.05/6(0.0083),具有统计学意义。在三叉神经下颌支显示中,3D-FIESTA=3D-FSE＞2D-FSE=2D-SE。在后组颅神经舌咽-迷走-副神经复合体和舌下神经的显示中,分别为3D-FIESTA＞3D-FSE＞2D-FSE＞2D-SE,和3D-FIESTA＞3D-FSE＞2D-FSE=2D-SE,P＜α=0.05/6(0.0083),具有统计学意义。结论:在Ⅲ-Ⅻ对脑神经脑池段的显示中,3D-FIESTA、3D-FSE和2D-FSE序列T2WI对大多数脑神经均能较好显示。在滑车神经、舌咽-迷走-副神经复合体及舌下神经的显示方面,3D-FIESTA序列扫描优于3D-FSE序列。动眼神经,三叉神经眼支、上颌支和下颌支,展神经,舌咽-迷走-副神经复合体及舌下神经的显示方面,3D-FIESTA和3D-FSE序列T2WI优于2D-FSE序列T2WI。2D-SE序列TIWI除三叉神经主干和面神经及前庭蜗神经能较好显示外,其他脑神经均显示困难,较3D-FIESTA,3D和2D FSE序列T2WI显示差。【第二部分】3D-FIESTA序列MR成像技术在脑神经直径测量中的初步研究目的:应用3D-FIESTA序列进行Ⅲ,Ⅴ,Ⅴ1,Ⅴ2,Ⅴ3,Ⅵ,Ⅶ,Ⅷ,及Ⅸ-Ⅺ对脑神经脑池段直径测量研究,获得正常数据标准。材料和方法:选择40例成年健康志愿者和45例无脑神经症状及脑神经异常MR表现的患者进行3D-FIESTA序列横断面扫描,应用eFilm 2.0软件在横断面上对每位受检者两侧清晰显示的动眼神经(脚间池段起始部)、三叉神经根部、三叉神经节眼支、上颌支和下颌支,Ⅵ,Ⅶ,Ⅷ,及Ⅸ-Ⅺ对脑神经脑池段直径进行测量。统计各对脑神经的直径均数和范围。统计比较85对脑神经左右两侧直径是否存在统计学差异。男、女两组间各对脑神经直径是否具有统计学差异。结果:动眼神经(脚间池段起始部),三叉神经根部,三叉神经节眼支、上颌支、下颌支,面神经、前庭窝神经和舌咽-迷走-副神经的复合体上干直径均值(中位数)分别为右Ⅲ2.58mm,左Ⅲ2.72mm;右Ⅴ3.32mm,左Ⅴ3.38mm;右Ⅵ1.60mm,左Ⅵ1.72mm,右Ⅶ1.52mm,左Ⅶ1.56mm;右Ⅷ2.00mm,左Ⅷ2.00mm;右Ⅸ-Ⅺ1.52mm,左Ⅸ-Ⅺ1.33mm。各对脑神经左、右两侧未见明显统计学差异。面神经左、右两侧直径粗细在男、女两组间存在统计学差异(P＜0.05),男性组均高于女性组,其余各对脑神经直径在男、女性别组间不存在统计学差异。三叉神经在三叉神经节的三个分支直径均数(中位数)分别为右Ⅴ1 1.81mm,左Ⅴ1 1.75mm;右Ⅴ2 1.79mm;左Ⅴ2 1.77mm;右Ⅴ3 1.93mm;左Ⅴ3 2.10mm。结论:3D-FIESTA能够较好地显示Ⅲ,Ⅴ-Ⅺ对脑池段脑神经,可用于脑神经直径的测量。面神经解剖变异较大,在评价面神经直径异常时,应考虑性别因素的影响。【第三部分】3D-FIESTA序列与增强后快速扰相梯度回波序列MR成像技术在头颈部肿瘤三叉神经侵犯中的对比研究目的:探讨3D-FIESTA序列与增强后快速扰相梯度回波(FSPGR)序列MR成像技术在头颈部肿瘤三叉神经侵犯中的应用价值,对比分析两种方法中三叉神经侵犯的MRI特征。材料和方法:16例出现三叉神经损害临床症状患者应用1.5T超导双梯度MR成像仪分别进行不增强3D-FIESTA横断面扫描(并进行多平面重建)和增强快速扰相梯度回波(FSPGR)脂肪抑制序列T1WI横断面及冠状面成像。由两名资深放射科医生重点观察和评价三叉神经脑池段,海绵窦段,圆孔及翼腭窝内上颌神经,卵圆孔及咀嚼肌间隙内下颌神经的侵犯情况,并对两种方法中神经侵犯的显示情况进行等级评分(1级:不能显示;2级:可以显示;3级:清晰显示),对比研究两种方法显示三叉神经侵犯情况。并应用eFilm 2.0软件测量增强FSPGR序列中可清晰显示的圆孔(或翼腭窝)及卵圆孔内病变上颌神经和下颌神经直径。结果:3D-FIESTA序列和增强FSPGR序列T1WI两种方法均能较好显示脑池段三叉神经的侵犯(两种方法不存在统计学差异,P＞0.05)。在脑池段外(海绵窦、圆孔、卵圆孔、翼腭窝和咀嚼肌间隙)三叉神经侵犯的清晰显示上增强FSPGR序列T1WI优于3D-FIESTA序列(P＜13.05)。增强FSPGR序列显示受侵的三叉神经及其分支表现为明显强化的肿块或结节影,低信号结节影和边缘强化中央呈低信号的“靶环样”改变。3D-FIESTA序列上病变主要表现为低信号结节或肿块影,以及神经孔道(圆孔、卵圆孔、翼腭窝和咀嚼肌间隙)的不规则扩大,正常脂肪信号消失,被低信号软组织影取代。增强FSPGR序列上圆孔及卵圆孔内病变上颌神经和下颌神经直径中位数和范围分别为4.435mm(3.2-6.7)和6.365mm(3.67-7.7)。结论:不增强3D-FIESTA序列能够很好地显示脑池段内正常和受侵犯的三叉神经,但在脑池段外三叉神经侵犯的显示上不如增强FSPGR序列T1WI。3D-FIESTA序列和增强FSPGR序列T1WI两种方法联合应用能更好地观察各段三叉神经的侵犯情况及其不同的MR表现。增强FSPGR序列T1WI上可见圆孔及卵圆孔内病变上颌神经和下颌神经直径明显增粗。更多还原

【Abstract】 【Part 1】Values of 3D-FIESTA,2D T1-weighted SE,2D and 3D T2-weighted FSE MR sequences on visualization of cranial nervesⅢ-Ⅻin their intracisternal segmentsObjective:To evaluate the sensitivities of three-dimensional(3D) fast imaging employing steady-state acquisition(3D-FIESTA) sequence(effective slice thickness 1mm) and three-and two-dimensional T2-weighted fast spin echo(FSE) sequences, and two-dimensional(2D) T1-weighted spin echo(SE) sequence(slice thickness 2mm) for the visualization of cranial nervesⅢ-Ⅻin their cisternal courses. Methods:Twenty-six healthy volunteers underwent MR examinations by using the 3D-FIESTA,2D and 3D T2-weighted FSE sequences,and 2D T1-weighted SE sequences.Two radiologists evaluated independently the cranial nerves(CN)Ⅲ-Ⅻin their cisternal courses.Results:The rates for visualization of CNⅤ,ⅦandⅧfor the four sequences were 100%(52/52).The cranial nerveⅣwas only revealed on the images by using 3D-FIESTA sequence with a rate for visualization of 23%.The rates of visualization on cranial nervesⅢ,Ⅴ2,Ⅴ3,Ⅵwith the 3D-FIESTA sequence was higher than those of 3D FSE sequence without statistic difference.And the 3D FSE sequence was better than 2D FSE and even more better than 2D SE in the rates of visualization for the above cranial nerves(P＜α=0.05/6).The rates for visualization of nervesⅨ-Ⅺcomplex andⅫfor the four sequences showed respectively: 3D-FIESTA＞3D FSE＞2D FSE＞2D SE and 3D FIESTA＞3D FSE＞2D FSE=2D SE(P＜α=0.05/6).Conclusions:Most of the cranial nervesⅢ-Ⅻin their cisternal courses can be reliably assessed when using the 3D-FIESTA,3D FSE and 2D SE T2WI sequences.Using 3D-FIESTA sequence is superior to increasing the rates of visualization of nervesⅣ,Ⅸ-ⅪandⅫthan that by using T2-weighted 3D FSE sequences.The 3D-FIESTA and 3D FSE T2WI sequence are superior to increasing the rates of visualization on cranial nervesⅢ,Ⅴ1,Ⅴ2,Ⅴ3,Ⅵ,Ⅸ-ⅪandⅫthan that of 2D FSE T2WI sequence.Except for cranial nervesⅤ,ⅦandⅧ,the 2D SE T1-weighted sequence is difficult to indicate the others of cranial nervesⅢ-Ⅻ.Part 2 Essential study on the diameter measurement of cranial nervesⅢ,Ⅴ,Ⅵ,Ⅶ-ⅧandⅨ-Ⅺcomplex in their cisternal segments by using 3D-FIESTA sequence MR imagingObjective:To measure the diameters of the cranial nervesⅢ,Ⅴ,Ⅵ,Ⅶ-ⅧandⅨ-Ⅺcomplex in their cisternal segments by using the three dimensional fast employing steady-state acquisition sequence(3D FIESTA sequence) so as to obtain the normal data as a reference.Methods:Forty healthy volunteers and forty-five patients without clinical symptoms and abnormal MRI appearances associated to cranial nerves underwent MR scans by using the 3D-FIESTA sequence.On the transversal images,measurement of the diameters of the cranial nervesⅢ,Ⅴ,Ⅵ,Ⅶ-ⅧandⅨ-Ⅺcomplex in their cistemal segments was performed.And the differences of the diameters of the above cranial nerves were tested according to the sex and left or right sides.Results:The median diameters of the right and left sides of the above cranial nerves exhibited as follow respectively:CNⅢfor 2.58mm and 2.72mm,CNⅤfor 3.32mm and 3.38mm,CNⅥfor 1.60mm and 1.72mm,CNⅦfor 1.52mm and 1.56mm,CNⅧfor 2.00mm and 2.00mm,and CNⅨ-Ⅺfor 1.52mm and 1.33mm.There was no statistical difference between the right and left sides of the cranial nervesⅢ,Ⅴ,Ⅵ,Ⅶ-ⅧandⅨ-Ⅺcomplex(P＞0.05).The diameter of the cranianl nerveⅦin males was larger than that of females with a statistical difference(P＜0.05).The median diameters of the right and left sides of CNⅤ1-Ⅴ3 were respectively CNⅤ1 1.81mm and 1.75mm,CNⅤ2 1.79 mm and 1.77mm,CNⅤ3 1.93mm and 2.10mm.Conclusions:The 3D-FIESTA MR sequence seems to be suitable to indicate the cranial nervesⅢ,Ⅴ,Ⅵ,Ⅶ-ⅧandⅨ-Ⅺcomplex in their cisternal courses and may be used in the diameter measurement. Because of a great anatomic variance in the cranial nerveⅦ,we should keep an eye on the sex factor in the evaluation of the abnormality of diameter mesurement of the nerveⅦ.Part 3 Infiltration of the trigeminal nerve by head and neck neoplasms: comparative analysis by using the 3D-FIESTA and gadalinium-enhanced FSPGR MR sequencesObjective:To evaluate the value of the three dimensional fast employing steady-state acquisition(3D-FIESTA) sequence MR imaging in the detection of the trigeminal nerve invasion in head and neck neoplasms in comparison to gadalinium-enhanced FSPGR T1-weighted imaging(T1WI) with fat-saturation and to analyze the MR features of perineural spread(PNS) of the trigeminal nerve by using the two sequences.Methods:Sixteen patients with head and neck neoplasms and symptoms of impairment of the trigeminal nerve underwent MR examinations by using the 3D-FIESTA sequence and gadalinium-enhanced FSPGR T1W imaging with fat-saturation. The visibility of invasion of the trigeminal nerve in six segments including cisternal, pterygopalatine fossa,foramen rotundum,foramen ovale and masticatory muscle space were observed and evaluated by consensus of two radiologists using an evaluation scale from 1(not visible) to 3(excellently visible ).By using an eFilm 2.0 software the diameters of invaded maxillary nerves and mandibular nerves in foramen rotundum and foramen ovale were measured on the images of enhanced FSPGR sequence.Results:The visualization of invasion of the trigeminal nerve in intracisternal segment by using the two sequences is satisfied without statistic difference(P＞0.05).However,the visualization of invasion of the trigeminal nerve out of cistemal segment by using enhanced FSPGR T1 WI with fat-saturation is better than that by using 3D-FIESTA sequence(P＜0.05).On the T1WI by using FSPGR sequence the invaded trigeminal nerve manifested an irregular hyperintense mass or nodular mass,hypointense node or the "target" sign—high signal margin with low signal in the centre.And the trigeminal nerve infiltration presented as a hypointense node or mass and irregular enlargement of foramen exhibited a hypointense mass instead of normal fat signal on the images by using 3D-FIESTA sequence.The median diameter of invaded maxillary nerve and mandibular nerve in foramen rotundum or foramen ovale were respectively 4.435mm and 6.365mm.Conclusions: The normal and invaded trigeminal nerves in cisternal segment are easily visualized by using the 3D FIESTA sequence without enhancement.But in visualization of invasion of the trigeminal nerves out of cisternal segments by using 3D FIESTA sequence without enhancement it is inferior to that by using enhanced FSPGR sequence with fat-saturation T1-weighted imaging.A combination of the two sequences is most useful for the detection of the invasion of the trigeminal nerves in all courses and observation of different appearance in the two MR sequences.The diameters of invaded maxillary nerve and mandibular nerve are larger than that of normal nerves.更多还原