Image-fusion Technique in Microvascular Decompression Surgery with 3D Constructive Interference in Steady-state and Modified 3D Time of Flight MR Images: Superior Detection of Possible Offending Vessels over Conventional Imaging

초록

Objective To assess the value of fusion imaging with three-dimensional (3D) constructive interference in steady-state (CISS) sequence magnetic resonance (MR) imaging and modified 3D time of flight (TOF) MR angiography (MRA) in the visualization of possible offending vessels in patients with neurovascular compression.Methods Pre-operative MR images of 15 consecutive patients who underwent surgical microvascular decompression for unilateral trigeminal neuralgia or hemifacial spasm were retrospectively collected. All patients were examined with 3D CISS sequence magnetic resonance (MR) imaging and 3D TOF MRA, and images were imported to OsiriX MD imaging software. The 3D TOF MR images were modified to exaggerate the arteries and fused with the 3D CISS MR images. We matched the images with intra-operative findings and post-operatively compared the offender prediction value between conventional MR images and fused MR images.Results Fused images showed spatial relationships between arterial vessels and nerves more clearly than conventional images. Of the 15 patients in the study, 11 cases (73.3%) were found identical to the prediction by using fused MR images. The fused images revealed a secondary possible candidate offender, and 5 cases were predicted to have another possible offender. Furthermore, 3 cases could be predicted by fused MR images, whereas not detected by conventional images.Conclusion The image-fusion technique can provide pre-operative information of possible offenders, which can be used to detect and localize an additional offending vessel during planning for cases with hidden vascular contacts on conventional MR images.

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