OBJECTIVES This study aimed to investigate the feasibility of segmentation-independent volume rendering (SI-VR) in visualising the root entry zone (REZ), and to explore the influence on the management of vascular compression syndromes (VCSs). METHODS Two hundred and twenty patients with VCSs were recruited in this prospective study from July 2015 to May 2019. SI-VR was reconstructed based on inverted 3D fast spin echo T2WI. They were assigned to the experimental group and control group randomly. Patients in the experimental group would accept extra evaluation based on SI-VR before microvascular decompression. Image quality and diagnostic accuracy between SI-VR and 3D fast spin echo T2WI in the experimental group were compared by Mann-Whitney U test and chi-square test, separately. Interobserver agreement was performed with intraclass correlation coefficient. Postsurgical outcomes and complications between two groups were compared by chi-square test. RESULTS SI-VR had a better interobserver agreement (0.82 vs 0.68) and diagnostic accuracy (95.5% vs 83.6%, p = 0.004) than that of 3D fast spin echo T2WI. Especially, significantly improved diagnostic accuracy was reached in detecting the multi-vascular branches compression (100% vs 15.4%, p < 0.001). There were fewer complications (7.1% vs 26.8%, p = 0.004) and less operation time (20.7 min vs 14.5 min, p = 0.007) but no significant difference of pain relief (p = 0.19) in the experimental group than in the control group. CONCLUSIONS The SI-VR method is feasible for the precise demonstration of the anatomy structure along the REZ, with high reliability and reproducibility. Unbiased pre-surgical visualisation could reduce redundant explorations and post-surgical complications in patients who undergo microvascular decompression. KEY POINTS • Visualisation of the root entry zone by the segmentation-independent volume rendering is in accordance with the landscape by the neuro-endoscopy. • Segmentation-independent volume rendering has an advantage over 3D fast spin echo T2WI in the visualisation of multi-vascular branches compression. • Presurgical 3D visualisation of the neurovascular compression at the root entry zone leads to less postsurgical complications from the decrease of redundant exploration.

中文翻译：

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独立于分割的体绘制可视化方法可以减少微血管减压的多余探索和术后并发症。

目的本研究旨在探讨分段独立体积渲染（SI-VR）在可视化根进入区（REZ）中的可行性，并探讨其对血管压迫综合征（VCS）管理的影响。方法从2015年7月至2019年5月，本研究共招募了220例VCS患者。SI-VR是基于倒置3D快速自旋回波T2WI重建的。他们被随机分为实验组和对照组。实验组患者将在微血管减压之前接受基于SI-VR的额外评估。通过Mann-Whitney U检验和卡方检验分别比较了实验组中SI-VR和3D快速自旋回波T2WI的图像质量和诊断准确性。观察者间协议是使用类内相关系数执行的。通过卡方检验比较两组之间的术后结果和并发症。结果与3D快速自旋回波T2WI相比，SI-VR具有更好的观察者之间一致性（0.82 vs 0.68）和诊断准确性（95.5％vs 83.6％，p = 0.004）。特别是，在检测多血管分支受压方面，诊断准确性得到了显着提高（100％比15.4％，p <0.001）。与对照组相比，实验组的并发症更少（7.1％vs. 26.8％，p = 0.004）和手术时间更少（20.7 min vs 14.5 min，p = 0.007），但疼痛缓解没有显着差异（p = 0.19）。组。结论SI-VR方法可用于沿REZ精确演示解剖结构，具有高可靠性和可重复性。无偏见的术前可视化可以减少进行微血管减压的患者的多余探查和术后并发症。要点•通过分段无关的体积渲染对根部进入区域的可视化与通过神经内窥镜检查所看到的风景一致。•在多血管分支压缩的可视化中，与分段无关的体绘制比3D快速自旋回波T2WI具有优势。•根部进入区的神经血管压迫的术前3D可视化通过减少多余探查而减少了术后并发症。要点•通过分段无关的体积渲染对根部进入区域的可视化与通过神经内窥镜检查所看到的风景一致。•在多血管分支压缩的可视化中，与分段无关的体绘制比3D快速自旋回波T2WI具有优势。•根部进入区的神经血管压迫的术前3D可视化通过减少多余探查而减少了术后并发症。要点•通过分段独立的体积渲染对根部进入区域的可视化与通过神经内窥镜检查所看到的风景一致。•在多血管分支压缩的可视化中，与分段无关的体绘制比3D快速自旋回波T2WI具有优势。•根部进入区的神经血管压迫的术前3D可视化通过减少多余探查而减少了术后并发症。