Purpose

Controversy exists on the association of arterial hypertension (HTN) and neurovascular compression (NVC) at the ventrolateral medulla (VLM). No standardized and reproducible technique has been introduced yet for detection of NVC in HTN. This study aimed to generate, analyze and compare different results of exact reproducible anatomical 3D-representations of the VLM in patients with HTN, based on magnetic resonance imaging (MRI).

Methods

A 3T scanner provided MRI (T2-constructive interference in steady state (CISS) high resolution imaging and three-dimensional Time-of-flight (3D-TOF) angiography) from the posterior fossa of 44 patients with clinical treatment-resistant HTN. Image processing consists of segmentation of the CISS data, registration and fusion of the CISS and TOF data and visualization. For each patient two 3D-visualizations (before and after fusion) were obtained. The reproduction quality of the vessels, flow-related signal variability and pulsation artifacts were analyzed and compared, using a ranking score.

Results

Integrating vascular information from TOF into CISS data reduced artifacts in 3D-visualizations of exclusively processed CISS data. The quality of 3D-visualization of the vessels near the brain stem was significantly improved (p = 0.004). The results were reproducible and reliable. The quality of the 3D-presentations of neurovascular relationships at the VLM improved significantly (p < 0.001).

Conclusion

The 3D-visualization of fused image data provides an excellent overview of the relationship between cranial nerves and vessels at the VLM and simplifies the detection of NVC in HTN. It provides a powerful tool for future clinical and scientific research. Although microvascular decompression (MVD) in treatment resistant HTN is not a standard procedure, it can be discussed in selected patients with intractable severe HTN.

中文翻译：

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动脉高血压患者腹外侧髓质神经血管压迫的 3D 可视化。

目的

关于动脉高压 (HTN) 和腹外侧髓质 (VLM) 神经血管压迫 (NVC) 的关联存在争议。尚未引入标准化和可重复的技术来检测 HTN 中的 NVC。本研究旨在基于磁共振成像 (MRI) 生成、分析和比较 HTN 患者 VLM 的精确可重复解剖 3D 表示的不同结果。

方法

3T 扫描仪从 44 名临床难治性 HTN 患者的后颅窝提供 MRI（稳态 T2 建设性干扰 (CISS) 高分辨率成像和三维飞行时间 (3D-TOF) 血管造影）。图像处理包括 CISS 数据的分割、CISS 和 TOF 数据的配准和融合以及可视化。对于每个患者，获得了两个 3D 可视化（融合之前和之后）。使用排名分数分析和比较血管的再现质量、与流动相关的信号变异性和脉动伪影。

结果

将来自 TOF 的血管信息集成到 CISS 数据中减少了专门处理的 CISS 数据的 3D 可视化中的伪影。脑干附近血管的 3D 可视化质量显着提高（p  = 0.004）。结果是可重复和可靠的。VLM 神经血管关系的 3D 演示质量显着提高（p  < 0.001）。

结论

融合图像数据的 3D 可视化为 VLM 中颅神经和血管之间的关系提供了极好的概述，并简化了 HTN 中 NVC 的检测。它为未来的临床和科学研究提供了强大的工具。虽然微血管减压 (MVD) 在治疗难治性 HTN 中不是标准程序，但可以在选定的顽固性重度 HTN 患者中讨论。