Author/Authors :
Jiang, W First School of Clinical Medicine - Shandong University of Traditional Chinese Medicine, Jinan , China - Department of Radiology - Qianfoshan Hospital - Cheeloo College of Medicine - Shandong University, Jinan , China - Department of Medical Imaging - Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China , Liu, B Department of Critical Care Medicine Ward 3 - Shandong Provincial Hospital Affiliated to Shandong First Medical University - Jinan, China , Liu, Y Department of Radiology - Changle People's Hospital - Changle, China , Wang, J Department of Medical Imaging - Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China , Ding, Q Department of Gastroenterology - Shandong Provincial Hospital Affiliated to Shandong First Medical University - Jinan, China , Ji, H Department of Critical Care Medicine Ward 3 - Shandong Provincial Hospital Affiliated to Shandong First Medical University - Jinan, China , Cui, Y Department of Radiology - Qianfoshan Hospital - Cheeloo College of Medicine - Shandong University, Jinan , China , Wang, Y First School of Clinical Medicine - Shandong University of Traditional Chinese Medicine, Jinan , China , Pang, Q Department of Neurosurgery - Shandong Provincial Hospital Affiliated to Shandong First Medical University - Jinan, China , Zeng, Q Department of Radiology - The First Affiliated Hospital of Shandong First Medical University & Shandong Provicial Qianfoshan Hospital - Jinan, China
Abstract :
Background: To explore the efficacy and optimal modality of three-dimensional (3D) MRI sequences in the preoperative detection of neurovascular compressions (NVCs) in patients with trigeminal neuralgia (TN). Materials and Methods: Forty-nine cases of typical unilateral TN had undergone 3D time-of-flight magnetic resonance angiography (3D-TOF MRA), 3D fast imaging employing steady-state acquisition (3D-FIESTA), and contrast-enhanced 3D spoiled gradient-recalled sequence (3D-SPGR) on a 3 Tesla MR
scanner. Neurovascular relationships (including neurovascular contact and position
and the nature of the offending vessels) on MR images were reviewed by a
neuroradiologist who was unaware of the clinical findings. Subsequently,
microvascular decompression (MVD) surgery was performed on all patients.
Comparison was made between the imaging results and surgical findings. Results:
MVD verified NVC in 48 (98%) symptomatic nerves, while 3D-TOF MRA, 3D-FIESTA, and
3D-SPGR revealed NVC in 38 (78%), 48 (98%), and 47 (96%) cases, respectively.
Agreement between the position of NVC, as defined by 3D-FIESTA (κ = 0.86) or 3DSPGR
(κ = 0.83) and surgical findings, was excellent. Moreover, excellent agreement
was confirmed between the nature of compressing vessels as defined by 3D-FIESTA in
combination with 3D-TOF MRA (κ = 0.95) or contrast-enhanced 3D-SPGR in
combination with 3D-TOF MRA (κ = 0.92) and surgical findings. Conclusions: NVCs
were visualized with good sensitivity and specificity with 3D MRI sequences in TN. We
propose that 3D-FIESTA combined with 3D-TOF MRA is a safe, convenient, and
efficacious MRI sequence for revealing NVCs and is crucial for the preoperative diagnosis and surgical planning of MVD.
Keywords :
Trigeminal neuralgia , Magnetic resonance , Neurovascular compression , Facial pain , Microvascular decompression
