Diagnostic value of 3D time-of-flight MRA in trigeminal neuralgia

Cai, Jing; Xin, Zhenxue; Zhang, Yuqiang; Sun, Jie; Lu, Jiliang; Xie, Feng

doi:10.1016/j.jocn.2015.02.023

Cited by 12 publications

(5 citation statements)

References 33 publications

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“…The relationship between peripheral blood vessels and nerves and brainstem could also be observed directly. The maximum density projection technique could also be used to realize arterial imaging to understand the origin and course of the responsible blood vessels [13]. It can provide an effective means for preoperative evaluation and screening.…”

Section: Discussionmentioning

confidence: 99%

Microvascular decompression for the treatment of neurogenic hypertension with trigeminal neuralgia

Lu¹,

Wang²,

Yan³

et al. 2019

BMC Neurol

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BackgroundTo evaluate the efficacy of microvascular decompression (MVD) in reducing hypertension (HTN) in hypertensive patients with trigeminal neuralgia (TN).MethodsThe clinical data of 58 cases of neurogenic HTN with TN treated in our hospital were retrospectively reviewed. Preoperative MR revealed abnormal blood pressure in the left rostral ventrolateral medulla (RVLM) and the posterior cranial nerve root entry zone (REZ). The patients were divided into control group: only trigeminal nerve was treated with MVD; experimental group: trigeminal nerve, RVLM and REZ were treated with MVD at the same time. The patients were followed up for 6 months to 1 year to observe the changes of blood pressure.ResultsThere was no significant difference in gender, age, course of TN, course of HTN, grade of HTN and preoperative blood pressure between the two groups. After operation, the effective rate of HTN improvement with MVD was 32.1% in the control group. There was no significant difference in the preoperative and post operative blood pressure. (P△SBP = 0.131; P△BDP = 0.078). In the experimental group, the effective rate was 83.3%. The postoperative blood pressure was significantly lower than preoperative values. (P△SBP < 0.001; P△DBP < 0.001).ConclusionsMVD is an effective treatment for neurogenic HTN. However, the criteria for selecting hypertensive patients who need MVD to control their HTN still needs to be further determined. Possible indications may include: left trigeminal neuralgia, neurogenic HTN; abnormal blood pressure compression in the left RVLM and REZ areas on MR; and blood pressure in these patients can not be effectively controlled by drugs.

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Section: Discussionmentioning

confidence: 99%

Microvascular decompression for the treatment of neurogenic hypertension with trigeminal neuralgia

Lu¹,

Wang²,

Yan³

et al. 2019

BMC Neurol

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“…According to the present results, when using 3D MIF technology, the sensitivity and specificity in diagnosing NVC was able to be improved. In a previous report, the DOR and AUROC of 3D TOF MRA in diagnosing NVC were 52.92 (95% CI, 26.39-106.11) and 0.97 (95% CI, 0.95-0.99), respectively ( 19 ). Compared with 3D TOF MRA, the DOR of 3D MIF technology based on 3D TOF MRA combined with HR T2WI reached 291 (95% CI, 99-853) and the AUROC was 0.98 (95% CI, 0.97-0.99).…”

Section: Discussionmentioning

confidence: 93%

“…As mentioned above, 3D TOF MRA is a widely used MRI sequence for detecting NVC, which is frequently used as a standard MRI-based method to compare with other methods. In a previous meta-analysis, the authors reported that 3D TOF MRA exhibited a sensitivity of 0.95 (95% CI, 0.93-0.96) and specificity of 0.77 (95% CI, 0.66-0.86) in correctly identifying NVC in patients with TN ( 19 ). According to the present results, when using 3D MIF technology, the sensitivity and specificity in diagnosing NVC was able to be improved.…”

Section: Discussionmentioning

confidence: 99%

3D multimodal image fusion based on MRI in the preoperative evaluation of microvascular decompression: A meta‑analysis

Liang

Yang²,

Zhang

et al. 2023

Exp Ther Med

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Neurovascular compression (NVC) is the main cause of hemifacial spasm (HFS) or trigeminal neuralgia (TN), and frequently occurs at the root entry zone of cranial nerves. Microvascular decompression (MVD) is an effective surgical treatment for TN and HFS caused by NVC. The accurate preoperative diagnosis of NVC is crucial to the evaluation of MVD as an appropriate treatment for TN and HFS. Three-dimensional (3D) time-of-flight magnetic resonance angiography (3D TOF MRA) and high resolution T2-weighted imaging (HR T2WI) are used to detect NVC prior to MVD; however, this combination alone has certain disadvantages. Multimodal image fusion (MIF) may combine two or more images from the same or different modalities, allowing neurosurgeons to use the reconstructed 3D model to observe anatomical details more clearly from different perspectives. The aim of the present meta-analysis was to evaluate the effect of 3D MIF based on 3D TOF MRA combined with HR T2WI in the preoperative diagnosis of NVC, and thus to evaluate its clinical application value in the preoperative evaluation of MVD. Relevant studies available on PubMed, Embase, Web of Science, Scopus, China National Knowledge Infrastructure and the Cochrane Library, and published from the inception of each database to September 2022, were retrieved. Studies using 3D MIF based on 3D TOF MRA combined with HR T2WI to diagnose NVC in patients with TN or HFS were included. The Quality Assessment of Diagnostic Accuracy Studies checklist was used to evaluate the quality of the included studies. The statistical software Stata 16.0 was used to perform the meta-analysis. Data extraction was performed by two independent investigators and discrepancies were resolved by discussion. Pooled sensitivities, specificities, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and the area under the receiver operating characteristic curve (AUROC) were calculated as the main summary effect size. The I² and Q-test were used to assess heterogeneity. The present search identified 702 articles, of which 7 (comprising 390 patients) fulfilled the inclusion criteria. Bivariate analysis indicated that the pooled sensitivity and specificity of 3D MIF based on 3D TOF MRA combined with HR T2WI for detecting NVC were 0.97 (95% CI, 0.95-0.99) and 0.89 (95% CI, 0.77-0.95), respectively. The pooled PLR was 8.8 (95% CI, 4.1-18.6), the pooled NLR was 0.03 (95% CI, 0.02-0.06) and the pooled DOR was 291 (95% CI, 99-853). The AUROC was 0.98 (95% CI, 0.97-0.99). The studies had no substantial heterogeneity (I 2 =0; Q=0.000; P=0.50). The present results suggested that 3D MIF based on 3D TOF MRA combined with HR T2WI had excellent sensitivity and specificity for diagnosing NVC in patients with TN or HFS. Therefore, this method should serve a key role in MVD preoperative evaluation.

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“…The results showed high diagnostic ability of this combination method with high sensitivity and specificity. In a meta-analysis in 2015, the authors reported that 3D TOF MRA had a sensitivity of 95% (95%CI: 0.93-0.96) and specificity of 77% (95%CI: 0.66-0.86) in identifying NVC in TN patients[ 21 ]. According to our results, when combined with HR T2WI, the specificity of 3D TOF MRA could be significantly improved in diagnosing NVC.…”

Section: Discussionmentioning

confidence: 99%

“…Likelihood ratio and DOR are composite indicators that can simultaneously reflect sensitivity and specificity. According to a previous report, the DOR of 3D TOF MRA in diagnosing NVC was 52.92 (95%CI: 26.39-106.11)[ 21 ]. Compared with 3D TOF MRA, combined 3D TOF MRA and HR T2WI had higher PLR and lower NLR, and its DOR reached 283 (95%CI: 50-1620).…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional time-of-flight magnetic resonance angiography combined with high resolution T2-weighted imaging in preoperative evaluation of microvascular decompression

Liang¹,

Yang²,

Zhang³

et al. 2022

World J Clin Cases

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BACKGROUND Neurovascular compression (NVC) is the main cause of primary trigeminal neuralgia (TN) and hemifacial spasm (HFS). Microvascular decompression (MVD) is an effective surgical method for the treatment of TN and HFS caused by NVC. The judgement of NVC is a critical step in the preoperative evaluation of MVD, which is related to the effect of MVD treatment. Magnetic resonance imaging (MRI) technology has been used to detect NVC prior to MVD for several years. Among many MRI sequences, three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is the most widely used. However, 3D TOF MRA has some shortcomings in detecting NVC. Therefore, 3D TOF MRA combined with high resolution T2-weighted imaging (HR T2WI) is considered to be a more effective method to detect NVC. AIM To determine the value of 3D TOF MRA combined with HR T2WI in the judgment of NVC, and thus to assess its value in the preoperative evaluation of MVD. METHODS Related studies published from inception to September 2022 based on PubMed, Embase, Web of Science, and the Cochrane Library were retrieved. Studies that investigated 3D TOF MRA combined with HR T2WI to judge NVC in patients with TN or HFS were included according to the inclusion criteria. Studies without complete data or not relevant to the research topics were excluded. The Quality Assessment of Diagnostic Accuracy Studies checklist was used to assess the quality of included studies. The publication bias of the included literature was examined by Deeks’ test. An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize data. Data analysis was performed using the MIDAS module of statistical software Stata 16.0. Two independent investigators extracted patient and study characteristics, and discrepancies were resolved by consensus. Individual and pooled sensitivities and specificities were calculated. The I² statistic and Q test were used to test heterogeneity. The study was registered on the website of PROSERO (registration No. CRD42022357158). RESULTS Our search identified 595 articles, of which 12 (including 855 patients) fulfilled the inclusion criteria. Bivariate analysis showed that the pooled sensitivity and specificity of 3D TOF MRA combined with HR T2WI for detecting NVC were 0.96 [95% confidence interval (CI): 0.92-0.98] and 0.92 (95%CI: 0.74-0.98), respectively. The pooled positive likelihood ratio was 12.4 (95%CI: 3.2-47.8), pooled negative likelihood ratio was 0.04 (95%CI: 0.02-0.09), and pooled diagnostic odds ratio was 283 (95%CI: 50-1620). The area under the receiver operating characteristic curve was 0.98 (95%CI: 0.97-0.99). The studies showed no substantial heterogeneity ( I 2 = 0, Q = 0.001 P = 0.50). CONCLUSION Our results suggest t...

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Diagnostic value of 3D time-of-flight MRA in trigeminal neuralgia

Cited by 12 publications

References 33 publications

Microvascular decompression for the treatment of neurogenic hypertension with trigeminal neuralgia

Microvascular decompression for the treatment of neurogenic hypertension with trigeminal neuralgia

3D multimodal image fusion based on MRI in the preoperative evaluation of microvascular decompression: A meta‑analysis

Three-dimensional time-of-flight magnetic resonance angiography combined with high resolution T2-weighted imaging in preoperative evaluation of microvascular decompression

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