Is preoperative high-resolution magnetic resonance imaging accurate in predicting neurovascular compression in patients with trigeminal neuralgia?

Abstract

High-resolution magnetic resonance imaging (HR-MRI) using three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) and double-dose contrast-enhanced three-dimensional fast spoiled gradient echo (3D-FSPGR) sequences is considered to be a useful tool in detecting neurovascular compression in patients with trigeminal neuralgia. The purpose of this study was to analyze the accuracy and preoperative diagnostic value of these high-resolution imaging techniques in patients with trigeminal neuralgia, in a single-blind study. The preoperative MRI images of 21 consecutive patients were matched to one neuroradiologist, who was blind as to which side exhibited the symptoms. The images and post-processing multiplanar reconstructions were compared with the video-documented operative observations. HR-MRI using only 3D-FSPGR sequences demonstrated neurovascular compression in accordance with the intraoperative finding in 11 patients (52.4%). In the subgroup where, additionally, 3D-FIESTA sequences were available, neurovascular compression was in accordance with the intraoperative finding in 71.4% (n = 7). High-resolution magnetic resonance imaging using double-dose contrast-enhanced 3D-FSPGR and 3D-FIESTA sequences is currently not sufficient enough to make an accurate prediction of neurovascular compression in a single-blind setting. These 3D imaging techniques currently provide only limited information, and one should consider their use carefully when identifying patients with trigeminal neuralgia from operation until image quality is improved by superior image resolution that can accurately discriminate vessels surrounding the trigeminal root entry zone.

Practice Parameter: The diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review)

“…19,20 Five studies were masked cohort surveys with prospective data collection (Class I). [21][22][23][24][25] The most common reference standard in these Class I studies was the masked comparison of the MRI of the symptomatic side to the asymptomatic side.…”

Preoperative detection of the neurovascular relationship in trigeminal neuralgia using three-dimensional fast imaging employing steady-state acquisition (FIESTA) and magnetic resonance angiography (MRA)

“…Three-dimensional fast imaging employing steadystate acquisition (FIESTA) sequence and time-of-flight (TOF) magnetic resonance angiography (MRA) have been used to detect NVC preoperatively in patients with TN. [7][8][9] A 3D FIESTA sequence produces a very high resolution T2-weighted MRI with an excellent contrast between structures, including cerebrospinal fluid (CSF), trigeminal nerve and adjacent blood vessels; however, it is difficult to distinguish between arteries and veins. 10 3D TOF MRA selectively demonstrates fast-flowing blood and provides visualization of arteries and nerves, but the inherent defect of this technique is that veins are insufficiently visualized.…”

Usefulness of Subtraction of 3D T2WI-DRIVE from Contrast-Enhanced 3D T1WI: Preoperative Evaluations of the Neurovascular Anatomy of Patients with Neurovascular Compression Syndrome

“…MR cisternography performed with techniques such as 3D FI-ESTA, 9,10 3D CISS, 11-13 3D T2-weighted-DRIVE sequences, 7,8 and reversed heavy T2WI 26 provides high spatial resolution and excellent visualization of vessels and cranial nerves and is thus a useful tool to depict cranial nerves and vessels in the cerebral cisterns. It is used for preoperative evaluations in cases of vascular compression syndrome, skull base tumors, and cerebrovascular disease.…”

“…However, in these sequences, the contrast between vessels and cranial nerves is not always great enough, occasionally making a clear understanding of the anatomic structure difficult, especially in cases of neurovascular compression syndrome. 9,14,15 Alternatives to standard MR cisternography (ie, image fusion between 3D CTA or 3D TOF-MRA and 3D MR cisternography) have been used to increase the contrast between vessels and cranial nerves. [19][20][21][22][23] However, several disadvantages of such image fusion techniques have been reported.…”