Large-diameter compression arteries as a possible facilitating factor for trigeminal neuralgia: analysis of axial and radial diffusivity

Abstract

BackgroundNeurovascular compression (NVC) of the trigeminal nerve is associated with trigeminal neuralgia (TN). Some arteries that compress the trigeminal nerve are large, while others are small. This study evaluated the influence of diameter of compression arteries (DCA) on NVC with and without TN using axial diffusivity (AD) and radial diffusivity (RD) of magnetic resonance (MR) imaging.MethodsFifty TN patients with unilateral NVC, 50 asymptomatic patients with unilateral NVC, and 50 healthy controls (HC) were divided into three groups (NVC with TN, NVC without TN, and HC). The three groups were imaged with a 3.0-T MR system using three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) and diffusion tensor imaging (DTI). We compared the mean size of DCA between NVC with and without TN. The mean values of AD and RD at the site of NVC were compared between the three groups. Correlation analyses were performed between the DCA and the diffusion metrics (AD and RD) in NVC patients with and without TN.ResultsThe mean DCA in NVC patients with TN (1.58 ± 0.34 mm) was larger than that without TN (0.89 ± 0.29 mm). Compared with NVC without TN and HC, the mean values of RD at the site of NVC with TN were significantly increased; however, no significant changes of AD were found between the groups. Correlation analysis showed that DCA positively correlated with RD in NVC patients with and without TN (r = 0.830, p = 0.000). No significant correlation was found between DCA and AD (r = 0.178, p = 0.077).ConclusionsLarger-diameter compression arteries may increase the chances of TN, and may be a possible facilitating factor for TN.

Clinical Applications for Diffusion MRI and Tractography of Cranial Nerves Within the Posterior Fossa: A Systematic Review

“…A maximum of 959 participants were included across all studies (ranging from 1 to 150 subjects per study), if multiple studies form a single institution did not include overlapping patient groups. Twenty-two studies focused on imaging the cranial nerves in relation to a posterior fossa tumor (Taoka et al, 2006; Chen et al, 2011; Gerganov et al, 2011; Roundy et al, 2012; Zhang et al, 2013, 2017; Choi et al, 2014; Ulrich et al, 2014; Wei et al, 2015, 2016; Yoshino et al, 2015a,b, 2016; Borkar et al, 2016; Hilly et al, 2016; Ma et al, 2016; Song et al, 2016; Behan et al, 2017; d'Almeida et al, 2017; Li et al, 2017; Zolal et al, 2017a,b), 16 studies imaged the trigeminal nerve in patients with trigeminal neuralgia (Herweh et al, 2007; Fujiwara et al, 2011; Leal et al, 2011; Lutz et al, 2011, 2016; Hodaie et al, 2012; Liu et al, 2013; Wilcox et al, 2013; DeSouza et al, 2014, 2015; Lummel et al, 2015; Chen, D. Q. et al, 2016; Chen, S. T. et al, 2016; Lin et al, 2016; Neetu et al, 2016; Hung et al, 2017) and the remaining 3 studies evaluated DTI and tractography of the cranial nerves in various other pathologies including the cochlear nerve in cases of unilateral deafness (Vos et al, 2015), and the trigeminal nerve in patients with herpetic keratouveitis (Rousseau et al, 2015) and short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) (Coskun et al, 2017) (Tables 1–3).…”

“…Sixteen non-randomized comparative studies evaluated the diffusion metrics of the trigeminal nerve in patients with trigeminal neuralgia (TN) (Table 1). Twelve studies included healthy volunteers as a control group (Herweh et al, 2007; Fujiwara et al, 2011; Leal et al, 2011; Liu et al, 2013; Wilcox et al, 2013; DeSouza et al, 2014, 2015; Lummel et al, 2015; Chen, D. Q. et al, 2016; Lin et al, 2016; Neetu et al, 2016; Hung et al, 2017) and 4 studies compared the patient's own affected and unaffected sides (Lutz et al, 2011, 2016; Hodaie et al, 2012; Chen, S. T. et al, 2016). Two studies also included analysis of trigeminal neuralgia in patients with Multiple Sclerosis (MS) (Lummel et al, 2015; Chen, D. Q. et al, 2016), two studies evaluated patients with non-neurovascular compression TN (n-NVC-TN) (Lin et al, 2016; Neetu et al, 2016) and one study included patients with painful trigeminal neuropathy and painful temporomandibular disorders (TMD) (Wilcox et al, 2013).…”

“…Analysis of diffusivity measurements was possible in all cases. Ten studies compared values in the root entry zone (REZ) (Herweh et al, 2007; Leal et al, 2011; Lutz et al, 2011, 2016; Liu et al, 2013; Wilcox et al, 2013; DeSouza et al, 2014; Lummel et al, 2015; Lin et al, 2016; Neetu et al, 2016), two studies focused on changes within the cisternal segment (Fujiwara et al, 2011; Chen, S. T. et al, 2016) and one study evaluated changes at both locations (Chen, D. Q. et al, 2016).…”

“…Six studies (75%) reported RD and AD values in the affected and unaffected nerves of patients with idiopathic TN (Liu et al, 2013; DeSouza et al, 2014, 2015; Chen, D. Q. et al, 2016; Chen, S. T. et al, 2016; Lin et al, 2016) and a further two studies studied changes in these diffusivity metrics in patients following treatment (Hodaie et al, 2012; Hung et al, 2017). All five studies that examined changes in the REZ of TN-affected nerves reported significantly higher RD values in the REZ compared to the nerves of healthy controls (Liu et al, 2013; DeSouza et al, 2014, 2015; Chen, D. Q. et al, 2016; Lin et al, 2016) but significantly lower RD values were observed in the cisternal segments of affected nerves (Chen, D. Q. et al, 2016; Chen, S. T. et al, 2016). No significant differences were observed in the RD values of TN-affected nerves when compared to the unaffected side in two studies (DeSouza et al, 2014, 2015).…”

Fraction of anisotropy and apparent diffusion coefficient as diagnostic tools in trigeminal neuralgia

“…Further, a certain number of patients with TN do not display NVC [4]. Certain authors did not find changes in DTI parameters in asymptomatic individuals with unilateral NVC [20,21], suggesting that neither demyelination nor axonal injury exists when a vascular contact is not pathological.…”