Abstract
BACKGROUND AND PURPOSE: Thin-section MR imaging through the posterior fossa is frequently used for trigeminal neuralgia. Typical heavily T2-weighted imaging methods yield high anatomic detail and contrast between CSF and neurovascular structures, but poor contrast between vessels and nerves. We hypothesized that the addition of gadolinium-based contrast material to 3D-constructive interference in steady-state imaging would improve the characterization of trigeminal compression.
MATERIALS AND METHODS: Retrospective review of high-resolution MRIs was performed in patients without prior microvascular decompression. 3D-CISS imaging without contrast and with contrast for 81 patients with trigeminal neuralgia and 15 controls was intermixed and independently reviewed in a blinded fashion. Cisternal segments of both trigeminal nerves were assessed for the grade of neurovascular conflict, cross-sectional area, and degree of flattening. Data were correlated with symptom side and pain relief after microvascular decompression using the Fisher exact test, receiver operating curve analysis, and a paired t test.
RESULTS: Contrast-enhanced CISS more than doubled the prevalence of the highest grade of neurovascular conflict (14.8% versus 33.3%, P = .001) and yielded significantly lower cross-sectional area (P = 8.6 × 10−6) and greater degree of flattening (P = .02) for advanced-grade neurovascular conflict on the symptoms side compared with non-contrast-enhanced CISS. Patients with complete pain relief after microvascular decompression had significantly lower cross-sectional area on contrast-enhanced CISS compared with non-contrast-enhanced CISS on preoperative imaging (P = 2.0 × 10−7). Performance based on receiver operating curve analysis was significantly improved for contrast-enhanced CISS compared with non-contrast-enhanced CISS.
CONCLUSIONS: The addition of contrast material to 3D-CISS imaging improves the performance of identifying unilateral neurovascular compression for symptomatic trigeminal neuralgia and predicting outcomes after microvascular decompression.
ABBREVIATIONS:
- AUC
- area under the curve
- CSA
- cross-sectional area
- CE
- contrast-enhanced
- DOF
- degree of flattening
- MVD
- microvascular decompression
- NE
- non-contrast-enhanced
- TN
- trigeminal neuralgia
Footnotes
Disclosures: Ari M. Blitz—UNRELATED: Board Membership: Guerbet, Comments: Medical Advisory Board; Grants/Grants Pending: Aesculab, Siemens, National Institutes of Health, Comments: Aesculab, research funding on hydrocephalus; Siemens, in-kind support for a pulse programming course for graduate students; National Institutes of Health, support unrelated to this submission: R21 NS096497 (coinvestigator), FAIN U01DC013778 (lead radiologist)*; Payment for Lectures Including Service on Speakers Bureaus: Siemens, Comments: payment for an educational talk at a symposium. C. Rory Goodwin—UNRELATED: Grants/Grants Pending: Johns Hopkins Neurosurgery Pain Research Institute, Burroughs Wellcome Fund, United Negro College Fund-Merck Science Initiative.* Michael Lim—UNRELATED: Consultancy: Stryker; Grants/Grants Pending: Stryker*; Payment for Lectures Including Service on Speakers Bureaus: Stryker, Comments: consulting and speaking; Payment for Development of Educational Presentations: Stryker, Comments: speaker for education; Travel/Accommodations/Meeting Expenses Unrelated to Activities Listed: Stryker, Comments: pay for travel to consulting and speaking engagements. *Money paid to the Institution.
Paper preciously presented at: Annual Meeting of the American Society of Head and Neck Radiology, September 9–13, 2015; Naples, Florida, by Seeburg et al; and Annual Meeting of the Congress of Neurological Surgeons, September 26–30, 2015; New Orleans, Louisiana, by Goodwin et al.
- © 2018 by American Journal of Neuroradiology
