Title |
Contrast-Enhanced CISS Imaging for Evaluation of Neurovascular Compression in Trigeminal Neuralgia: Improved Correlation with Symptoms and Prediction of Surgical Outcomes
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Published in |
American Journal of Neuroradiology, August 2018
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DOI | 10.3174/ajnr.a5743 |
Pubmed ID | |
Authors |
A.M. Blitz, B. Northcutt, J. Shin, N. Aygun, D.A. Herzka, D. Theodros, C.R. Goodwin, M. Lim, D.P. Seeburg |
Abstract |
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. 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. 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. 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. |
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Country | Count | As % |
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United States | 6 | 26% |
Spain | 5 | 22% |
Switzerland | 1 | 4% |
United Arab Emirates | 1 | 4% |
India | 1 | 4% |
Tanzania, United Republic of | 1 | 4% |
Unknown | 8 | 35% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 15 | 65% |
Practitioners (doctors, other healthcare professionals) | 4 | 17% |
Scientists | 3 | 13% |
Science communicators (journalists, bloggers, editors) | 1 | 4% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 33 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Other | 4 | 12% |
Researcher | 4 | 12% |
Student > Postgraduate | 4 | 12% |
Student > Master | 3 | 9% |
Professor > Associate Professor | 2 | 6% |
Other | 3 | 9% |
Unknown | 13 | 39% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 16 | 48% |
Neuroscience | 2 | 6% |
Chemistry | 1 | 3% |
Engineering | 1 | 3% |
Unknown | 13 | 39% |