PT  - JOURNAL ARTICLE
AU  - Blitz, A.M.
AU  - Northcutt, B.
AU  - Shin, J.
AU  - Aygun, N.
AU  - Herzka, D.A.
AU  - Theodros, D.
AU  - Goodwin, C.R.
AU  - Lim, M.
AU  - Seeburg, D.P.
TI  - Contrast-Enhanced CISS Imaging for Evaluation of Neurovascular Compression in Trigeminal Neuralgia: Improved Correlation with Symptoms and Prediction of Surgical Outcomes
AID  - 10.3174/ajnr.A5743
DP  - 2018 Aug 23
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2018/08/23/ajnr.A5743.short
4100  - http://www.ajnr.org/content/early/2018/08/23/ajnr.A5743.full
AB  - 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.AUCarea under the curveCSAcross-sectional areaCEcontrast-enhancedDOFdegree of flatteningMVDmicrovascular decompressionNEnon-contrast-enhancedTNtrigeminal neuralgia