Contrast-enhanced CISS imaging for evaluation of neurovascular compression in trigeminal neuralgia: Improved correlation with symptoms and prediction of surgical outcomes

Ari M Blitz, B. Northcutt, J. Shin, Nafi Aygun, Daniel Herzka, D. Theodros, C. R. Goodwin, Michael Lim, D. P. Seeburg

Research output: Contribution to journalArticle

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 8.6 106) 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 2.0 107). 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.

Original languageEnglish (US)
Pages (from-to)1724-1732
Number of pages9
JournalAmerican Journal of Neuroradiology
Volume39
Issue number9
DOIs
StatePublished - Sep 1 2018

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Microvascular Decompression Surgery
Trigeminal Neuralgia
Contrast Media
Pain
Trigeminal Nerve
Gadolinium
Conflict (Psychology)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Contrast-enhanced CISS imaging for evaluation of neurovascular compression in trigeminal neuralgia : Improved correlation with symptoms and prediction of surgical outcomes. / Blitz, Ari M; Northcutt, B.; Shin, J.; Aygun, Nafi; Herzka, Daniel; Theodros, D.; Goodwin, C. R.; Lim, Michael; Seeburg, D. P.

In: American Journal of Neuroradiology, Vol. 39, No. 9, 01.09.2018, p. 1724-1732.

Research output: Contribution to journalArticle

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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 8.6 106) 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 2.0 107). 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.",
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T2 - Improved correlation with symptoms and prediction of surgical outcomes

AU - Blitz, Ari M

AU - Northcutt, B.

AU - Shin, J.

AU - Aygun, Nafi

AU - Herzka, Daniel

AU - Theodros, D.

AU - Goodwin, C. R.

AU - Lim, Michael

AU - Seeburg, D. P.

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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 8.6 106) 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 2.0 107). 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.

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