Study On MRI Whole-course Imaging Technique Of Trigeminal Nerve And Its Clinical Application

Part ?:A comparative study on the value of trigeminal nerve imaging based on magnetic resonance three-dimensional volume acquisition technologyObjective:To explore the value of 3.0T magnetic resonance three-dimensional volume acquisition technique in trigeminal nerve imaging,and to provide reference for the establishment of trigeminal nerve standardized whole-course imaging scheme.Methods:In this study,44 healthy volunteers(88 trigeminal nerves)were scanned by conventional magnetic resonance imaging(MRI)and volume imaging sequences(3D-FIESTA,3D-CUBE fs and 3D-FSPGR IDEAL).All images were processed with multi-plane reconstruction(MPR),maximum signal intensity projection(MIP),and curved surface reconstruction(CPR)to visualize the anterior trigeminal ganglion,semilunar ganglion and postganglionic nerve branches as much as possible.Two experienced Neuroradiologists evaluated the display value of each volume scan sequence to each segment and whole course of trigeminal nerve according to the criterion.In addition,they also evaluated the display value of different image reconstruction methods of each sequence to trigeminal nerve.Results:A total of 88 trigeminal nerves of 44 patients were scanned.The display scores of three volume imaging sequences including FIESTA,CUBE fs and FSPGR IDEAL for the cistern segment of trigeminal nerve were 2.99±0.13,3.0±0.00,and 3.0±0.00 respectively(P>0.05).The display scores of FIESTA,CUBE fs and FSPGR IDEAL for semilunar ganglion were 1.93±0.26,2.93±0.26,and 1.85±0.37 respectively(P<0.05).The display scores of FIESTA,CUBE fs and FSPGR IDEAL for V1 ophthalmic branch were 1.00±0.00,2.94±0.23,and 1.37±0.54 respectively(P<0.05).The display score of V2 maxillary branch was 1.27±0.45,2.35±0.50,2.60±0.50 respectively(P<0.05).The display score of V3 mandibular branch was 1.92±0.27,2.74±0.45,2.84±0.44 respectively(P<0.05).The display score of the whole course of trigeminal nerve(intracranial segment+extracranial segment)was 9.15±0.58,13.93±0.81 and 11.61±1.08,respectively(P<0.05).The CUBE fs sequence was superior to all other sequences.The excellent and good rates for eye branches by FIESTA,CUBE fs and FSPGR IDEAL sequences were 0%,100%,and 28.41%respectively(P<0.05).The excellent and good rates for maxillary branches by FIESTA,CUBE fs and FSPGR IDEAL sequences were 25%,98.86%and 81.82%respectively(P<0.05)whereas for mandibular branches were 87.50%,100%and 79.55%,respectively(P<0.05).FIESTA sequence was only suitable for cistern segment reconstruction.The continuous display scores of MIP,MPR and CPR for cistern segment were all 2.0±0.00(P>0.05).The scores of CPR reconstruction,MIP-OAx and MPR-OAx for ophthalmic branch in CUBE sequence were 2.0±0.00,1.0±0.21,and 0.91±0.32 respectively(P<0.05)..The scores of CPR reconstruction,MIP-OAx and MPR-OAx for maxillary branch reconstruction were 1.54±0.50,1.25±0.46 and 0.16±0.37 respectively(P<0.05).MIP reconstruction was better than MPR.The scores of CPR reconstruction,MIP-OCor and MIP-OSag for mandibular ramus were 1.87±0.34,1.15±0.35,and 1.43±0.50 respectively(P<0.05).Furthermore,the reconstruction orientation of OAx was better than that of OSag.The scores of CPR reconstruction,MIP-OAx and MPR-OAx for maxillary branch by FSPGR sequence were 1.78±0.42,1.54±0.50,and 0.16±0.37 respectively(P<0.05).The orientation of OAx reconstruction was better than that of OSag.The scores of CPR reconstruction,MIP-OCor and MIP-OSag of mandibular ramus were 1.86±0.35,1.0±0.00,1.04±0.25 respectively(P<0.05).Conclusion:3D-CUBE fs sequence is helpful to display each segment and whole course of trigeminal nerve,especially ophthalmic branch of trigeminal neuralgia.3D-FSPGR IDEAL sequence can be used to display maxillary branch and mandibular branch,whereas 3D-FIESTA sequence is only suitable for displaying cistern segment of trigeminal nerve.Rational for use of different MRN sequences is that it can be helpful to improve the efficiency of examination.Trigeminal nerve reconstruction by CPR is more favorable for trigeminal nerve continuity observation.The continuity of extracranial trigeminal nerve reconstruction by maximum intensity projection(MIP)is better than that of multiplanar reconstruction(MRP).Mastering the relevant knowledge of the anatomical distribution of each branch of the trigeminal nerve and being familiar with the post-processing techniques of three-dimensional volume images might be helpful to enhance the display of each segment of the trigeminal nerve.Part ?:A preliminary study on the clinical value of trigeminal nerve volume acquisition and whole-course imaging in trigeminal neuralgiaObjectives:To compare and analyze the value of traditional trigeminal nerve imaging and conventional imaging combined with multi-sequence trigeminal nerve volume imaging in the diagnosis of trigeminal neuralgia.Methods:A total of 110 nerves of 55 patients with trigeminal neuralgia who visited our hospital from April 2019 to January 2020 were prospectively enrolled in this study.All patients underwent 3.0T MR routine scan and volume imaging sequence(3D-FIESTA,3D-CUBE fs,3D-FSPGR IDEAL and 3D-TOF)scan.MRI data werereformattedusing multi-planar reconstruction(MPR),maximum signal intensity projection(MIP),and curved surface reconstruction(CPR)post-processing techniques.Two Radiologist withyears of experience in reading neuroimagingwho were blinded to the final diagnosis evaluatedand compare the diagnostic value of conventional MRI sequence with the combined conventional and multi-sequence volume scanning.The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value of each of the sequence were evaluated.MedCalc softwarewas used to draw ROC curve.The area under ROC curve of the two groups was compared.Results:40 cases were diagnosed as positive and 70 cases as negative for trigeminal neuralgiaby routine MRI sequence.Diagnosis of 28 cases were found to be true positive,27 cases false negative,43 cases true negative and 12 cases were false positive.The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 50.91%,78.18%,64.55%,70.00%and 61.43%,respectively.70 cases were diagnosed as positive and 40 cases as negative for trigeminal neuralgia bycombined sequence imaging.Diagnosis of 48 cases were found to be true positive,7 cases false negative,33 cases true negative and 22 cases were false positive.The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 87.27%,60.00%,73.64%,68.57%and 82.50%,respectively.The areas under the ROC curve forconventional MRM imaging and combined sequence imaging in the diagnosis of trigeminal neuralgia were 0.645 and 0.736 respectively(P<0.05).The etiology of trigeminal neuralgia detected by combined sequence imaging showed that the detection rates of neurovascular conflicts,inflammatory lesions,neoplasia lesions and other causes andno abnormalities in MR imaging were 45.45%,90.91%,5.45%,9.09%and 9.09%,respectively.Conclusion:Conventional sequence combined with three-dimensional volume neuromorphological imaging is helpful to detect the etiology of trigeminal neuralgia.It has high sensitivity,specificity,accuracy,positive predictive value and negative predictive value for the identification of trigeminal neuralgia.And hence,it can be used as a recommended sequence for clinical trigeminal neuralgia evaluation.