Bell palsy: quantitative analysis of MR imaging data as a method of predicting outcome.
OBJECTIVE
To assess the prognostic value of quantitative analyses of region-of-interest (ROI) magnetic resonance (MR) imaging data in patients with acute facial nerve palsy.


METHODS
In a single-blinded study, MR images were obtained in 39 patients (32 men and seven women; age range, 18-75 years; average age, 37.9 years) with acute facial nerve palsy. MR images were obtained before the 6th day of illness, on the first day of standard inpatient treatment with high-dose steroids. Signal intensity (SI) was measured at ROIs in each of five segments (internal auditory canal [IAC]; geniculate ganglion; and labyrinth, tympanic, and mastoid segments) of the intratemporal portion of the facial nerve and quantitatively analyzed. The SI measurements in the five segments were summed and divided by 100 to provide a basis for establishing an MR imaging index. SI increases and MR imaging indexes were compared with available clinical findings and electrophysiologic data.


RESULTS
Data for all 39 patients could be analyzed. The MR imaging index was significantly higher in patients with poor outcomes than in patients with favorable outcomes (specificity, 97%; sensitivity, 75%; P <.01). The SI increases in the IAC were significantly different between patients who progressed to full recovery (mean increase, 45.7%) and patients who developed chronic facial paralysis (mean increase, 156.5%) (sensitivity, 100%; specificity, 97%; P <.001). The results of differentiating between patients with good and those with poor outcomes on the basis of SI measurements in the IAC were found to be in complete agreement with electrophysiologic data.


CONCLUSIONS
Quantitative analysis of ROI MR imaging data is a valid method of predicting the outcome of acute facial nerve palsy during the first days after onset of symptoms and thus at a time when it is not yet possible to obtain valuable prognostic information by using electrophysiologic methods.
Kress
Bodo
B
Department of Neurology, Division of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany. bodo_kress@med.uni-heidelberg.de
Griesbeck
Franz
F
Stippich
Christoph
C
Bähren
Wolfgang
W
Sartor
Klaus
K
D000200:Action Potentials / Q000187:drug effects / Q000502:physiology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D020330:Bell Palsy / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D003287:Contrast Media / Q000493:pharmacokinetics; D005154:Facial Nerve / Q000473:pathology / Q000503:physiopathology; D005260:Female; D019786:Gadolinium DTPA / Q000493:pharmacokinetics; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D000893:Anti-Inflammatory Agents; D003287:Contrast Media; D019786:Gadolinium DTPA; D008775:Methylprednisolone