High-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled gradient-recalled imaging in the evaluation of neurovascular compression in patients with trigeminal neuralgia: a double-blind pilot study.
OBJECTIVE
To assess the value of high-resolution three-dimensional (3D) time-of-flight (TOF) magnetic resonance (MR) angiography and gadolinium (Gad)-enhanced 3D spoiled gradient-recalled imaging in the visualization of neurovascular compression in patients with trigeminal neuralgia.


METHODS
Forty-eight patients with unilateral trigeminal neuralgia underwent high-resolution 3D TOF MR angiography. After administration of a contrast agent, a 3D spoiled gradient-recalled sequence (3D Gad) was run. Images were reviewed by a radiologist blinded to clinical details. All patients underwent microvascular decompression surgery. Microdissection of the trigeminal nerve and compressing vessels was videotaped during surgery and reviewed by surgeons uninvolved in patient care. Results from neuroradiological studies were then compared with findings on operative videotapes.


RESULTS
MR angiography in combination with 3D Gad imaging identified surgically verified neurovascular contact in 42 of 46 (91%) symptomatic nerves. The offending vessel (artery, vein) was correctly identified in 31 of 41 cases (sensitivity, 76%; specificity, 75%). Neurovascular compression was observed in 71% of asymptomatic nerves with a trend toward greater compression severity on the symptomatic nerve (P < 0.09). Agreement between the direction of neurovascular contact defined by 3D TOF MR angiography and 3D Gad and findings at surgery was good (kappa = 0.78; 95% confidence interval, 0.61-0.94).


CONCLUSIONS
Double-blind assessment of surgical and neuroradiological findings confirms that neurovascular compression can be visualized with good sensitivity in patients with trigeminal neuralgia by 3D TOF MR angiography in combination with Gad-enhanced 3D spoiled gradient-recalled sequences. Anatomic relationships defined by this method can be useful in predicting surgical findings.
Anderson
Valerie C
VC
Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon 97239-3098, USA. andersov@ohsu.edu
Berryhill
Phillip C
PC
Sandquist
Michael A
MA
Ciaverella
David P
DP
Nesbit
Gary M
GM
Burchiel
Kim J
KJ
D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000150:complications / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D011859:Radiography; D014277:Trigeminal Neuralgia / Q000150:complications / Q000000981:diagnostic imaging*