Artikel
Microstructural neural changes in Trigeminal Neuralgia (TN) detected by Diffusion Tensor Imaging (DTI): correlation with intra-operative findings and possible clinical implications
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Autoren
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J.H. Mehrkens
- Neurochirurgische Universitätsklinik der Ludwig-Maximilians-Universität München
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N. Thon
- Neurochirurgische Universitätsklinik der Ludwig-Maximilians-Universität München
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M. Kunz
- Neurochirurgische Universitätsklinik der Ludwig-Maximilians-Universität München
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J. Linn
- Abteilung für Neuroradiologie der Ludwig-Maximilians-Universität München
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J.C. Tonn
- Neurochirurgische Universitätsklinik der Ludwig-Maximilians-Universität München
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J. Lutz
- Abteilung für Neuroradiologie der Ludwig-Maximilians-Universität München
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: We aimed to pre-operatively evaluate the microstructural changes of the trigeminal nerves and the possible clinical implications in patients with typical TN due to neurovascular compression (NVC) by diffusion tensor imaging (DTI) and a 3D fast imaging employing steady state acquisition sequence (3D FIESTA).
Methods: 60 patients (36 females, 24 males; mean age: 58±11 years) with TN (Type 1) and clinical suspicion of neurovascular compression were included, all of whom underwent microsurgical decompression (MVD). A single shot DTI-EPI-sequence along 15 different diffusion directions (3.0 T MR scanner (Signa HDx, GE, USA)) was acquired along with a 0.6 mm isotropic three-dimensional fast imaging employing steady state acquisition sequence (3D-FIESTA) for anatomic correlation. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were correlated with intra-operative and clinical findings.
Results: Identification of the trigeminal nerves was significantly improved by co-registration with the 3D-FIESTA sequence. FA was significantly (p<0.005) lower on the affected side (mean 0.28, contralateral side mean 0.49). ADC was higher on the ipsilateral side compared with the contralateral side (not significant). In 45/50 cases (90%), image-analysis showed NVC-features, that were congruent with surgical findings. In 3/5 patients, who did not show NVC on MRI, no NVC was found intra-operatively, resulting in 2 false negative cases. All patients were free from TN directly post-op and on first follow-up at 3 months.
Conclusions: Pre-operative DTI, co-registered with a high-resolution 3D-FIESTA, allows the identification and quantification of microstructural changes due to vascular compression of the affected nerve in patients with typical TN with high sensitivity and specificity. This could facilitate therapeutic decisions in patients with clinical evidence of TN and allow the estimation of the probability of success-rate of microvascular decompression on an objective anatomical and "functional" basis.
