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Gaudino C, Cassoni A, Pisciotti ML, Pucci R, Palma A, Fantoni N, Pantano P, Valentini V. MR-Neurography of the facial nerve in parotid tumors: intra-parotid nerve visualization and surgical correlation. Neuroradiology 2024:10.1007/s00234-024-03372-5. [PMID: 38714544 DOI: 10.1007/s00234-024-03372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/01/2024] [Indexed: 05/10/2024]
Abstract
PURPOSE One of the most severe complications in surgery of parotid tumors is facial palsy. Imaging of the intra-parotid facial nerve is challenging due to small dimensions. Our aim was to assess, in patients with parotid tumors, the ability of high-resolution 3D double-echo steady-state sequence with water excitation (DE3D-WE) (1) to visualize the extracranial facial nerve and its tracts, (2) to evaluate their relationship to the parotid lesion and (3) to compare MRI and surgical findings. METHODS A retrospective study was conducted including all patients with parotid tumors, who underwent MRI from April 2022 to December 2023. Two radiologists independently reviewed DE3D-WE images, assessing quality of visualization of the facial nerve bilaterally and localizing the nerve's divisions in relation to the tumor. MRI data were compared with surgical findings. RESULTS Forty consecutive patients were included (M:F = 22:18; mean age 56.3 ± 17.4 years). DE3D-WE could excellently visualize the nerve main trunk and the temporofacial division in all cases. The cervicofacial branch was visible in 99% of cases and visibility was good. Distal divisions were displayed in 34% of cases with a higher visibility on the tumor side (p < 0.05). Interrater agreement was high (weighted kappa 0.94 ± 0.01 [95% CI 0.92-0.97]). Compared to surgery accuracy of MRI in localizing the nerve was 100% for the main trunk, 96% for the temporofacial and 89% for the cervicofacial branches. CONCLUSIONS Facial nerve MR-neurography represents a reliable tool. DE3D-WE can play an important role in surgical planning of patients with parotid tumors, reducing the risk of nerve injury.
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Affiliation(s)
- Chiara Gaudino
- Department of Neuroradiology, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161, -Rome, Italy.
| | - Andrea Cassoni
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Via Caserta 6, 00161, Rome, Italy
- Department of Maxillo-Facial Surgery, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Martina Lucia Pisciotti
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00180, Rome, Italy
| | - Resi Pucci
- Department of Maxillo-Facial Surgery, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense 87, 00152, Rome, Italy
| | - Angela Palma
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Via Caserta 6, 00161, Rome, Italy
| | - Nicoletta Fantoni
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00180, Rome, Italy
| | - Patrizia Pantano
- Department of Neuroradiology, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161, -Rome, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, -Rome, Italy
- IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy
| | - Valentino Valentini
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Via Caserta 6, 00161, Rome, Italy
- Department of Maxillo-Facial Surgery, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
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Bangia M, Ahmadzai I, Casselman J, Politis C, Jacobs R, Van der Cruyssen F. Accuracy of MR neurography as a diagnostic tool in detecting injuries to the lingual and inferior alveolar nerve in patients with iatrogenic post-traumatic trigeminal neuropathy. Eur Radiol 2023:10.1007/s00330-023-10363-2. [PMID: 38047973 DOI: 10.1007/s00330-023-10363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES MR neurography has the ability to detect and depict peripheral nerve injuries. This study evaluated the potential of MR neurography in the diagnosis of post-traumatic trigeminal neuropathy. METHODS Forty-one participants prospectively underwent MR neurography of the lingual and inferior alveolar nerves using a 3D TSE STIR black-blood sequence. Two blinded and independent observers recorded the following information for each nerve of interest: presence of injury, nerve thickness, nerve signal intensity, MR neurography Sunderland class, and signal gap. Afterwards, the apparent nerve-muscle contrast-to-noise ratio and apparent signal-to-noise ratio were calculated. Clinical data (neurosensory testing score and clinical Sunderland class) was extracted retrospectively from the medical records of patients diagnosed with post-traumatic trigeminal neuropathy. RESULTS Compared to neurosensory testing, MR neurography had a sensitivity of 38.2% and specificity of 93.5% detecting nerve injuries. When differentiated according to clinical Sunderland class, sensitivity was 19.1% in the presence of a low class injury (I to III) and improved to 83.3% in the presence of a high class (IV to V). Specificity remained unchanged. The area under the curve using the apparent nerve-muscle contrast-to-noise ratio, apparent signal-to-noise ratio, and nerve thickness to predict the presence of an injury was 0.78 (p < .05). Signal intensities and nerve diameter increased in injured nerves (p < .05). Clinical and MR neurography Sunderland scores positively correlated (correlation coefficient = 0.53; p = .005). CONCLUSIONS This study shows that MR neurography can accurately differentiate between injured and healthy nerves, especially in the presence of a more severe nerve injury. CLINICAL RELEVANCE STATEMENT MR neurography is not only able to detect trigeminal nerve injuries, but it can also provide information about the anatomical specifications of the injury, which is not possible with clinical neurosensory testing. This makes MR neurography an added value in the management of post-traumatic trigeminal neuropathy. KEY POINTS • The current diagnosis of post-traumatic trigeminal neuropathy is mainly based on clinical examination. • MR neurography is able to visualize and stratify peripheral trigeminal nerve injuries. • MR neurography contributes to the diagnostic process as well as to further decision-making.
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Affiliation(s)
- Mado Bangia
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium
| | - Iraj Ahmadzai
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium
| | - Jan Casselman
- Department of Radiology, AZ St-Jan Brugge-Oostende, Brugge, Belgium
- Department of Radiology, AZ St-Augustinus, Antwerp, Belgium
- University Ghent, Ghent, Belgium
| | - Constantinus Politis
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium
| | - Reinhilde Jacobs
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium
- Dentomaxillofacial Imaging Center, University Hospitals Leuven, Louvain, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fréderic Van der Cruyssen
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium.
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium.
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3
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Poelaert J, Coopman R, Ureel M, Dhooghe N, Genbrugge E, Mwewa T, Blondeel P, Vermeersch H. Visualization of the Facial Nerve with Ultra-high-Frequency Ultrasound. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5489. [PMID: 38115834 PMCID: PMC10730079 DOI: 10.1097/gox.0000000000005489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/18/2023] [Indexed: 12/21/2023]
Abstract
Background Profound variations in facial nerve branching, combined with the severe impact of facial palsy on the patient's quality of life, make surgery in this region challenging. Recent advancements in ultrasound (US) technology, including the improved visualization of small structures, have led to a sharp increase in its medical indications in various medical disciplines. We aimed to prove the feasibility of using ultra-high-frequency (UHF) US to visualize the facial nerve and to guide surgeons during surgery on and around the facial nerve. Methods A cadaveric study was performed on one hemi-face with a UHF US imaging system and state-of-the-art transducers. Firstly, a transcutaneous US was performed, and the facial nerve branches of interest (zygomatic, buccal, and marginal mandibular branches) were marked using US-guided color-injections of filler mixed with methylene blue. Skin and subcutaneous fat were then removed to simulate the intraoperative field. Secondly, an "intraoperative" US examination was performed, and the same branches were marked by US-guided color-injections of filler mixed with indocyanine green. Anterograde facial nerve dissection was performed, and the distance between the nerve branches and the injected filler was measured. Results All color-injections (mixed with both methylene blue and indocyanine green) were positioned right next to the nerve branches (<1 mm). The image quality of the US below the skin was observed to be far superior to that of the transcutaneous US. Conclusion UHF US can be used to visualize the facial nerve with high precision both transcutaneously and intraoperatively (after elevation of the skin flap).
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Affiliation(s)
- Jeroen Poelaert
- From the Plastic, Reconstructive and Aesthetic Surgery, UZ Gent, Ghent, Belgium
| | - Renaat Coopman
- From the Plastic, Reconstructive and Aesthetic Surgery, UZ Gent, Ghent, Belgium
| | - Matthias Ureel
- From the Plastic, Reconstructive and Aesthetic Surgery, UZ Gent, Ghent, Belgium
| | - Nicolas Dhooghe
- From the Plastic, Reconstructive and Aesthetic Surgery, UZ Gent, Ghent, Belgium
| | | | - Tana Mwewa
- Radiology, UZ Brussel, Brussels, Belgium
| | - Phillip Blondeel
- From the Plastic, Reconstructive and Aesthetic Surgery, UZ Gent, Ghent, Belgium
| | - Hubert Vermeersch
- From the Plastic, Reconstructive and Aesthetic Surgery, UZ Gent, Ghent, Belgium
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Messaoud O, Horache K, Cherraqi A, Meriem F, Mohamed J, Firdaous T. A Rare Case of an Isolated Facial Nerve Aplasia: Radiological Findings. Glob Pediatr Health 2023; 10:2333794X231208365. [PMID: 38024468 PMCID: PMC10644746 DOI: 10.1177/2333794x231208365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/23/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023] Open
Abstract
Congenital facial palsy is a rare condition that can be categorized into traumatic and developmental etiologies. Trauma related congenital facial palsy represents by far the most frequent cause with a spontaneous complete recovery within weeks, contrary to developmental causes that can be syndromic or non-syndromic, and have a poor prognosis. We present the case of an 11-month-old boy who suffers a congenital facial palsy. He undergoes an MRI examination with the adapted sequences to assess the facial nerve, and a high-resolution CT scan that reveals a seventh cranial nerve agenesis.
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Affiliation(s)
- Ola Messaoud
- The Rabat Speciality Hospital IBN SINA (HSR), Rabat, Morocco
| | - Kenza Horache
- The Rabat Speciality Hospital IBN SINA (HSR), Rabat, Morocco
| | - Amine Cherraqi
- The Rabat Speciality Hospital IBN SINA (HSR), Rabat, Morocco
| | - Fikri Meriem
- The Rabat Speciality Hospital IBN SINA (HSR), Rabat, Morocco
| | - Jiddane Mohamed
- The Rabat Speciality Hospital IBN SINA (HSR), Rabat, Morocco
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5
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Burian E, Feuerriegel G, Sollmann N, Burian G, Palla B, Griesbauer M, Bumm C, Probst M, Beer M, Folwaczny M. Visualization of clinically silent, odontogenic maxillary sinus mucositis originating from periapical inflammation using MRI: a feasibility study. Clin Oral Investig 2023:10.1007/s00784-023-04986-4. [PMID: 37039958 DOI: 10.1007/s00784-023-04986-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVES Maxillary sinus mucositis is frequently associated with odontogenic foci. Periapical inflammation of maxillary molars and premolars cannot be visualized directly using radiation-based imaging. The purpose of this study was to answer the following clinical question: among patients with periapical inflammatory processes in the maxilla, does the use of magnetic resonance imaging (MRI), as compared to conventional periapical (AP) and panoramic radiography (OPT), improve diagnostic accuracy? METHODS Forty-two subjects with generalized periodontitis were scanned on a 3 T MRI. Sixteen asymptomatic subjects with mucosal swelling of the maxillary sinus were enrolled in the study. Periapical edema was assessed using short tau inversion recovery (STIR) sequence. Apical osteolysis and mucosal swelling were assessed by MRI, AP, and OPT imaging using the periapical index score (PAI). Comparisons between groups were performed with chi-squared tests with Yates' correction. Significance was set at p < 0.05. RESULTS Periapical lesions of maxillary premolars and molars were identified in 16 subjects, 21 sinuses, and 58 teeth. Bone edema and PAI scores were significantly higher using MRI as compared to OPT and AP (p < 0.05). Using the STIR sequence, a significant association of PAI score > 1 and the presence of mucosal swelling in the maxillary sinus was detected (p = 0.03). CONCLUSION Periapical inflammation and maxillary mucositis could be visualized using STIR imaging. The use of MRI may help detect early, subtle inflammatory changes in the periapical tissues surrounding maxillary dentition. Early detection could guide diagnostic criteria, as well as treatment and prevention.
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Affiliation(s)
- Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Georg Feuerriegel
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- TUM-Neuroimaging Center, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Gintare Burian
- Department of Prosthodontics, LMU University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Benjamin Palla
- Department of Oral and Maxillofacial Surgery, University of Illinois, Chicago, IL, USA
| | - Magdalena Griesbauer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Caspar Bumm
- Department of Restorative Dentistry and Periodontology, LMU University Hospital, Munich, Germany
| | - Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Matthias Folwaczny
- Department of Restorative Dentistry and Periodontology, LMU University Hospital, Munich, Germany
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6
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Casselman J, Van der Cruyssen F, Vanhove F, Peeters R, Hermans R, Politis C, Jacobs R. 3D CRANI, a novel MR neurography sequence, can reliable visualise the extraforaminal cranial and occipital nerves. Eur Radiol 2023; 33:2861-2870. [PMID: 36435876 PMCID: PMC10017653 DOI: 10.1007/s00330-022-09269-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/04/2022] [Accepted: 10/23/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We aim to validate 3D CRANI, a novel high-field STIR TSE, MR neurography sequence in the visualisation of the extraforaminal cranial and occipital nerve branches on a 3-T system. Furthermore, we wish to evaluate the role of gadolinium administration and calculate nerve benchmark values for future reference. METHODS Eleven consecutive patients underwent MR imaging including the 3D CRANI sequence before and immediately after intravenous gadolinium administration. Two observers rated suppression quality and nerve visualisation using Likert scales before and after contrast administration. Extraforaminal cranial and occipital nerves were assessed. Nerve calibers and signal intensities were measured at predefined anatomical landmarks, and apparent signal intensity ratios were calculated. RESULTS The assessed segments of the cranial and occipital nerves could be identified in most cases. The overall intrarater agreement was 79.2% and interrater agreement was 82.7% (intrarater κ = .561, p < .0001; interrater κ = .642, p < .0001). After contrast administration, this significantly improved to an intrarater agreement of 92.7% and interrater agreement of 93.6% (intrarater κ = .688, p < .0001; interrater κ = .727, p < .0001). Contrast administration improved suppression quality and significant changes in nerve caliber and signal intensity measurements. Nerve diameter and signal intensity benchmarking values were obtained. CONCLUSION 3D CRANI is reliable for the visualization of the extraforaminal cranial and occipital nerves. Intravenous gadolinium significantly improves MR neurography when applying this sequence. Benchmarking data are published to allow future assessment of the 3D CRANI sequence in patients with pathology of the extraforaminal cranial and occipital nerves. KEY POINTS • MR neurography using the 3D CRANI sequence is a reliable method to evaluate the extraforaminal cranial and occipital nerves. • Gadolinium contrast administration significantly improves suppression quality and nerve visualisation. • Benchmarking values including apparent signal intensity ratios and nerve calibers depend on contrast administration and might play an important role in future studies evaluating extraforaminal cranial and occipital neuropathies.
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Affiliation(s)
- Jan Casselman
- Department of Radiology, AZ St-Jan Brugge-Oostende, Ruddershove 10, 8000, Bruges, Belgium. .,Department of Radiology, AZ St-Augustinus, Antwerp, Belgium. .,University Ghent, Ghent, Belgium.
| | - Fréderic Van der Cruyssen
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium. .,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium.
| | - Frédéric Vanhove
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,Department of Radiology, AZ Groeninge, Kortrijk, Belgium
| | - Ronald Peeters
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Robert Hermans
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium.,Department of Oral Health Sciences, KU Leuven and Department of Dentistry, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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7
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Vestibular paroxysmia entails vestibular nerve function, microstructure and endolymphatic space changes linked to root-entry zone neurovascular compression. J Neurol 2023; 270:82-100. [PMID: 36255522 DOI: 10.1007/s00415-022-11399-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/07/2023]
Abstract
Combining magnetic resonance imaging (MRI) sequences that permit the determination of vestibular nerve angulation (NA = change of nerve caliber or direction), structural nerve integrity via diffusion tensor imaging (DTI), and exclusion of endolymphatic hydrops (ELH) via delayed gadolinium-enhanced MRI of the inner ear (iMRI) could increase the diagnostic accuracy in patients with vestibular paroxysmia (VP). Thirty-six participants were examined, 18 with VP (52.6 ± 18.1 years) and 18 age-matched with normal vestibulocochlear testing (NP 50.3 ± 16.5 years). This study investigated whether (i) NA, (ii) DTI changes, or (iii) ELH occur in VP, and (iv) to what extent said parameters relate. Methods included vestibulocochlear testing and MRI data analyses for neurovascular compression (NVC) and NA verification, DTI and ELS quantification. As a result, (i) NA increased NVC specificity. (ii) DTI structural integrity was reduced on the side affected by VP (p < 0.05). (iii) 61.1% VP showed mild ELH and higher asymmetry indices than NP (p > 0.05). (iv) "Disease duration" and "total number of attacks" correlated with the decreased structural integrity of the affected nerve in DTI (p < 0.001). NVC distance within the nerve's root-entry zone correlated with nerve function (Roh = 0.72, p < 0.001), nerve integrity loss (Roh = - 0.638, p < 0.001), and ELS volume (Roh = - 0.604, p < 0.001) in VP. In conclusion, this study is the first to link eighth cranial nerve function, microstructure, and ELS changes in VP to clinical features and increased vulnerability of NVC in the root-entry zone. Combined MRI with NVC or NA verification, DTI and ELS quantification increased the diagnostic accuracy at group-level but did not suffice to diagnose VP on a single-subject level due to individual variability and lack of diagnostic specificity.
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8
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Kinger NP, Chien LC, Sharma PS, Gravolet RB, Aiken AH, Baugnon KL, Wu X. Comparison of 3D constructive interference in steady state (CISS) and T2 sampling perfection with application optimized contrasts using different flip angle evolution MR imaging of the intracranial trigeminal nerve and central skull base neuroforamina. Neuroradiol J 2022; 35:678-683. [PMID: 35400223 PMCID: PMC9626844 DOI: 10.1177/19714009221084248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Due to surgical advancements, the accurate detection of perineural disease spread has become increasingly important in the management and prognostication of head and neck cancers, though MR evaluation has thus far been limited by technical and logistic challenges. The purpose of this study was to specifically evaluate the relative capability of 3D CISS and 3D T2-SPACE imaging to delineate the proximal intracranial divisions of the normal trigeminal nerve, an area important in determining the resectability of intracranial perineural disease. MATERIALS AND METHODS A single center HIPAA-compliant, IRB approved retrospective review of 40 patients with clinical temporal bone/internal auditory canal MR imaging was conducted. 20 patients with 3D CISS images and 20 patients with 3D T2-SPACE images met inclusion criteria. Two radiologists scored the sequences on a 3-point scale based on ability to visualize anatomic structures surrounding the trigeminal nerve in Meckel's cave, intracranial trigeminal divisions, skull base neuroforamina, and proximal extracranial mandibular division. RESULTS The following anatomic locations scored significantly better in the T2-SPACE sequence compared to the CISS sequence for both raters: intracranial V3 (p < .05), foramen ovale (p < .05), and extracranial V3 (p < .01). The average scores for the anterior Meckel's cave and foramen rotundum were higher for the T2-SPACE sequence, although not significantly. Percent interobserver agreement ranged from 50 to 90% and 65-100% for the different anatomic locations on the CISS and T2-SPACE sequences, respectively. CONCLUSION 3D T2-SPACE was found to be superior to 3D CISS in the evaluation of the distal intracranial and extracranial portions of the normal trigeminal nerve.
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Affiliation(s)
- Nikhar P Kinger
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ling-Chen Chien
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Puneet S Sharma
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ryan B Gravolet
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ashley H Aiken
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Kristen L Baugnon
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Xin Wu
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
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9
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Sundermann B, Billebaut B, Bauer J, Iacoban CG, Alykova O, Schülke C, Gerdes M, Kugel H, Neduvakkattu S, Bösenberg H, Mathys C. Practical Aspects of novel MRI Techniques in Neuroradiology: Part 2 - Acceleration Methods and Implications for Individual Regions. ROFO-FORTSCHR RONTG 2022; 194:1195-1203. [PMID: 35798335 DOI: 10.1055/a-1800-8789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Recently introduced MRI techniques facilitate accelerated examinations or increased resolution with the same duration. Further techniques offer homogeneous image quality in regions with anatomical transitions. The question arises whether and how these techniques can be adopted for routine diagnostic imaging. METHODS Narrative review with an educational focus based on current literature research and practical experiences of different professions involved (physicians, MRI technologists/radiographers, physics/biomedical engineering). Different hardware manufacturers are considered. RESULTS AND CONCLUSIONS Compressed sensing and simultaneous multi-slice imaging are novel acceleration techniques with different yet complimentary applications. They do not suffer from classical signal-to-noise-ratio penalties. Combining 3 D and acceleration techniques facilitates new broader examination protocols, particularly for clinical brain imaging. In further regions of the nervous systems mainly specific applications appear to benefit from recent technological improvements. KEY POINTS · New acceleration techniques allow for faster or higher resolution examinations.. · New brain imaging approaches have evolved, including more universal examination protocols.. · Other regions of the nervous system are dominated by targeted applications of recently introduced MRI techniques.. CITATION FORMAT · Sundermann B, Billebaut B, Bauer J et al. Practical Aspects of novel MRI Techniques in Neuroradiology: Part 2 - Acceleration Methods and Implications for Individual Regions. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1800-8789.
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Affiliation(s)
- Benedikt Sundermann
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Germany.,Clinic for Radiology, University Hospital Münster, Germany
| | - Benoit Billebaut
- Clinic for Radiology, University Hospital Münster, Germany.,School for Radiologic Technologists, University Hospital Münster, Germany
| | - Jochen Bauer
- Clinic for Radiology, University Hospital Münster, Germany
| | - Catalin George Iacoban
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Olga Alykova
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | | | - Maike Gerdes
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Harald Kugel
- Clinic for Radiology, University Hospital Münster, Germany
| | | | - Holger Bösenberg
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Christian Mathys
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Germany.,Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Germany
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Martín-Noguerol T, Montesinos P, Hassankhani A, Bencardino DA, Barousse R, Luna A. Technical Update on MR Neurography. Semin Musculoskelet Radiol 2022; 26:93-104. [PMID: 35609571 DOI: 10.1055/s-0042-1742753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Imaging evaluation of peripheral nerves (PNs) is challenging. Magnetic resonance imaging (MRI) and ultrasonography are the modalities of choice in the imaging assessment of PNs. Both conventional MRI pulse sequences and advanced techniques have important roles. Routine MR sequences are the workhorse, with the main goal to provide superb anatomical definition and identify focal or diffuse nerve T2 signal abnormalities. Selective techniques, such as three-dimensional (3D) cranial nerve imaging (CRANI) or 3D NerveVIEW, allow for a more detailed evaluation of normal and pathologic states. These conventional pulse sequences have a limited role in the comprehensive assessment of pathophysiologic and ultrastructural abnormalities of PNs. Advanced functional MR neurography sequences, such as diffusion tensor imaging tractography or T2 mapping, provide useful and robust quantitative parameters that can be useful in the assessment of PNs on a microscopic level. This article offers an overview of various technical parameters, pulse sequences, and protocols available in the imaging of PNs and provides tips on avoiding potential pitfalls.
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Affiliation(s)
| | | | - Alvand Hassankhani
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | - Rafael Barousse
- Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina
| | - Antonio Luna
- MRI Unit, Radiology Department, HT Médica, Jaén, Spain
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11
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Radiation Therapy for Adenoid Cystic Carcinoma of the Head and Neck. Cancers (Basel) 2021; 13:cancers13246335. [PMID: 34944955 PMCID: PMC8699151 DOI: 10.3390/cancers13246335] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Adenoid cystic carcinoma is a rare histology arising in the head and neck region that has a high propensity for perineural invasion. While surgical resection is the preferred primary treatment modality, adjuvant radiotherapy is often indicated to improve local control. For unresectable disease, definitive radiotherapy can be utilized. Given the predilection for perineural tumor spread, target volumes often must encompass relevant nerve pathways back to the base of skull. Treatment strategies for ACC must therefore balance the disease burden and risk of failure against the morbidity of treatment. Abstract Adenoid cystic carcinoma of the head and neck is an uncommon malignancy that can arise in the major or minor salivary glands. Perineural invasion (PNI) is an extremely frequent finding in cases of adenoid cystic carcinoma (ACC) that can be associated with significant patient morbidity and poor prognosis. By contrast, ACC rarely demonstrates lymphovascular space invasion thereby making PNI the major avenue for metastasis and a driver of treatment rationale and design. Radiotherapy is often utilized post-operatively to improve locoregional control or as a primary therapy in unresectable disease. Here we aim to review the role of radiotherapy in the management of this malignancy with a focus on target delineation and treatment regimens in the definitive, recurrent, and metastatic settings.
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Meewis J, Renton T, Jacobs R, Politis C, Van der Cruyssen F. Post-traumatic trigeminal neuropathy: correlation between objective and subjective assessments and a prediction model for neurosensory recovery. J Headache Pain 2021; 22:44. [PMID: 34030632 PMCID: PMC8146662 DOI: 10.1186/s10194-021-01261-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/19/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Post-traumatic trigeminal neuropathy (PTN) can have a substantial effect on patient well-being. However, the relation between the neuropathic symptoms and their effect on psychosocial functioning remains a matter of debate. The purpose of this study was to evaluate the association between objective and subjective assessments of neurosensory function in PTN and predict neurosensory outcome using baseline measurements. METHODS This prospective observational cohort study included patients diagnosed with PTN at the Department of Oral and Maxillofacial Surgery, University Hospital Leuven, Belgium, between April 2018 and May 2020. Standardized objective and subjective neurosensory examinations were recorded simultaneously on multiple occasions during the follow-up period. Correlation analyses and principal component analysis were conducted, and a prediction model of neurosensory recovery was developed. RESULTS Quality of life correlated significantly (P < 0.05) with percentage of affected dermatome (ρ = - 0.35), the presence of brush stroke allodynia (ρ = - 0.24), gain-of-function sensory phenotype (ρ = - 0.41), Medical Research Council Scale (ρ = 0.36), and Sunderland classification (ρ = - 0.21). Quality of life was not significantly correlated (P > 0.05) with directional discrimination, stimulus localization, two-point discrimination, or sensory loss-of-function. The prediction model showed a negative predictive value for neurosensory recovery after 6 months of 87%. CONCLUSIONS We found a strong correlation of subjective well-being with the presence of brush stroke allodynia, thermal and/or mechanical hyperesthesia, and the size of the neuropathic area. These results suggest that positive symptoms dominate the effect on affect. In patients reporting poor subjective well-being in the absence of positive symptoms or a large neuropathic area, additional attention towards psychosocial triggers might enhance treatment outcome. The prediction model could contribute to establishing realistic expectations about the likelihood of neurosensory recovery but remains to be validated in future studies.
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Affiliation(s)
- Jeroen Meewis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium.
| | - Tara Renton
- Department of Oral Surgery, King's College London Dental Institute, London, UK
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska institutet, Stockholm, Sweden
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Fréderic Van der Cruyssen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
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