The value of 3D-TOF-MRA and 3D-FIESTA fusion three-dimensional images in judgment of offending vessel in primary trigeminal neuralgia

Abstract

Objective To investigate the value of three-dimensional time-flying magnetic resonance angiography (3D-TOF-MRA) and three-dimensional fast imaging employing steady-state acquisition sequence (3D-FIESTA) fusion three-dimensional image in identification of offending vessels of primary trigeminal neuralgia (PTN). Methods A total of 48 patients with PTN who underwent microvascular decompression (MVD) from January 2016 to June 2019 at Department of Neurosurgery, Affiliated Hospital of Qingdao University were retrospectively enrolled into this study. All patients underwent 3D-TOF-MRA and 3D-FIESTA sequence examinations before operation. The 3D-slicer software was used to fuse 3D-TOF-MRA and 3D-FIESTA sequence images and conduct three-dimensional reconstruction. Using MVD as a standard, 3D-TOF-MRA, 3D-FIESTA and fused images were evaluated to determine the offending vessels and their compressive degree on the nerves. Results In MVD, except for 1 patient who had no offending vessel, the other 47 patients had clear offending vessels. The offending vessels were merely arteries in 40 cases, veins in 2, and both arteries and veins in 5. The 3D-TOF-MRA results showed that 5 patients had no offending vessels, and the remaining 43 patients had arteries as offending vessels. The 3D-FIESTA showed that 4 cases had no offending vessels; the offending vessels were arteries in 36 cases, veins in 3 cases, and both arteries and veins in 5 cases. The fused images showed that there were 2 cases without offending vessels; the offending vessels were arteries in 39 cases, veins in 2 cases, and both arteries and veins in 5 cases. Using the MVD as the standard, the accuracy of 3D-TOF-MRA, 3D-FIEST and fusion 3D images for determining the presence/absence offending vessels was 91.7% (44/48), 93.8% (45/48) and 97.9%(45/48), respectively. The accuracy of correct identification of offending vessels by 3D-TOF-MRA, 3D-FIEST and fused images was 54.2% (26/48), 89.6% (43/48) and 93.8% (45/48), respectively. Compared with intraoperative findings, those 3 types of images commonly showed lighter degree of nerve compression, and the differences were statistically significant (all P<0.05). Conclusion Compared with 3D-TOF-MRA and 3D-FIESTA single sequences, the fused images seem to be more accurate in identification of the offending vessels of PTN, which, however, is still associated with underestimation of the nerve compression degree. Key words: Trigeminal neuralgia; Offending vessel; Three-dimensional time-of-flight magnetic resonance angiography; Three-dimensional fast imaging employing steady-state acquisition; Microva-scular decompression