Abstract
The trochlear groove and trochlear cistern are anatomic landmarks closely associated with the tentorial segment of cranial nerve IV. The purposes of this study were to describe the MR imaging appearances of the trochlear groove and trochlear cistern and to test our hypothesis that knowledge of these anatomic landmarks facilitates identification of cranial nerve IV in routine clinical practice. For this retrospective study, consecutive MR imaging examinations of the sinuses performed in 25 patients (50 sides) at our institution were reviewed. Patient characteristics and study indications were recorded. Three readers performed independent assessments of trochlear groove, cistern, and nerve visibility on coronal images obtained by using a T2-weighted driven equilibrium radiofrequency reset pulse sequence. Interobserver agreement was 78% for visibility of the trochlear groove, 56% for the trochlear cistern, and 68% for cranial nerve IV. Following consensus review, the trochlear groove was present in 44/50 sides (88%), the trochlear cistern was present in 25/50 sides (50%), and cranial nerve IV was identified in 36/50 sides (72%). When the trochlear groove was present, cranial nerve IV was identified in 35/44 sides (80%), in contrast to 1/6 sides (17%) with no groove (P = .0013). When the trochlear cistern was present, cranial nerve IV was identified in 23/25 sides (92%), in contrast to 13/25 sides (52%) with no cistern (P = .0016). The trochlear groove and trochlear cistern are anatomic landmarks that facilitate identification of cranial nerve IV in routine clinical practice.
Highlights
BACKGROUND AND PURPOSEThe trochlear groove and trochlear cistern are anatomic landmarks closely associated with the tentorial segment of cranial nerve IV
The trochlear groove was present in 44/50 sides (88%), the trochlear cistern was present in 25/50 sides (50%), and cranial nerve IV was identified in 36/50 sides (72%)
When the trochlear cistern was present, cranial nerve IV was identified in 23/25 sides (92%), in contrast to 13/25 sides (52%) with no cistern (P ϭ .0016)
Summary
Consecutive MR imaging examinations of the sinuses performed in 25 patients (50 sides) at our institution were reviewed. Subjects For this Health Insurance Portability and Accountability Act– compliant, institutional review board–approved study, all sinus MR imaging examinations performed at Massachusetts Eye and Ear between December 1, 2015, and April 1, 2016, were retrospectively reviewed. Inclusion criteria were the following: 1) older than 18 years of age, 2) coronal T2 DRIVE sequence performed, and 3) no superior oblique palsy documented in the patient’s electronic medical record. Twenty-five MR imaging examinations in 25 patients met the inclusion criteria and were included in the study. To maximize generalizability and to best simulate routine clinical practice, we did not exclude examinations containing motion, pulsation, and other MR imaging artifacts from our study. These findings are consistent with the common progression of the cranial nerves through a transitional “dural cave segment” in their course from the intracranial to the extracranial compartment.[14]
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