Zuniga John R, Mistry Cyrus, Tikhonov Igor, Dessouky Riham, Chhabra Avneesh
Robert V. Walker DDS Chair, Division of Oral and Maxillofacial Surgery, and Professor, Departments of Surgery and Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
Chief Resident, Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
J Oral Maxillofac Surg. 2018 Apr;76(4):725-736. doi: 10.1016/j.joms.2017.11.007. Epub 2017 Nov 16.
The clinical neurosensory testing (NST) is currently the reference standard for the diagnosis of traumatic and nontraumatic peripheral trigeminal neuropathies (PTNs), but exhibits both false-positive and false-negative results compared with surgical findings and frequently results in treatment decision delays. We tested the hypothesis that magnetic resonance neurography (MRN) of PTNs can serve as a diagnostic modality by correlating the NST, MRN, and surgical findings.
Sixty patients with traumatic and nontraumatic PTN of varying etiologies and Sunderland classifications underwent NST, followed by MRN using 1.5T and 3.0T scanners. The protocol included 2-dimensional and 3-dimensional (3D) imaging, including diffusion imaging and isotropic 3D PSIF. The MRN findings were read by 2 readers in consensus with the clinical findings but without knowing the side of abnormality. The MRN results were summarized using the Sunderland classification. In 26 patients, surgery was performed, and the Sunderland classification was assigned using the surgical photographs. Agreement between the MRN findings and NST/surgical classification was evaluated using kappa statistics. Pearson's correlation coefficient was used to assess the correlation between continuous measurements of MRN/NST and surgical classification.
Of the 60 patients, 19 males and 41 females, mean age 41 years (range 12 to 75), with 54 complaints of altered sensation of the lip, chin, or tongue, including 16 with neuropathic pain and 4 with no neurosensory complaint, were included. Third molar surgery (n = 29) represented the most common cause of traumatic PTN. Assuming 1 nerve abnormality per patient, the lower class was accepted, a kappa of 0.57 was observed between the MRN and NST classification. A kappa of 0.5 was found between MRN and surgical findings with a Pearson correlation coefficient of 0.67.
MRN anatomically maps PTNs and stratifies the nerve injury and neuropathies with moderate to good agreement with NST and surgical findings for clinical use.
临床神经感觉测试（NST）目前是诊断创伤性和非创伤性周围三叉神经病变（PTN）的参考标准，但与手术结果相比，存在假阳性和假阴性结果，且常常导致治疗决策延迟。我们检验了这样一个假设，即通过关联NST、磁共振神经成像（MRN）和手术结果，PTN的MRN可作为一种诊断方式。
60例病因和桑德兰分类各异的创伤性和非创伤性PTN患者接受了NST，随后使用1.5T和3.0T扫描仪进行MRN检查。方案包括二维和三维（3D）成像，包括扩散成像和各向同性3D PSIF。由2名阅片者在与临床结果一致但不知道异常侧别的情况下阅读MRN结果。MRN结果采用桑德兰分类进行总结。26例患者接受了手术，并根据手术照片确定桑德兰分类。使用kappa统计评估MRN结果与NST/手术分类之间的一致性。采用Pearson相关系数评估MRN/NST连续测量值与手术分类之间的相关性。
60例患者中，男性19例，女性41例，平均年龄41岁（范围12至75岁），有54例出现唇、颏或舌感觉改变的主诉，其中16例伴有神经性疼痛，4例无神经感觉主诉。第三磨牙手术（n = 29）是创伤性PTN最常见的原因。假设每位患者有1处神经异常，采用较低的分类，MRN与NST分类之间的kappa值为0.57。MRN与手术结果之间的kappa值为0.5，Pearson相关系数为0.67。
MRN在解剖学上描绘了PTN，并对神经损伤和神经病变进行分层，与NST和手术结果具有中度至良好的一致性，可供临床使用。
