Service de Radiologie 1, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France.
Service ORL, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Eur Arch Otorhinolaryngol. 2021 Jul;278(7):2501-2509. doi: 10.1007/s00405-020-06375-z. Epub 2020 Sep 22.
MRI is the modality of choice for the imaging of facial neuritis. Previously, gadolinium-enhanced T1-weighted imaging of the petrous bone, then FLAIR sequences were thought to be most informative for acute facial neuritis imaging. The aim of this study is to evaluate the value of contrast-enhanced T2-weighted sequence for the diagnosis of acute facial neuritis and compare it to contrast-enhanced T1-weighted and FLAIR sequences.
We included 50 patients with an acute unilateral idiopathic peripheral facial neuritis. An MRI (3 T) with three sequences was performed (T1-weighted, T2-weighted and FLAIR), all acquired after intravenous contrast-media injection.
The contrast-enhanced T2-weighted sequence appeared to be the most accurate one for the diagnosis of acute facial neuritis (Se 94%, Sp 100%, accuracy 98.2%, p < 0.001), with a pathological facial nerve strongly (grade 2-3) enhancing and a homogenous enhancement along the course of the entire facial nerve. Contrast-enhanced T1-weighted (Se 80%, Sp 100%, accuracy 94.1%) and FLAIR sequences (92%, Sp 88%, accuracy 90%, p < 0.001) showed lower accuracy. On T1-weighted sequence, a strong enhancement (blurred margins) of the canalicular segment was observed in 80% of the cases when it was never observed in normal nerves.
A strong (= iso to hyperintense to the petrous fat signal) and diffuse (all segments) enhancement of the facial nerve on T2-weighted steady-state free precession sequence is a sensitive and specific sign for the diagnosis of acute idiopathic facial neuritis, and appears superior to T1WI and FLAIR sequences.
MRI 是面神经炎影像学检查的首选方法。既往认为，钆增强 T1 加权成像的岩骨和 FLAIR 序列对视神经炎的急性成像最有帮助。本研究旨在评估对比增强 T2 加权序列对急性面神经炎诊断的价值，并与对比增强 T1 加权和 FLAIR 序列进行比较。
我们纳入了 50 例单侧特发性急性周围性面神经炎患者。所有患者均进行了 MRI（3T）检查，包括 T1 加权、T2 加权和 FLAIR 序列，均在静脉注射对比剂后采集。
对比增强 T2 加权序列似乎是诊断急性面神经炎最准确的序列（Se 94%，Sp 100%，准确性 98.2%，p<0.001），表现为病理性面神经明显增强（2-3 级），整个面神经走行均匀强化。对比增强 T1 加权（Se 80%，Sp 100%，准确性 94.1%）和 FLAIR 序列（Se 92%，Sp 88%，准确性 90%，p<0.001）的准确性较低。在 T1 加权序列上，80%的病例可见管内段明显强化（边缘模糊），而正常神经中从未观察到这种情况。
面神经在 T2 加权稳态自由进动序列上呈强（与岩骨脂肪信号等或高信号）、弥漫性（所有节段）强化是急性特发性面神经炎的敏感且特异的征象，优于 T1WI 和 FLAIR 序列。
