Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
Department of Radiology, University of Minnesota, Minneapolis, MN, USA.
Clin Neurol Neurosurg. 2022 Oct;221:107403. doi: 10.1016/j.clineuro.2022.107403. Epub 2022 Aug 2.
Neurovascular compression (NVC) has been the primary hypothesis for the underlying mechanism of classical trigeminal neuralgia (TN). However, a substantial body of literature has emerged highlighting notable exceptions to this hypothesis. The purpose of this study is to assess the reliability and diagnostic accuracy of high resolution, high contrast MRI-determined neurovascular contact for TN.
We performed a retrospective, randomized, and blinded parallel characterization of neurovascular interaction and diagnosis in a population of TN patients and controls using four expert reviewers. Performance statistics were calculated, as well as assessments for generalizability using shuffled bootstraps.
Fair to moderate agreement (ICC: 0.32-0.68) about diagnosis between reviewers was observed using MRIs from 47 TN patients and 47 controls. On average reviewers performed no better than chance when diagnosing participants, with an accuracy of 0.57 (95% CI 0.40, 0.59) per patient.
While MRI is useful in determining structural causes in secondary TN, expert reviewers do no better to only slightly better than chance with distinguishing TN with MRI, despite moderate agreement. Further, the causal role of NVC for TN is not clear, limiting the applicability of MRI to diagnose or prognosticate treatment of TN.
神经血管压迫（NVC）一直是经典三叉神经痛（TN）的潜在机制的主要假说。然而，大量文献突出了这一假说的显著例外。本研究的目的是评估高分辨率、高对比度 MRI 确定的 TN 神经血管接触的可靠性和诊断准确性。
我们使用四位专家评审员对 TN 患者和对照组进行了神经血管相互作用和诊断的回顾性、随机和盲法平行特征描述。计算了性能统计数据，并使用随机重排进行了可推广性评估。
使用来自 47 名 TN 患者和 47 名对照者的 MRI，观察到诊断之间存在中等至中度一致（ICC：0.32-0.68）。平均而言，评审员在诊断参与者时的表现并不比随机更好，每位患者的准确率为 0.57（95%CI 0.40，0.59）。
尽管 MRI 在确定继发性 TN 的结构原因方面很有用，但专家评审员在仅凭 MRI 区分 TN 方面表现不佳，尽管存在中度一致。此外，NVC 对 TN 的因果作用尚不清楚，这限制了 MRI 诊断或预测 TN 治疗的适用性。
