Service d'ORL, d'Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
Université de Lyon, Université Lyon 1, Lyon, France.
JAMA Netw Open. 2023 Apr 3;6(4):e239158. doi: 10.1001/jamanetworkopen.2023.9158.
There is no consensus on the benefits of routine magnetic resonance imaging (MRI) of the facial nerve in patients with suspected idiopathic peripheral facial palsy (PFP) (ie, Bell palsy [BP]).
To estimate the proportion of adult patients in whom MRI led to correction of an initial clinical diagnosis of BP; to determine the proportion of patients with confirmed BP who had MRI evidence of facial nerve neuritis without secondary lesions; and to identify factors associated with secondary (nonidiopathic) PFP at initial presentation and 1 month later.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective multicenter cohort study analyzed the clinical and radiological data of 120 patients initially diagnosed with suspected BP from January 1, 2018, to April 30, 2022, at the emergency department of 3 tertiary referral centers in France.
All patients screened for clinically suspected BP underwent an MRI of the entire facial nerve with a double-blind reading of all images.
The proportion of patients in whom MRI led to a correction of the initial diagnosis of BP (any condition other than BP, including potentially life-threating conditions) and results of contrast enhancement of the facial nerve were described.
Among the 120 patients initially diagnosed with suspected BP, 64 (53.3%) were men, and the mean (SD) age was 51 (18) years. Magnetic resonance imaging of the facial nerve led to a correction of the diagnosis in 8 patients (6.7%); among them, potentially life-threatening conditions that required changes in treatment were identified in 3 (37.5%). The MRI confirmed the diagnosis of BP in 112 patients (93.3%), among whom 106 (94.6%) showed evidence of facial nerve neuritis on the affected side (hypersignal on gadolinium-enhanced T1-weighted images). This was the only objective sign confirming the idiopathic nature of PFP.
These preliminary results suggest the added value of the routine use of facial nerve MRI in suspected cases of BP. Multicentered international prospective studies should be organized to confirm these results.
在疑似特发性周围性面瘫（PFP）（即贝尔面瘫[BP]）患者中，常规磁共振成像（MRI）对面神经的益处尚无共识。
估计 MRI 纠正初始临床诊断为 BP 的成年患者比例；确定确诊为 BP 的患者中，有多少人存在 MRI 证据表明面神经炎而无继发性病变；并确定在初始表现和 1 个月后与初始表现时的继发性（非特发性）PFP 相关的因素。
设计、地点和参与者：这项回顾性多中心队列研究分析了 2018 年 1 月 1 日至 2022 年 4 月 30 日期间法国 3 家三级转诊中心急诊科最初诊断为疑似 BP 的 120 例患者的临床和影像学数据。
所有筛查出临床疑似 BP 的患者均接受整个面神经 MRI 检查，所有图像均进行双盲阅读。
描述了 MRI 纠正初始 BP 诊断（BP 以外的任何情况，包括可能危及生命的情况）的患者比例和面神经对比增强的结果。
在最初诊断为疑似 BP 的 120 例患者中，64 例（53.3%）为男性，平均（SD）年龄为 51（18）岁。面神经 MRI 检查纠正了 8 例（6.7%）患者的诊断；其中，有 3 例（37.5%）确定为危及生命的情况，需要改变治疗方案。112 例（93.3%）患者 MRI 确诊为 BP，其中 106 例（94.6%）患侧面神经炎在钆增强 T1 加权图像上呈高信号。这是唯一一项证实 PFP 特发性的客观征象。
这些初步结果表明，在疑似 BP 患者中常规使用面神经 MRI 具有附加价值。应组织多中心国际前瞻性研究来证实这些结果。
