Finger Guilherme, Wu Kyle C, Vignolles-Jeong Joshua, Godil Saniya S, McGahan Ben G, Kreatsoulas Daniel, Shujaat Mohammad T, Prevedello Luciano M, Prevedello Daniel M
Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH 43210, USA.
College of Medicine, The Ohio State University College of Medicine, Columbus, OH 43210, USA.
Brain Sci. 2023 Oct 9;13(10):1434. doi: 10.3390/brainsci13101434.
Among patients with clinical hemifacial spasm (HFS), imaging exams aim to identify the neurovascular conflict (NVC) location. It has been proven that the identification in the preoperative exam increases the rate of surgical success. Despite the description of specific magnetic resonance image (MRI) acquisitions, the site of neurovascular compression is not always visualized. The authors describe a new MRI finding that helps in the diagnosis of HFS, and evaluate the sensitivity, specificity, and interobserver correlation of the described sign. A cross-sectional study including cases of hemifacial spasm treated surgically from 1 August 2011 to 31 July 2021 was performed. The MRIs of the cases were independently evaluated by two experienced neuroradiologists, who were blinded regarding the side of the symptom. The neuroradiologists were assigned to evaluate the MRIs in two separate moments. Primarily, they evaluated whether there was a neurovascular conflict based on the standard technique. Following this initial analysis, the neuroradiologists received a file with the description of the novel sign, named Prevedello Sign (PS). In a second moment, the same neuroradiologists were asked to identify the presence of the PS and, if it was present, to report on which side. A total of 35 patients were included, mostly females (65.7%) with a mean age of 59.02 (+0.48). Since the 35 cases were independently evaluated by two neuroradiologists, a total of 70 reports were included in the analysis. The PS was present in 66 patients (sensitivity of 94.2%, specificity of 91.4% and positive predictive value of 90.9%). When both analyses were performed in parallel (standard plus PS), the sensitivity increased to 99.2%. Based on the findings of this study, the authors conclude that PS is helpful in determining the neurovascular conflict location in patients with HFS. Its presence, combined with the standard evaluation, increases the sensitivity of the MRI to over 99%, without increasing risks of harm to patients or resulting in additional costs.
在临床半面痉挛（HFS）患者中，影像学检查旨在确定神经血管冲突（NVC）的位置。已证实术前检查中识别出该冲突可提高手术成功率。尽管对特定磁共振成像（MRI）采集方法有描述，但神经血管压迫部位并不总是能被可视化。作者描述了一种有助于HFS诊断的新MRI发现，并评估了所描述征象的敏感性、特异性和观察者间的相关性。进行了一项横断面研究，纳入2011年8月1日至2021年7月31日接受手术治疗的半面痉挛病例。这些病例的MRI由两位经验丰富的神经放射科医生独立评估，他们对症状所在侧不知情。神经放射科医生被安排在两个不同时间评估MRI。首先，他们根据标准技术评估是否存在神经血管冲突。在初步分析之后，神经放射科医生收到一份包含新征象描述的文件，该征象名为普雷韦代洛征（PS）。在第二个阶段，要求同一位神经放射科医生识别PS的存在情况，如果存在，报告其所在侧。共纳入35例患者，大多数为女性（65.7%），平均年龄59.02岁（±0.48）。由于这35例病例由两位神经放射科医生独立评估，分析中总共纳入70份报告。PS在66例患者中存在（敏感性为94.2%，特异性为91.4%，阳性预测值为90.9%）。当同时进行两种分析（标准分析加PS分析）时，敏感性提高到99.2%。基于本研究结果，作者得出结论，PS有助于确定HFS患者的神经血管冲突位置。其存在与标准评估相结合，可将MRI的敏感性提高到99%以上，且不会增加对患者造成伤害的风险或产生额外费用。
