School of Biological and Health System Engineering, Arizona State University, Tempe, Arizona, USA.
Department of Neuroradiology, Barrow Neurological Institute, Phoenix, Arizona, USA.
J Neuroimaging. 2024 Sep-Oct;34(5):595-602. doi: 10.1111/jon.13230. Epub 2024 Aug 22.
The 3-dimensional cranial nerve imaging (CRANI) sequence may assist visualization of anatomical details of extraforaminal cranial nerves and aid in clinical diagnosis and preoperative planning. In this study, we investigated the feasibility of using a combined CRANI and magnetization-prepared rapid-acquisition gradient-echo (MPRAGE) imaging protocol to comprehensively identify trigeminal nerve projections.
We evaluated the detection of distal regions of three branches of the ophthalmic nerve (V1), three branches of the maxillary nerve (V2), and five branches of the mandibular nerve (V3) in seven healthy adult subjects, with and without contrast injection. Nerve branches were rated on a 5-point scale by three observers. Interobserver reliability was studied using weighted kappa statistics and percentage agreement.
Among V1 and V2 branches, the frontal nerve and infraorbital nerve were most successfully identified (average rating of 3.9, agreement >80%) in precontrast MPRAGE images. In V3 branches, lingual and inferior alveolar nerves were most successfully identified (average rating of 3.9, agreement >80%) in precontrast CRANI images, with an excellent average rating. In all cases except one, interobserver reliability was rated good to excellent. The buccal nerve was the only branch with a low average interobserver rating. Gadolinium contrast did not improve nerve segment visualization in our study. This may relate to the specific anatomic regions assessed, gadolinium dose, postcontrast image timing, and lack of pathology.
A combined CRANI and MPRAGE protocol can be combined to visualize distal branches of V1, V2, and V3 and has potential for clinical use.
3 维颅神经成像（CRANI）序列可能有助于显示颅神经颅外段的解剖细节，并有助于临床诊断和术前规划。本研究旨在探讨使用联合 CRANI 和磁化准备快速获取梯度回波（MPRAGE）成像方案全面识别三叉神经投射的可行性。
我们评估了 7 名健康成年受试者在有无对比剂注射的情况下，对眼神经（V1）的三个分支、上颌神经（V2）的三个分支和下颌神经（V3）的五个分支的远侧区域的检测情况。由三位观察者对神经分支进行 5 分制评分。使用加权κ统计和百分比一致性评估观察者间的可靠性。
在 V1 和 V2 分支中，额神经和眶下神经在未增强 MPRAGE 图像中最易识别（平均评分为 3.9，一致性>80%）。在 V3 分支中，舌神经和下牙槽神经在未增强 CRANI 图像中最易识别（平均评分为 3.9，一致性>80%），且具有极好的平均评分。除了一个病例外，观察者间的可靠性均评为良好至极好。颊神经是唯一分支的平均观察者间评分较低。在本研究中，钆对比剂并不能改善神经节段的可视化，这可能与评估的特定解剖区域、钆剂量、对比后图像时间以及缺乏病理学有关。
联合 CRANI 和 MPRAGE 方案可用于可视化 V1、V2 和 V3 的远侧分支，具有临床应用潜力。
