Magnetic Resonance Neurography of Traumatic and Non-Traumatic Peripheral Trigeminal Neuropathies

Publication date: Available online 16 November 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): John R. Zuniga, Robert V. Walker, Cyrus Mistry, Igor Tikhonov, Riham Dessouky, Avneesh Chhabra
PurposeThe clinical neurosensory testing (NST) is currently the gold-standard for the diagnosis of traumatic and non-traumatic peripheral trigeminal neuropathies (PTN), but exhibits both false positive and negative results when compared to surgical findings and frequently delays treatment decisions. We tested the hypothesis that magnetic resonance neurography (MRN) of PTN can serve as a diagnostic modality by correlating NST, MRN and surgical findings.Materials and MethodsSixty patients with traumatic and non-traumatic PTN of varying etiologies and Sunderland classifications underwent NST followed by MRN on 1.5T and 3.0 T scanners. The protocol included 2D and 3D imaging, including diffusion imaging and isotropic 3D PSIF. The MRN findings were read by two readers in consensus of clinical findings but blinded to the side of abnormality. The MRN results were summarized using Sunderland Classification. In 26 patients, surgery was performed and Sunderland classification was assigned based on surgical photos. Agreement between MRN and NST/Surgical classification was evaluated using kappa statistics. Pearson's Correlation Coefficient (PCC) was used to assess the correlation between continuous measurements of MRN/NST and surgical classification.ResultsNineteen males and 41 females, mean age 41, ranging 12 to 75, with 54 complaints of altered sensation of the lip/chin/or tongue, including 16 with neuropathic pain and 4 with no neurosensory complaint were included. Third molar surgery (n=29) represented the most common cause of traumatic PTN. Assuming one nerve abnormality per patient, the lower class was accepted, a kappa of 0.57 was observed between MRN and NST classification. A kappa of 0.5 existed between MRN and surgical findings with a PCC of 0.67.ConclusionsMRN anatomically maps PTN and stratifies the nerve injury and neuropathies with moderate to good agreement with NST and surgical findings for clinical use.



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