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Trigeminal neuralgia: comparison of two MR imaging techniques in the demonstration of neurovascular contact.

PURPOSE
To compare two magnetic resonance (MR) imaging techniques for demonstration of vascular contact with the trigeminal nerve.


MATERIALS AND METHODS
Thirteen patients with unilateral trigeminal neuralgia and 50 control subjects underwent three-dimensional fast inflow with steady-state precession (FISP) and contrast material-enhanced magnetization-prepared rapid acquisition gradient-echo (MP-RAGE) MR imaging. The images were independently reviewed by two neuroradiologists, who were blinded to the clinical details. Six of the 13 patients underwent surgery.


RESULTS
Vascular contact with the trigeminal nerve at the root entry zone was seen on FISP images in 10 of 13 (77%) symptomatic nerves and in eight of 113 (7%) asymptomatic nerves (P < .001). MP-RAGE and FISP images demonstrated arterial contacts equally well. MP-RAGE images demonstrated one additional venous contact at the root entry zone in a patient with ipsilateral trigeminal neuralgia. Interobserver agreement was good for both FISP (kappa = 0.69) and MP-RAGE (kappa = 0.78) images. The presence of vascular contact at the root entry zone, seen on preoperative MR images, was confirmed in all six patients who underwent surgery.


CONCLUSION
Both FISP and MP-RAGE MR imaging are useful in demonstrating vascular contact with the trigeminal nerve at the root entry zone in patients with trigeminal neuralgia.