TITLE:
Inter-Observer Reliability of Fused Time-of-Flight MR Angiography and 3D Steady State Sequence versus 3D Contrast Enhanced Images in Evaluation of Neurovascular Compression
AUTHORS:
Mohamed Mahmoud Elsherbini, Ali Hassan Elmokadem, Ahmed El-Morsy, Fatma Mohamed Sherif, Amr Farid Khalil
KEYWORDS:
Neurovascular Compression, Trigeminal Neuralgia, Microvascular Decompression, Tinnitus, Vertigo, Hemifacial Spasm
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.12 No.2,
March
10,
2022
ABSTRACT: Purpose: Is to evaluate the accuracy of fused 3D
time-of-flight (TOF) MR angiography and 3D Steady-State sequence (FIESTA)
versus 3D contrast-enhanced T1 weighted
images in evaluation of neurovascular compression via an inter-observer
agreement protocol. Methods: Patients presented with trigeminal
neuralgia, tinnitus, or facial hemispasm were examined using 3D-TOF-MRA, 3D-FIESTA, and 3D contrast-enhanced T1WI of
the cerebellopontine angle to assess neurovascular compression. Two independent
readers assessed the location, signal alteration, offending vascular structure,
and grade of neurovascular compression using fused 3D-TOF-MRA and 3D-FIESTA
versus contrast-enhanced T1 weighted images. The Kappa test for
interobserver agreement was done. Results: The final study cohort consisted of 56 patients (42 females and 14
males) with a mean age of 38.25 ± 1.94.
AICA was the offending vessel for 32 (57.1%) patients. The most common offending nerve was the trigeminal nerve in 26 patients, followed by
facial/vestibulocochlear complex in 18 patients, and solely the 8th nerve in 12
patients. All three grades of compression were encountered in this study with
percentages of 48.2% (27/56), 30.3% (17/56), and 21.4% (12/56) for grades I,
II, III respectively. Fused TOF and steady-state images, and contrast-enhanced
images showed perfect agreement for detection of the side of compression, the
relation between nerve and vascular loop, offended neural segment, and
offending vessel, while showing good
agreement regarding the degree of compression. Conclusion: Fused TOF and steady-state images provide sufficient data to diagnose
and grade microvascular compression syndromes comparable to contrast-enhanced
images.