Improving the accuracy of pre-operative evaluation of neurovascular conflict in trigeminal neuralgia using magnetic resonance subtraction

Purpose To investigate the ability of magnetic resonance (MR) subtraction to evaluate neurovascular conflict (NVC) and to compare it with conventional MR protocols. Methods This prospective study included 82 patients with trigeminal neuralgia who underwent microvascular decompression for NVC. All patients had a pre-operative examination using 3T MRI. The MRI protocols used comprised 3D balanced (B)-fast field echo (FFE), 3D steady-state magnetic resonance angiography (MRA), and 3D T1-FFE sequences. MR subtraction images were obtained by subtracting native images from B-FFE and steady-state MRA. NVC evaluation was performed using subtraction images (MR subtraction) and combination images (conventional MR protocols using B-FFE and T1-FFE in combination). Clinical assessment of the degree of compression, the type of compressing vessel, and the location of conflict were undertaken by two independent observers. The two methods were then compared using surgical criteria. Results MR subtraction exhibited greater accuracy than the conventional method in terms of the estimated severity of conflict (87.80% vs. 57.32%, p < 0.05), and demonstrated better consistency with surgical findings ( k = 0.794 vs. k = 0.365, p < 0.05). For the type of compressing vessel and the location of conflict, both methods were highly accurate and agreed to a similar extent with surgical findings ( p = 0.987, compressing vessel; p = 0.665, location of conflict). Conclusion MR subtraction proved reliable in NVC pre-operative evaluation, with increased accuracy when estimating severity. This result strongly supports the wider use of MR subtraction as the preferred choice in clinical application.