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mDIXON TSE skull base imaging of trigeminal neuralgia

Case Study

Patient history

A 56-year-old female with severe pain along the cheekbone and upper jaw on the left and unremarkable clinical examination was referred for MR imaging of the trigeminal nerve (CN V) at Leiden University Medical Center.

MR examination

The MRI exam was done on Ingenia 3.0T using the dS Head coil.

 

MR imaging of the trigeminal nerve (CN V) requires highly focused imaging of the peripheral and central segments of the CN V. Fat suppression may be needed distinguish the nerve from fatty tissue but has the risk of increased susceptibility artifacts along the skull base.

 

With mDIXON, images with and without fat suppression can be obtained at the same time. It provides homogeneous fat suppression and low sensitivitiy to susceptibility artifacts.

 

Scans were optimized for high image quality rather than speed. T1 TSE SPIR scan time 4:32 min. and 9:04 min for both with and without fat suppression. mDIXON TSE scan time 4:03 min.

Images

Click on an image to enlarge
 T1 TSE SPIR<br> mDIXON TSE water only<br> mDIXON TSE in-phase<br>
T1 TSE SPIR
mDIXON TSE water only
mDIXON TSE in-phase
 T1 TSE SPIR<br> mDIXON TSE water only<br> mDIXON TSE in-phase<br>
T1 TSE SPIR
mDIXON TSE water only
mDIXON TSE in-phase


Images are from the levels of the infraorbital nerve (top row) and the foramen rotundum (bottom row).

Post-contrast T1 TSE SPIR images (0.47 x 0.59 mm pixels) show inhomogeneous fat suppression (for instance in the cheek) and susceptibility artifacts along the orbital floor and skull base, which obscure the regions of interest. Scanning an additional T1 TSE without fat suppression is required for better visualization of the infraorbital nerve (white arrows) and foramen rotundum (other color arrows).

Instead, one mDIXON TSE scan provides four image types including images with and without fat suppression (water only and in-phase, respectively) in one acquisition. Homogenous fat suppression and decreased susceptibility artifacts in the mDIXON images provide excellent delineation of all branches of the trigeminal nerve. Shown here are the infraorbital nerve (arrows top row), maxillary nerve in the foramen rotundum (arrow bottom row) and inferior alveolar nerve (branch of the mandibular nerve V3; arrowheads).

Diagnosis

Such image quality is indispensible to rule out underlying disease in neuralgia – as in our patient - or for evaluation of perineural spread in oncologic patients.

Clinical impact of mDIXON TSE

mDIXON TSE provides 4 image types -- including images with and without fat suppression -- in one acquisition. Homogenous fat suppression and decreased susceptibility artifacts provide excellent delineation of all branches of the trigeminal nerve.

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Jun 23, 2014

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Case Study
Ingenia 3.0T
Release 4
dStream, Head, mDIXON TSE, Neck, Neuro, trigeminal neuralgia
 

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