Objectives Trigeminal neuralgia (TN) is a severe pain disorder for which MRI helps to identify the anatomical causes of pain. However, imaging protocols vary widely, and a plethora of imaging features that might contribute to different forms of TN have been described. This review aims to (1) summarize current evidence on MRI techniques and their diagnostic performance, and (2) evaluate imaging markers that improve our understanding of TN pathophysiology and support clinical decision-making regarding surgical or interventional treatment. Materials and methods A comprehensive literature search was performed in PubMed, EMBASE, and the Cochrane Library databases, yielding 1441 studies. After applying strict inclusion criteria, 140 articles were included, and three papers were added from cross-referencing. Results The review revealed that advanced MRI sequences (e.g., 3D CISS, 3D FLASH, 3D FIESTA) improve the visualization of neurovascular conflicts. Imaging at 3.0 T was found to be superior to 1.5 T for detecting small vessels responsible for nerve compression. However, distinguishing clinically significant neurovascular conflicts from asymptomatic neurovascular contacts remains a challenge. In secondary TN, MRI reliably detects lesions related to multiple sclerosis and other pathological conditions. Diffusion tensor imaging (DTI) has shown potential in identifying microstructural changes in the trigeminal nerve, further supporting its diagnostic use. Conclusions Although MRI remains an essential tool in diagnosing TN, limitations in its diagnostic accuracy highlight the need for more homogeneous study designs and further refinement of imaging protocols and interpretation criteria. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Accurate identification of the anatomical cause of trigeminal neuralgia is clinically important, but variable MRI protocols result in inconsistent diagnostic accuracy. <Emphasis Type="BoldItalic">Findings</Emphasis> Advanced MRI sequences and higher field strength improve visualization of neurovascular conflict, although interobserver variability and limited clinical correlation remain major challenges. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Standardized magnetic resonance imaging protocols and clearer interpretation criteria may enhance diagnostic confidence and assist treatment planning in patients with suspected trigeminal neuralgia, particularly when surgical intervention is considered to relieve severe, medication-resistant facial pain.

Magnetic resonance imaging in the diagnosis of trigeminal neuralgia: a systematic review of the imaging protocol and diagnostic accuracy

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2025年11月27日

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Dylan Henssen,
Max van Grinsven,
Kris Vissers,
Johan van Goethem

摘要

Objectives

Trigeminal neuralgia (TN) is a severe pain disorder for which MRI helps to identify the anatomical causes of pain. However, imaging protocols vary widely, and a plethora of imaging features that might contribute to different forms of TN have been described. This review aims to (1) summarize current evidence on MRI techniques and their diagnostic performance, and (2) evaluate imaging markers that improve our understanding of TN pathophysiology and support clinical decision-making regarding surgical or interventional treatment.

Materials and methods

A comprehensive literature search was performed in PubMed, EMBASE, and the Cochrane Library databases, yielding 1441 studies. After applying strict inclusion criteria, 140 articles were included, and three papers were added from cross-referencing.

Results

The review revealed that advanced MRI sequences (e.g., 3D CISS, 3D FLASH, 3D FIESTA) improve the visualization of neurovascular conflicts. Imaging at 3.0 T was found to be superior to 1.5 T for detecting small vessels responsible for nerve compression. However, distinguishing clinically significant neurovascular conflicts from asymptomatic neurovascular contacts remains a challenge. In secondary TN, MRI reliably detects lesions related to multiple sclerosis and other pathological conditions. Diffusion tensor imaging (DTI) has shown potential in identifying microstructural changes in the trigeminal nerve, further supporting its diagnostic use.

Conclusions

Although MRI remains an essential tool in diagnosing TN, limitations in its diagnostic accuracy highlight the need for more homogeneous study designs and further refinement of imaging protocols and interpretation criteria.

Key Points

Question Accurate identification of the anatomical cause of trigeminal neuralgia is clinically important, but variable MRI protocols result in inconsistent diagnostic accuracy.

Findings Advanced MRI sequences and higher field strength improve visualization of neurovascular conflict, although interobserver variability and limited clinical correlation remain major challenges.

Clinical relevance Standardized magnetic resonance imaging protocols and clearer interpretation criteria may enhance diagnostic confidence and assist treatment planning in patients with suspected trigeminal neuralgia, particularly when surgical intervention is considered to relieve severe, medication-resistant facial pain.