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Objective <p>To evaluate the clinical value of three-dimensional time-of-flight magnetic resonance angiography (3D TOF-MRA), three-dimensional fast imaging employing steady-state acquisition with phase cycling (3D FIESTA-c), and their combination for preoperative assessment of responsible vessels in primary trigeminal neuralgia (PTN) before microvascular decompression (MVD).</p> Methods <p>We retrospectively reviewed 412 patients with PTN confirmed by MVD who underwent preoperative 3D TOF-MRA and 3D FIESTA-c. Intraoperative findings served as the reference standard. Diagnostic performance was assessed using 2 criteria: binary identification of the presence or absence of a responsible vessel and complete concordance of vessel type. Agreement with surgical findings was evaluated using Cohen’s kappa. Subgroup analyses were performed according to responsible vessel type.</p> Results <p>Responsible vessels were identified intraoperatively in 407 of 412 patients (98.79%), whereas no responsible vessel was found in 5 patients (1.21%). The superior cerebellar artery (SCA) was the most common responsible vessel (250/412, 60.68%), followed by involvement of the SCA and petrosal vein (54/412, 13.11%). Under binary criteria, the accuracy of 3D TOF-MRA, 3D FIESTA-c, and the combined approach was 90.53%, 91.99%, and 96.36%, respectively, with a significant overall difference (Cochran’s Q = 23.400, P &lt; 0.001). Under complete concordance criteria, the corresponding matching rates were 74.27%, 82.77%, and 87.86%, respectively, with kappa values of 0.531, 0.702, and 0.786 (Cochran’s Q = 64.892, P &lt; 0.001). Pairwise comparisons showed that the combined approach outperformed either sequence alone, and 3D FIESTA-c also outperformed 3D TOF-MRA under complete concordance. The combined approach also performed better in the SCA and anterior inferior cerebellar artery (AICA) subgroups.</p> Conclusion <p>The combination of 3D TOF-MRA and 3D FIESTA-c improves preoperative assessment of responsible vessels in PTN, with higher diagnostic accuracy and better agreement with intraoperative findings than either modality alone.</p>

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Preoperative imaging evaluation of primary trigeminal neuralgia using 3D TOF-MRA and 3D FIESTA-c: A retrospective study of 412 cases

  • 期刊论文

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  • 发表日期：

    2026年6月24日

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  • Yu Huang,
  • Ying Huang,
  • Chaoyong Xiao,
  • Qingling Huang,
  • Xue Chai

摘要

Objective

To evaluate the clinical value of three-dimensional time-of-flight magnetic resonance angiography (3D TOF-MRA), three-dimensional fast imaging employing steady-state acquisition with phase cycling (3D FIESTA-c), and their combination for preoperative assessment of responsible vessels in primary trigeminal neuralgia (PTN) before microvascular decompression (MVD).

Methods

We retrospectively reviewed 412 patients with PTN confirmed by MVD who underwent preoperative 3D TOF-MRA and 3D FIESTA-c. Intraoperative findings served as the reference standard. Diagnostic performance was assessed using 2 criteria: binary identification of the presence or absence of a responsible vessel and complete concordance of vessel type. Agreement with surgical findings was evaluated using Cohen’s kappa. Subgroup analyses were performed according to responsible vessel type.

Results

Responsible vessels were identified intraoperatively in 407 of 412 patients (98.79%), whereas no responsible vessel was found in 5 patients (1.21%). The superior cerebellar artery (SCA) was the most common responsible vessel (250/412, 60.68%), followed by involvement of the SCA and petrosal vein (54/412, 13.11%). Under binary criteria, the accuracy of 3D TOF-MRA, 3D FIESTA-c, and the combined approach was 90.53%, 91.99%, and 96.36%, respectively, with a significant overall difference (Cochran’s Q = 23.400, P < 0.001). Under complete concordance criteria, the corresponding matching rates were 74.27%, 82.77%, and 87.86%, respectively, with kappa values of 0.531, 0.702, and 0.786 (Cochran’s Q = 64.892, P < 0.001). Pairwise comparisons showed that the combined approach outperformed either sequence alone, and 3D FIESTA-c also outperformed 3D TOF-MRA under complete concordance. The combined approach also performed better in the SCA and anterior inferior cerebellar artery (AICA) subgroups.

Conclusion

The combination of 3D TOF-MRA and 3D FIESTA-c improves preoperative assessment of responsible vessels in PTN, with higher diagnostic accuracy and better agreement with intraoperative findings than either modality alone.