First application of 7-T ultra–high field diffusion tensor imaging to detect altered microstructure of thalamic-somatosensory anatomy in trigeminal neuralgia

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OBJECTIVE

Trigeminal neuralgia (TN) is a debilitating neurological disease that commonly results from neurovascular compression of the trigeminal nerve (CN V). Although the CN V has been extensively studied at the site of neurovascular compression, many pathophysiological factors remain obscure. For example, thalamic-somatosensory function is thought to be altered in TN, but the abnormalities are inadequately characterized. Furthermore, there are few studies using 7-T MRI to examine patients with TN. The purpose of the present study was to use 7-T MRI to assess microstructural alteration in the thalamic-somatosensory tracts of patients with TN by using ultra–high field MRI.

METHODS

Ten patients with TN and 10 age- and sex-matched healthy controls underwent scanning using 7-T MRI with diffusion tensor imaging. Structural images were segmented with an automated algorithm to obtain thalamus and primary somatosensory cortex (S1). Probabilistic tractography was performed between the thalamus and S1, and the microstructure of the thalamic-somatosensory tracts was compared between patients with TN and controls.

RESULTS

Fractional anisotropy of the thalamic-somatosensory tract ipsilateral to the site of neurovascular compression was reduced in patients (mean 0.43) compared with side-matched controls (mean 0.47, p = 0.01). The mean diffusivity was increased ipsilaterally in patients (mean 6.58 × 10−4 mm2/second) compared with controls (mean 6.15 × 10−4 mm2/second, p = 0.02). Radial diffusivity was increased ipsilaterally in patients (mean 4.91 × 10−4 mm2/second) compared with controls (mean 4.44 × 10−4 mm2/second, p = 0.01). Topographical analysis revealed fractional anisotropy reduction and diffusivity elevation along the entire anatomical S1 arc in patients with TN.

CONCLUSIONS

The present study is the first to examine microstructural properties of the thalamic-somatosensory anatomy in patients with TN and to evaluate quantitative differences compared with healthy controls. The finding of reduced integrity of these white matter fibers provides evidence of microstructural alteration at the level of the thalamus and S1, and furthers the understanding of TN neurobiology.

ABBREVIATIONS AD = axial diffusivity; CN V = trigeminal nerve; DTI = diffusion tensor imaging; FA = fractional anisotropy; MD = mean diffusivity; MP2RAGE = magnetization-prepared 2 rapid acquisition gradient echoes; RD = radial diffusivity; REZ = root entry zone; ROI = region of interest; S1 = primary somatosensory cortex; TN = trigeminal neuralgia.

Article Information

Correspondence John W. Rutland: Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY. jack.rutland@icahn.mssm.edu.

INCLUDE WHEN CITING Published online August 30, 2019; DOI: 10.3171/2019.6.JNS19541.

Disclosures Dr. Balchandani, the principal investigator in this study, is a named inventor on patents relating to MRI and radiofrequency (RF) pulse design. The patents have been licensed to GE Healthcare, Siemens AG, and Philips International. Dr. Balchandani receives royalty payments relating to these patents. Dr. Balchandani is a named inventor on patents relating to Slice-selective adiabatic magnetization T2-preparation (SAMPA) for efficient T2-weighted imaging at ultra–high field strengths, Methods for Producing a Semi-Adiabatic Spectral-Spatial Spectroscopic Imaging Sequence and Devices Thereof, and Semi-Adiabatic Spectral-Spatial Spectroscopic Imaging. Dr. Bederson, a significant contributor in this study and chair of the Department of Neurosurgery, owns equity in Surgical Theater, LLC (manufacturer of the Surgical Navigation Advanced Platform [SNAP] system that may have been used for intraoperative image guidance in the study).

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    ROI selection. A: Coronal T1-weighted image used for the whole-brain segmentation. B: Thalamic cortex and S1 segmentation results on coronal T1-weighted image. C: A 3D rendering of thalamic and primary visual cortices. Figure is available in color online only.

  • View in gallery

    Probabilistic tractography of the thalamic-somatosensory tracts shown in 3D. Figure is available in color online only.

  • View in gallery

    Upper: Topographic representation of thalamic-somatosensory tract microstructure on the side of neurovascular compression in patients with TN compared with healthy controls. Values on the y axes are expressed in mm2/second. Lower: Somatosensory homunculus is overlaid on tracts innervating S1 to represent anatomical regions of sensory cortical processing with regard to angle position. Figure is available in color online only.

  • View in gallery

    Artistic representation of left-sided neurovascular compression with diminished left thalamic-somatosensory tract integrity. Printed with permission from ©Mount Sinai Health System. Figure is available in color online only.

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