Predicting pain relief: Use of pre-surgical trigeminal nerve diffusion metrics in trigeminal neuralgia

Autor: Karen D. Davis, David Qixiang Chen, Mojgan Hodaie, Peter Shih-Ping Hung, Jidan Zhong
Rok vydání: 2017
Předmět:
Male
Treatment response prediction
Pain relief
lcsh:RC346-429
Neurosurgical Procedures
030218 nuclear medicine & medical imaging
0302 clinical medicine
Trigeminal neuralgia
Pons
(MVD)
microvascular decompression
(GKRS)
Gamma Knife radiosurgery
(DTI)
diffusion tensor imaging
(TN)
trigeminal neuralgia
(MD)
mean diffusivity
Multi-tensor tractography
Regular Article
Middle Aged
3. Good health
Peripheral
Diffusion Tensor Imaging
Treatment Outcome
Neurology
Anesthesia
lcsh:R858-859.7
Female
Radiology
(ROI)
region of interest
Tractography
Adult
medicine.medical_specialty
Cognitive Neuroscience
(FSPGR)
fast spoiled gradient-echo
lcsh:Computer applications to medicine. Medical informatics
(XST)
eXtended Streamline Tractography
03 medical and health sciences
Discriminant function analysis
Image Interpretation
Computer-Assisted
Fractional anisotropy
medicine
Humans
Radiology
Nuclear Medicine and imaging
Trigeminal Nerve
lcsh:Neurology. Diseases of the nervous system
Aged
Trigeminal nerve
Surgical outcome
Chronic facial pain
business.industry
(RD)
radial diffusivity
Trigeminal Neuralgia
medicine.disease
(AD)
axial diffusivity
(FA)
fractional anisotropy
Neurology (clinical)
(MR)
magnetic resonance
business
030217 neurology & neurosurgery
Diffusion MRI
Zdroj: NeuroImage : Clinical
NeuroImage: Clinical, Vol 15, Iss, Pp 710-718 (2017)
ISSN: 2213-1582
Popis: Trigeminal neuralgia (TN) is a chronic neuropathic facial pain disorder that commonly responds to surgery. A proportion of patients, however, do not benefit and suffer ongoing pain. There are currently no imaging tools that permit the prediction of treatment response. To address this paucity, we used diffusion tensor imaging (DTI) to determine whether pre-surgical trigeminal nerve microstructural diffusivities can prognosticate response to TN treatment. In 31 TN patients and 16 healthy controls, multi-tensor tractography was used to extract DTI-derived metrics—axial (AD), radial (RD), mean diffusivity (MD), and fractional anisotropy (FA)—from the cisternal segment, root entry zone and pontine segment of trigeminal nerves for false discovery rate-corrected Student's t-tests. Ipsilateral diffusivities were bootstrap resampled to visualize group-level diffusivity thresholds of long-term response. To obtain an individual-level statistical classifier of surgical response, we conducted discriminant function analysis (DFA) with the type of surgery chosen alongside ipsilateral measurements and ipsilateral/contralateral ratios of AD and RD from all regions of interest as prediction variables. Abnormal diffusivity in the trigeminal pontine fibers, demonstrated by increased AD, highlighted non-responders (n = 14) compared to controls. Bootstrap resampling revealed three ipsilateral diffusivity thresholds of response—pontine AD, MD, cisternal FA—separating 85% of non-responders from responders. DFA produced an 83.9% (71.0% using leave-one-out-cross-validation) accurate prognosticator of response that successfully identified 12/14 non-responders. Our study demonstrates that pre-surgical DTI metrics can serve as a highly predictive, individualized tool to prognosticate surgical response. We further highlight abnormal pontine segment diffusivities as key features of treatment non-response and confirm the axiom that central pain does not commonly benefit from peripheral treatments.
Highlights • Pre-surgical trigeminal diffusivities are highly predictive of individual response. • Diffusivities were measured in pons, root entry zone and trigeminal nerve cisterns. • Non-responders have unique pontine trigeminal nerve microstructural abnormalities. • Responders, instead, have cisternal trigeminal nerve microstructural abnormalities. • A highly successful individual-level prognosticator of surgical response was created.
Databáze: OpenAIRE
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