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Corresponding author at: Department of Neurosurgery, First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an 710061, Shaanxi, China. Department of Radiology Medical Physics, University Medical Center Freiburg, University of Freiburg, Killian str. 5a, Freiburg 79106, Germany.
Department of Neurosurgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, ChinaDepartment of Radiology Medical Physics, University Medical Center Freiburg, University of Freiburg, Freiburg 79106, Germany
Accurate preoperative diagnosis of neurovascular compression (NVC) is crucial in microvascular decompression (MVD).
•
NVC can be detected by magnetic resonance imaging (MRI)-based methods.
•
MIF technique based on 3D TOF MRA combined with HR T2WI has better diagnostic performance for detecting NVC.
Abstract
Background
Accurate preoperative diagnosis of neurovascular compression (NVC) is crucial in the treatment of trigeminal neuralgia (TN) or hemifacial spasm (HFS). At present, there are many magnetic resonance imaging (MRI)-based methods for diagnosing NVC in clinical practice. This network meta-analysis (NMA) aimed to evaluate the diagnostic performance of different MRI-based imaging methods for NVC in patients with TN and HFS.
Materials and methods
Related studies based on a search of PubMed, Embase, Web of Science and the Cochrane Library were retrieved. A two-way analysis of variance model was constructed for the Bayesian NMA to compare the performance of different diagnostic imaging methods.
Results
Our search identified 595 articles, of which 26 studies (including 2085 patients) related to 4 diagnostic imaging methods (3D time-of-flight magnetic resonance angiography (3D TOF MRA), high resolution T2-weighted imaging (HR T2WI), 3D TOF MRA combined with HR T2WI, and 3D multimodal image fusion (MIF) based on 3D TOF MRA combined with HR T2WI) were included in this NMA. The results showed that 3D MIF based on 3D TOF MRA combined with HR T2WI had the highest related sensitivity, the highest superiority index and the largest area under the receiver operating characteristic curve among all the methods.
Conclusions
3D MIF based on 3D TOF MRA combined with HR T2WI had better diagnostic performance for detecting NVC in patients with TN or HSF than other MRI-based imaging methods. This method can be used as an effective tool for preoperative evaluation of MVD.
Neurovascular compression (NVC) often occurs at the root entry zone (REZ) of cranial nerves, which is the main cause of primary trigeminal neuralgia (TN) or hemifacial spasm (HFS) [
]. However, preoperative diagnosis of NVC is sometimes very challenging for neurosurgeons and radiologists. Sometimes, NVC may not be identified during MVD. Although this operation is safe and minimally invasive, it appears not to be the best choice for patients with TN or HFS not caused by NVC [
]. Therefore, accurate preoperative diagnosis of NVC is crucial to MVD as an appropriate treatment of TN or HFS.
Magnetic resonance imaging (MRI) can clearly show the intercranial anatomy and has been used to detect NVC prior to MVD for many years. Initially, routine MRI sequences were used to detect NVC. However, it does have certain disadvantages as it cannot clearly and accurately display the relationship between nerves and blood vessels at the REZ [
]. With the development of MRI technology, the accuracy of diagnostic imaging methods based on MRI for NVC is gradually improving. One of the most representative methods is 3D time-of-flight magnetic resonance angiography (3D TOF MRA). 3D TOF MRA is a commonly used MRI sequence for detecting NVC, which can selectively demonstrate fast-flowing blood, and both nerves and blood vessels can be clearly displayed [
]. High resolution T2-weighted imaging (HR T2WI) can adequately demonstrate the anatomical structure in the cerebellopontine angle (CPA) against the background of the cerebrospinal fluid (CSF) signal, which is another commonly used MRI sequence for MVD preoperative evaluation [
Radiologic and neurosurgical diagnosis of arterial neurovascular conflict on magnetic resonance imaging for trigeminal neuralgia in routine clinical practice.
Preoperative evaluation of neurovascular relationship in trigeminal neuralgia by three-dimensional fast low angle shot (3D-FLASH) and three-dimensional constructive interference in steady-state (3D-CISS) MRI sequence.
High-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled gradient-recalled imaging in the evaluation of neurovascular compression in patients with trigeminal neuralgia: A double-blind pilot study.
Visualization of vascular compression of the trigeminal nerve with high-resolution 3T MRI: A prospective study comparing preoperative imaging analysis to surgical findings in 40 consecutive patients who underwent microvascular decompression for trigeminal neuralgia.
]. MIF can combine two or more images from the same or different modalities, allowing neurosurgeons to use the reconstructed 3D model to observe anatomical details more clearly from different perspectives [
]. However, there is no research which comprehensively evaluates the diagnostic accuracy of these methods in detecting NVC.
The present study aimed to conduct a network meta-analysis (NMA) of diagnostic test accuracy (DTA) to evaluate the diagnostic performance of different MRI-based imaging methods for NVC in patients with TN and HFS.
2. Materials and methods
2.1 Search strategy and selection criteria
PubMed, Embase, Web of Science and the Cochrane Library were systematically searched. The medical subject heading (MeSH) or Emtree terms used were “Magnetic Resonance Angiography” and “Microvascular Decompression Surgery”. The search query was “((Microvascular Decompression Surgery) OR (Decompression Surgeries, Microvascular) OR (Decompression Surgery, Microvascular) OR (Microvascular Decompression Surgeries) OR (Surgeries, Microvascular Decompression) OR (Surgery, Microvascular Decompression) OR (Microvascular Decompression) OR (Decompression, Microvascular) OR (Decompressions, Microvascular) OR (Microvascular Decompressions)) AND ((Magnetic Resonance Angiography) OR (MRI Angiography) OR (Angiographies, MRI) OR (Angiography, MRI) OR (MRI Angiographies) OR (Angiographies, Magnetic Resonance) OR (Magnetic Resonance Angiographies) OR (Perfusion Magnetic Resonance Imaging) OR (Perfusion Weighted MRI) OR (MRI, Perfusion Weighted) OR (time-of-flight))”. Studies published from the establishment of the database to September 2022 were retrieved.
After deleting duplicate publications, reasonable inclusion criteria and exclusion criteria were developed to review the remaining studies. Two investigators independently evaluated the inclusion and exclusion of each study according to the criteria. Discrepancies were resolved in a consensus meeting or, if agreement could not be reached, they were resolved by referral to a third investigator. The inclusion criteria were: (1) the purpose of the study was related to MRI-based imaging methods for judging NVC in patients with TN or HSF; (2) the study design was prospective or retrospective; and (3) the intraoperative findings were used as the reference standard for NVC diagnosis. The exclusion criteria were: (1) reviews, case reports, editorials, correspondence, comments, or meeting abstracts/meeting minutes; (2) significant bias in patient selection; (3) the patients in the study received only imaging diagnosis and did not receive MVD; (4) studies without sufficient data to construct the 2 × 2 contingency table; and (5) if there were only no more than 2 studies that met the inclusion criteria for a diagnostic imaging method, the method was not included in the present NMA.
2.2 Data extraction
Two investigators independently extracted data, including the quality assessment and similarity assessment from the included studies. Discrepancies were resolved in a consensus meeting or, if agreement could not be reached, they were resolved by referral to a third investigator. The extracted data included: (1) basic research information, including the first author, the publication year, the country of the first author, sample size and the type of research design; (2) the characteristics of the patients, including their age and diagnosis; (3) the diagnostic imaging method used; and (4) the research results, including the number of true positives (TP), false positives (FP), false negatives (FN), and true negatives (TN).
2.3 Literature quality assessment
The methodological quality of the included studies was assessed on the basis of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) checklist. Review Manager 5.4.1 software (The Cochrane Collaboration, UK) was used to generate a methodological quality graph and methodological quality graph summary.
2.4 Statistical analysis
A network diagram was constructed using STATA 16.0 software (StataCorp LLC, USA) to display the network. The nodes in the network diagram represented different diagnostic imaging methods and their size represented the number of corresponding studies. The edges in the diagram represented the direct comparisons, and their thickness represented the number of comparisons between the two methods.
A two-way analysis of variance (ANOVA) model was constructed for the Bayesian NMA to compare the diagnostic performance of different diagnostic imaging methods [
]. “Rstan”, “loo” and “plyr” packages in R 4.2.1 software (RStudio, USA) were used for model construction and data analysis. The pooled sensitivity, specificity and 95 % CIs of each diagnostic imaging method were calculated. The relative sensitivity (RSEN), relative specificity (RSPE) and superiority index (SI) were used to assess the diagnostic performance of each method. SI was estimated to quantify the rank probability of each method and its value was proportional to the diagnostic effectiveness of the method [
]. In addition, in order to visualize the diagnostic effectiveness, a summary receiver operating characteristic curve (SROC) of all diagnostic imaging methods was plotted with Review Manager software.
To assess inconsistency in the network, the loop specific approach was used for the inconsistency test [
]. The “Ifplot” module of STATA 16.0 software was used to perform the inconsistency test. The I2 and Q-test performed using the “midas” module of STATA 16.0 software were used to assess heterogeneity. When the I2 value was greater than 50 % or the P value of the Q-test was less than 0.05, it indicated that there was heterogeneity between studies, and further analysis was needed to find the source of heterogeneity. The publication bias of the included literature was examined by Deeks' test on STATA 16.0. Graphs were produced with the “midas” and “metan” modules for STATA 16.0 and Review Manager 5.4.1 software.
This NMA was registered on the website of PROSERO (registration no. CRD42022366234), The manuscript was prepared and revised according to the PRISMA NMA Checklist.
3. Results
3.1 Articles included
We identified 595 articles after the database search, and 391 articles remained after deleting duplicate records. Full-text analysis was performed on the 52 articles remaining after screening by titles and abstracts, of which 19 articles without complete data were excluded. In addition, as few studies met the inclusion criteria, 7 articles related to the 4 diagnostic imaging methods (Gd-enhanced MRA, combination of two different HR T2WIs, 3D TOF MRA combined with Gd-enhanced T1WI, and 3D TOF MRA combined with HR T2WI and Gd-enhanced T1WI) were also excluded from the analysis. Finally, 26 articles related to 4 diagnostic imaging methods (3D TOF MRA, 3D TOF MRA combined with HR T2WI, 3D MIF based on 3D TOF MRA combined with HR T2WI, and HR T2WI) were included in this NMA (Fig. 1, Fig. 2).
3.2 Basic characteristics of the included literature
The basic characteristics of the literature included in this study are shown in Table 1 and Supplementary Fig. 1. A total of 2085 patients were included in the 26 studies. Among them, 3D TOF MRA was used in 8 studies [
The evaluation of neurovascular relationships in trigeminal neuralgia: a pilot study on the optimal combination of high-resolution three-dimensional MR sequences.
Preoperative evaluation of patients with hemifacial spasm by three-dimensional time-of-flight (3D-TOF) and three-dimensional constructive interference in steady state (3D-CISS) sequence.
Radiologic and neurosurgical diagnosis of arterial neurovascular conflict on magnetic resonance imaging for trigeminal neuralgia in routine clinical practice.
The evaluation of neurovascular relationships in trigeminal neuralgia: a pilot study on the optimal combination of high-resolution three-dimensional MR sequences.
Preoperative evaluation of patients with hemifacial spasm by three-dimensional time-of-flight (3D-TOF) and three-dimensional constructive interference in steady state (3D-CISS) sequence.
Efficacy of microvascular decompression in patients with trigeminal neuralgia with negative neurovascular relationship shown by magnetic resonance tomography.
Differentiation of arterial and venous neurovascular conflicts estimates the clinical outcome after microvascular decompression in trigeminal neuralgia.
3.0T MR three-dimensional time-of-flight and fast imaging employing steady state acquisition sequences in pre-operative evaluation on spatial relationship among trigeminal nerve, facial nerve and peripheral vessels.
Preoperative evaluation of trigeminal neuralgia using 3T three - dimensional time - of - flight magnetic resonance angiography and three - dimensional fast imaging employing steady - state acquisition.
Preoperative detection of the neurovascular relationship in trigeminal neuralgia using three-dimensional fast imaging employing steady-state acquisition (FIESTA) and magnetic resonance angiography (MRA).
Vergani F, Panaretos P, Penalosa A, English P, Nicholson C, Jenkins A. Preoperative MRI/MRA for microvascular decompression in trigeminal neuralgia: consecutive series of 67 patients. Acta Neurochir (Wien). 2011;153:2377-81; discussion 82.
Pre-operative image-based segmentation of the cranial nerves and blood vessels in microvascular decompression: Can we prevent unnecessary explorations?.
Preoperative evaluation of neurovascular relationship in trigeminal neuralgia by three-dimensional fast low angle shot (3D-FLASH) and three-dimensional constructive interference in steady-state (3D-CISS) MRI sequence.
The evaluation of neurovascular relationships in trigeminal neuralgia: a pilot study on the optimal combination of high-resolution three-dimensional MR sequences.
Preoperative evaluation of patients with hemifacial spasm by three-dimensional time-of-flight (3D-TOF) and three-dimensional constructive interference in steady state (3D-CISS) sequence.
Efficacy of microvascular decompression in patients with trigeminal neuralgia with negative neurovascular relationship shown by magnetic resonance tomography.
Differentiation of arterial and venous neurovascular conflicts estimates the clinical outcome after microvascular decompression in trigeminal neuralgia.
The evaluation of neurovascular relationships in trigeminal neuralgia: a pilot study on the optimal combination of high-resolution three-dimensional MR sequences.
Preoperative evaluation of patients with hemifacial spasm by three-dimensional time-of-flight (3D-TOF) and three-dimensional constructive interference in steady state (3D-CISS) sequence.
Preoperative evaluation of trigeminal neuralgia using 3T three - dimensional time - of - flight magnetic resonance angiography and three - dimensional fast imaging employing steady - state acquisition.
Pre-operative image-based segmentation of the cranial nerves and blood vessels in microvascular decompression: Can we prevent unnecessary explorations?.
Preoperative evaluation of patients with hemifacial spasm by three-dimensional time-of-flight (3D-TOF) and three-dimensional constructive interference in steady state (3D-CISS) sequence.
3.0T MR three-dimensional time-of-flight and fast imaging employing steady state acquisition sequences in pre-operative evaluation on spatial relationship among trigeminal nerve, facial nerve and peripheral vessels.
Pre-operative image-based segmentation of the cranial nerves and blood vessels in microvascular decompression: Can we prevent unnecessary explorations?.
] on both HFS and TN and the remaining 19 on TN. The study design characteristics and patient characteristics of these studies in the network were similar. According to the methodological quality assessment conducted using the QUADAS checklist, the quality of the literature included in this study was acceptable (Supplementary Fig. 2).
Table 1Basic characteristics of the studies included.
Study
Year
Country
Sample size
Age
Diagnosis
Study Type
Methods
Singhal
2022
Australia
68
62 (21–87)
TN
Retrospective
B
Shi
2022
China
40
49.6 (24–66)
HFS
Retrospective
BC
Jiang
2022
China
49
53.1 (30–77)
TN
Prospective
ABD
Wei
2020
China
146
56 (32–83)
TN
Retrospective
BD
Müller
2020
Germany
38
59.63 ± 13.56
TN
Retrospective
BD
Jiao
2019
China
48
ND
TN
Retrospective
ACD
Ruiz-Juretschke
2019
Spain
74
61.1
TN
Retrospective
D
Guo
2018
China
36
55.8 (31–80)
TN
Retrospective
B
31
51.5 (39–64)
HFS
Yao
2018
China
42
51.2 ± 11.6 (22–76)
TN/HFS
Prospective
C
Yang
2018
China
65
50 (35–80)
TN
Retrospective
D
Huang
2017
China
115
59.7 (34–74)
TN
Retrospective
A
Jia
2016
China
95
49.2
HFS
Prospective
ABD
Liu
2016
China
52
53.7 (35–72)
TN
Prospective
B
Han
2016
China
40
58.4 (30–78)
TN
Retrospective
D
Xia
2015
China
106
51.9 (26–81)
TN/HFS
Retrospective
B
Dolati
2015
USA
14
65 ± 10
TN
Prospective
C
6
61 ± 7
HFS
Xie
2014
China
90
56.8 (31–76)
TN
Retrospective
BD
Lee
2014
USA
190
56 ± 14.2
TN
Retrospective
C
Zhang
2014
China
341
57.52 (24–85)
TN
Retrospective
A
Zeng
2013
China
37
56.3 (22–81)
TN
Prospective
B
Granata
2013
Italy
32
42 ± 7 (23–68)
TN/HFS
Prospective
C
Zhou
2012
China
37
55.3 (26–81)
TN
Prospective
AD
Vergani
2011
UK
67
59.8 (32–84)
TN
Retrospective
B
Shang
2010
China
167
57.6 (34–80)
TN
Prospective
A
Miller
2008
USA
18
52.9(26–80)
TN
Prospective
C
Vörös
2001
Hungary
41
62.3(34–85)
TN
Prospective
A
ND: no data; TN: trigeminal neuralgia; HFS: hemifacial spasm; A: 3D time-of-flight magnetic resonance angiography (3D TOF MRA); B: 3D TOF MRA + high resolution T2-weighted imaging (HR T2WI); C: 3D multimodal image fusion (MIF) (based on 3D TOF MRA + HR T2WI); D: HR T2WI.
3.3 Summary effect size of each diagnostic imaging method
The pooled sensitivity and specificity of each diagnostic imaging method are shown in Fig. 3. The pooled sensitivity and specificity of 3D TOF MRA were 0.88 (95 % CI 0.80–0.93) and 0.74 (95 % CI 0.53–0.91), 3D TOF MRA combined with HR T2WI were 0.95 (95 % CI 0.92–0.97) and 0.92 (95 % CI 0.82–0.98), 3D MIF based on 3D TOF MRA combined with HR T2WI were 0.97 (95 % CI 0.94–0.99) and 0.86 (95 % CI 0.65–0.97) and HR T2WI were 0.91 (95 % CI 0.86–0.94) and 0.94 (95 % CI 0.80–1.00), respectively.
Fig. 3Summary effect size of each diagnostic imaging method. A: The pooled sensitivity; B: The pooled specificity; TOF MRA: time-of-flight magnetic resonance angiography; HR T2WI: high resolution T2-weighted imaging; MIF: multimodal image fusion.
The Bayesian NMA showed that compared with HR T2WI, 3D MIF based on 3D TOF MRA combined with HR T2WI had the highest RSEN, followed by 3D TOF MRA combined with HR T2WI. 3D TOF MRA had the lowest RSEN. HR T2WI had the highest RSPE, followed by 3D TOF MRA combined with HR T2WI and 3D MIF based on 3D TOF MRA combined with HR T2WI. 3D TOF MRA had the lowest RSPE. In terms of SI, 3D MIF based on 3D TOF MRA combined with HR T2WI had the largest SI, followed by 3D TOF MRA combined with HR T2WI and HR T2WI, and 3D TOF MRA ranked last (Table 2). The results of SROCs were consistent with SI. 3D MIF based on 3D TOF MRA combined with HR T2WI had the largest area under the receiver operating characteristic curve (AUROC), followed by 3D TOF MRA combined with HR T2WI, HR T2WI and 3D TOF MRA (Fig. 4).
3.5 Heterogeneity, publication bias and inconsistency test
The I2 and Q-test were used to assess heterogeneity. The results indicated that the studies of the four diagnostic imaging methods had no substantial heterogeneity (Supplementary Table 1). Deeks' funnel plot asymmetry test was conducted to assess the publication bias of the studies in each method. The results indicated no significant publication bias for 3D TOF MRA (P = 1.00), 3D TOF MRA combined with HR T2WI (P = 0.97), 3D MIF based on 3D TOF MRA combined with HR T2WI (P = 0.59) and HR T2WI (P = 0.42) (Supplementary Fig. 3). The results of the inconsistency test showed no significant loop inconsistency in this NMA (Supplementary Fig. 4).
4. Discussion
In this NMA, we analyzed the diagnostic performance of several MRI-based diagnostic imaging methods for detecting NVC. The results showed that 3D MIF based on 3D TOF MRA combined with HR T2WI had the highest pooled sensitivity and RSEN, followed by 3D TOF MRA combined with HR T2WI, HR T2WI and 3D TOF MRA. In addition, HR T2WI had the highest pooled specificity and RSPE, followed by 3D TOF MRA combined with HR T2WI, 3D MIF based on 3D TOF MRA combined with HR T2WI and 3D TOF MRA. The main advantage of the NMA is that it can rank the performance of different diagnostic methods [
]. SI and SROCs, as two comprehensive evaluation indicators of diagnostic methods, were used to rank the diagnostic accuracy of these methods in this NMA. The results showed that 3D MIF based on 3D TOF MRA combined with HR T2WI had the highest SI and AUROC, followed by 3D TOF MRA combined with HR T2WI, HR T2WI and 3D TOF MRA. These results indicated that 3D MIF based on 3D TOF MRA combined with HR T2WI had more advantages in diagnosing NVC in terms of diagnostic accuracy among these methods.
As mentioned above, 3D TOF MRA is a common method for detecting NVC. In a meta-analysis in 2015, the authors reported that 3D TOF MRA had a sensitivity of 0.95 (95 % CI 0.93–0.96) and a specificity of 0.77 (95 % CI 0.66–0.86) in detecting NVC in TN patients [
]. The diagnostic performance of 3D TOF MRA seems to be better than that in the present study. However, in the previous meta-analysis, the authors included studies on some combined diagnostic methods, such as 3D TOF MRA combined with HR T2WI, and analyzed the data as 3D TOF MRA data. According to previous clinical research [
The evaluation of neurovascular relationships in trigeminal neuralgia: a pilot study on the optimal combination of high-resolution three-dimensional MR sequences.
] and our results, these combined methods have higher diagnostic performance than 3D TOF MRA alone. The consequence is that the sensitivity and specificity of 3D TOF MRA in this previous study may be inappropriately improved. This may be the reason for the difference in the sensitivity and specificity of 3D TOF MRA in the two studies. The main disadvantage of the 3D TOF MRA sequence is that it shows poor ability to visualize blood vessels with a slow blood flow, such as veins and arterioles [
]. This may affect its diagnostic performance. Thus, under these circumstances, another MRI sequence is needed to assist the diagnosis. HR T2WI is another commonly used MRI sequence for NVC detection. It is also a commonly used MRI sequence combined with 3D TOF MRA to detect NVC. HR T2WI can adequately show the anatomical structure in the cerebellopontine angle (CPA) against the background of the cerebrospinal fluid (CSF) signal and help detect NVC, which can be obtained by different technologies including 3D balanced steady state gradient echo and 3D fast turbo spin echo [
]. However, it is difficult for HR T2WI to distinguish the relationship between nerves and blood vessels when they are in close contact or there is a lack of CSF signal contrast around them. Therefore, 3D TOF MRA combined with HR T2WI is considered to be a more effective method for detecting NVC. Many single center clinical studies [
The evaluation of neurovascular relationships in trigeminal neuralgia: a pilot study on the optimal combination of high-resolution three-dimensional MR sequences.
Differentiation of arterial and venous neurovascular conflicts estimates the clinical outcome after microvascular decompression in trigeminal neuralgia.
] and our results have confirmed that 3D TOF MRA combined with HR T2WI had higher diagnostic accuracy than 3D TOF MRA or HR T2WI alone.
Although 3D TOF MRA combined with HR T2WI has excellent diagnostic performance in detecting NVC, this method still has shortcomings. Either 3D TOF MRA or HR T2WI cannot display the spatial structure of the CPA intuitively and dynamically. Therefore, it is necessary to identify more accurate imaging or post-processing technology to improve image quality. As previously mentioned, 3D multimodal image fusion (MIF) can combine two or more images to reconstruct a 3D model which allows neurosurgeons to observe anatomical details more clearly from different perspectives [
]. Therefore, the MIF technique is very helpful in improving the diagnostic accuracy of MRI based methods. The selection of MRI sequences for fusion is also very important for the quality of 3D MIF. As mentioned above, the combination of 3D TOF MRA and HR T2WI exhibited certain advantages in detecting NVC. Therefore, it is also an ideal sequence combination for 3D MIF. In fact, this is also the most frequently used combination of MRI sequences in clinical studies on 3D MIF for detecting NVC. Some clinical studies have confirmed that 3D MIF based on 3D TOF MRA combined with HR T2WI can accurately display the precise anatomical structures at the REZ and judge the relationship between cranial nerves and blood vessels [
According to our results, 3D MIF based on 3D TOF MRA combined with HR T2WI seems to be the most effective method to detect NVC; however, this technique still has some limitations. Firstly, the model reconstruction of MIF is based on MRI image data, so the reconstruction quality is largely limited by the quality of the imaging data used. Secondly, MIF reconstruction requires the operator to be very familiar with the anatomical structure of the CPA and neuroimaging, otherwise the model quality will be easily affected by subjective factors [
There are still some limitations in this NMA: (1) some diagnostic methods were not included in this NMA as there were few studies to evaluate the heterogeneity and publication bias, or the data did not meet the inclusion criteria; (2) non-MRI-based methods were not included; (3) In the MIF group, due to the limitation of the number of included studies, we combined different image fusion methods and analyzed them. In the future, it will be better if there are enough studies to compare and analyze the diagnostic effects of different image fusion methods; and (4) the method of NMA for diagnostic test accuracy is still in the process of continuous research, and the model used in this study also has its limitations, and the results need to be validated in large-scale clinical studies.
5. Conclusion
Our results suggested that 3D MIF based on 3D TOF MRA combined with HR T2WI had better diagnostic performance for detecting NVC in patients with TN or HSF than other MRI-based imaging methods. This method can be used as an effective tool for preoperative evaluation of MVD.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgements
We would like to thank all authors of the included primary studies.
Author contributions
Chen Liang wrote the main manuscript and fully participated in all analyses. Chen Liang and Ling Yang contributed to the study concept and design; Wilfried Reichardt reviewed contents related to imaging methods. Binbin Zhang and RuiChun Li participated in the literature search, data extraction, and quality assessment; all authors read and approved the final manuscript.
Funding
This work was supported by the Key Research and Development Plan of Shaanxi Province, China [grant number 2021SF-298].
Appendix A. Supplementary data
The following are the Supplementary data to this article:
Radiologic and neurosurgical diagnosis of arterial neurovascular conflict on magnetic resonance imaging for trigeminal neuralgia in routine clinical practice.
Preoperative evaluation of neurovascular relationship in trigeminal neuralgia by three-dimensional fast low angle shot (3D-FLASH) and three-dimensional constructive interference in steady-state (3D-CISS) MRI sequence.
High-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled gradient-recalled imaging in the evaluation of neurovascular compression in patients with trigeminal neuralgia: A double-blind pilot study.
Visualization of vascular compression of the trigeminal nerve with high-resolution 3T MRI: A prospective study comparing preoperative imaging analysis to surgical findings in 40 consecutive patients who underwent microvascular decompression for trigeminal neuralgia.
The evaluation of neurovascular relationships in trigeminal neuralgia: a pilot study on the optimal combination of high-resolution three-dimensional MR sequences.
Preoperative evaluation of patients with hemifacial spasm by three-dimensional time-of-flight (3D-TOF) and three-dimensional constructive interference in steady state (3D-CISS) sequence.
Efficacy of microvascular decompression in patients with trigeminal neuralgia with negative neurovascular relationship shown by magnetic resonance tomography.
Differentiation of arterial and venous neurovascular conflicts estimates the clinical outcome after microvascular decompression in trigeminal neuralgia.
3.0T MR three-dimensional time-of-flight and fast imaging employing steady state acquisition sequences in pre-operative evaluation on spatial relationship among trigeminal nerve, facial nerve and peripheral vessels.
Preoperative evaluation of trigeminal neuralgia using 3T three - dimensional time - of - flight magnetic resonance angiography and three - dimensional fast imaging employing steady - state acquisition.
Preoperative detection of the neurovascular relationship in trigeminal neuralgia using three-dimensional fast imaging employing steady-state acquisition (FIESTA) and magnetic resonance angiography (MRA).
Vergani F, Panaretos P, Penalosa A, English P, Nicholson C, Jenkins A. Preoperative MRI/MRA for microvascular decompression in trigeminal neuralgia: consecutive series of 67 patients. Acta Neurochir (Wien). 2011;153:2377-81; discussion 82.
Pre-operative image-based segmentation of the cranial nerves and blood vessels in microvascular decompression: Can we prevent unnecessary explorations?.
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