Hiroyuki Fujii, Tomohiro Kikuchi, Nana Fujii, Emiko Chiba, Sota Masuoka, Akihiro Nakamata, Kohei Hamamoto, Mitsuru Matsuki, Harushi Mori
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Quantitative metrics included SI<sub>FN</sub> and TH<sub>FN</sub> measurements and affected-to-unaffected ratios (SR<sub>A/U</sub> and TR<sub>A/U</sub>) in the BP group, and right-to-left ratios in controls. Interobserver agreement, group comparisons, correlations with clinical severity (Yanagihara score), and diagnostic performance were assessed. In a subset of 17 matched pairs, the diagnostic performance of contrast-enhanced T1WI (CE-T1WI) was assessed, and its agreement with 3D-DESS-WE-based qualitative assessment was evaluated.</p><p><strong>Results: </strong>Qualitative scores for SI<sub>FN</sub> and TH<sub>FN</sub> were significantly higher in the BP group than in controls (<i>P</i> < .001), with high interobserver agreement (κ = 0.810, 0.788, respectively). When dichotomized (score 0 vs. 1-2), qualitative assessments showed good diagnostic performance with sensitivity and specificity of 0.87 and 0.82 for SI<sub>FN</sub>, and 0.90 and 0.80 for TH<sub>FN</sub>, respectively. Neither qualitative score correlated significantly with clinical severity. Agreement between 3D-DESS-WE-based and CE-T1WI-based qualitative assessments was substantial to almost perfect (κ = 0.766-0.882). In quantitative analysis, both SI<sub>FN</sub> and TH<sub>FN</sub> were significantly higher on the affected side in the BP group (<i>P</i> < .001), whereas no significant lateral differences were observed in controls. Although SI<sub>FN</sub>, TH<sub>FN</sub>, and SR<sub>A/U</sub> did not correlate significantly with clinical severity, TR<sub>A/U</sub> was significantly inversely correlated with the Yanagihara score (r = -0.413, <i>P</i> = .02), which corresponds to a positive correlation with clinical severity. The Yanagihara score was the only independent predictor for TR<sub>A/U</sub> in multiple regression analysis (β = -0.425, <i>P</i> = .04). ROC analysis showed high diagnostic performance: AUC = 0.908 for SR<sub>A/U</sub> and 0.927 for TR<sub>A/U</sub>.</p><p><strong>Conclusions: </strong>3D-DESS-WE may be a valuable tool for the routine clinical assessment of BP.</p><p><strong>Abbreviations: </strong>3D-DESS-WE＝3D Double-Echo Steady-State with Water Excitation; 3D-PSIF＝3D reversed fast imaging in steady-state free precession.</p>","PeriodicalId":93863,"journal":{"name":"AJNR. 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This study aimed to investigate the diagnostic ability of the 3D Double-Echo Steady-State with Water Excitation (3D-DESS-WE) sequence to visualize pathological changes in the FN of BP patients.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 30 BP patients who underwent 3T MRI including 3D-DESS-WE within 30 days of onset and 60 sex-and age±2-matched controls. Qualitative evaluation of FN signal intensity (SI<sub>FN</sub>) and thickness (TH<sub>FN</sub>) was performed using a 3-point scale. Quantitative metrics included SI<sub>FN</sub> and TH<sub>FN</sub> measurements and affected-to-unaffected ratios (SR<sub>A/U</sub> and TR<sub>A/U</sub>) in the BP group, and right-to-left ratios in controls. Interobserver agreement, group comparisons, correlations with clinical severity (Yanagihara score), and diagnostic performance were assessed. In a subset of 17 matched pairs, the diagnostic performance of contrast-enhanced T1WI (CE-T1WI) was assessed, and its agreement with 3D-DESS-WE-based qualitative assessment was evaluated.</p><p><strong>Results: </strong>Qualitative scores for SI<sub>FN</sub> and TH<sub>FN</sub> were significantly higher in the BP group than in controls (<i>P</i> < .001), with high interobserver agreement (κ = 0.810, 0.788, respectively). When dichotomized (score 0 vs. 1-2), qualitative assessments showed good diagnostic performance with sensitivity and specificity of 0.87 and 0.82 for SI<sub>FN</sub>, and 0.90 and 0.80 for TH<sub>FN</sub>, respectively. Neither qualitative score correlated significantly with clinical severity. Agreement between 3D-DESS-WE-based and CE-T1WI-based qualitative assessments was substantial to almost perfect (κ = 0.766-0.882). In quantitative analysis, both SI<sub>FN</sub> and TH<sub>FN</sub> were significantly higher on the affected side in the BP group (<i>P</i> < .001), whereas no significant lateral differences were observed in controls. Although SI<sub>FN</sub>, TH<sub>FN</sub>, and SR<sub>A/U</sub> did not correlate significantly with clinical severity, TR<sub>A/U</sub> was significantly inversely correlated with the Yanagihara score (r = -0.413, <i>P</i> = .02), which corresponds to a positive correlation with clinical severity. The Yanagihara score was the only independent predictor for TR<sub>A/U</sub> in multiple regression analysis (β = -0.425, <i>P</i> = .04). 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引用次数: 0
摘要
背景与目的：贝尔氏麻痹（BP）是面神经麻痹最常见的病因。本研究旨在探讨三维双回声稳态水激发序列（3D- dess - we）对BP患者FN病理变化的可视化诊断能力。材料和方法：我们回顾性分析了30例发病30天内接受3T MRI（包括3D-DESS-WE）检查的BP患者和60例性别和年龄±2匹配的对照组。采用3分制对FN信号强度（SIFN）和厚度（THFN）进行定性评价。定量指标包括BP组的SIFN和THFN测量和受影响与未受影响的比率（SRA/U和TRA/U），以及对照组的右至左比率。评估了观察者间的一致性、组间比较、与临床严重程度的相关性（Yanagihara评分）和诊断表现。在17对配对的子集中，评估对比增强T1WI （CE-T1WI）的诊断性能，并评估其与基于3d - dess - we的定性评估的一致性。结果：BP组患者的SIFN和THFN定性评分显著高于对照组（P < 0.001），且观察者间一致性高（κ = 0.810, 0.788）。当二分类（评分0 vs. 1-2）时，定性评估显示出良好的诊断效果，SIFN的敏感性和特异性分别为0.87和0.82，THFN的敏感性和特异性分别为0.90和0.80。定性评分与临床严重程度均无显著相关性。基于3d - dess - we的定性评价与基于ce - t1wi的定性评价基本一致（κ = 0.766-0.882）。定量分析中，BP组患侧SIFN和THFN均显著升高（P < 0.001），而对照组无显著侧方差异。虽然SIFN、THFN、SRA/U与临床严重程度无显著相关，但TRA/U与Yanagihara评分呈显著负相关（r = -0.413, P = 0.02），与临床严重程度呈正相关。多元回归分析中，Yanagihara评分是TRA/U的唯一独立预测因子（β = -0.425, P = 0.04）。ROC分析显示较高的诊断效能：SRA/U的AUC = 0.908， TRA/U的AUC = 0.927。结论：3D-DESS-WE可能是一种有价值的常规临床评估BP的工具。缩写：3D- dess -我们=水激励下的三维双回波稳态；3D- psif =三维反向快速成像稳态自由进动。
Visualization of Nerve Pathology and Correlation with Clinical Severity in Bell's Palsy Using 3D Double-Echo Steady-State with Water Excitation Sequence.
Background and purpose: Bell's palsy (BP) is the most common cause of facial nerve (FN) palsy. This study aimed to investigate the diagnostic ability of the 3D Double-Echo Steady-State with Water Excitation (3D-DESS-WE) sequence to visualize pathological changes in the FN of BP patients.
Materials and methods: We retrospectively analyzed 30 BP patients who underwent 3T MRI including 3D-DESS-WE within 30 days of onset and 60 sex-and age±2-matched controls. Qualitative evaluation of FN signal intensity (SIFN) and thickness (THFN) was performed using a 3-point scale. Quantitative metrics included SIFN and THFN measurements and affected-to-unaffected ratios (SRA/U and TRA/U) in the BP group, and right-to-left ratios in controls. Interobserver agreement, group comparisons, correlations with clinical severity (Yanagihara score), and diagnostic performance were assessed. In a subset of 17 matched pairs, the diagnostic performance of contrast-enhanced T1WI (CE-T1WI) was assessed, and its agreement with 3D-DESS-WE-based qualitative assessment was evaluated.
Results: Qualitative scores for SIFN and THFN were significantly higher in the BP group than in controls (P < .001), with high interobserver agreement (κ = 0.810, 0.788, respectively). When dichotomized (score 0 vs. 1-2), qualitative assessments showed good diagnostic performance with sensitivity and specificity of 0.87 and 0.82 for SIFN, and 0.90 and 0.80 for THFN, respectively. Neither qualitative score correlated significantly with clinical severity. Agreement between 3D-DESS-WE-based and CE-T1WI-based qualitative assessments was substantial to almost perfect (κ = 0.766-0.882). In quantitative analysis, both SIFN and THFN were significantly higher on the affected side in the BP group (P < .001), whereas no significant lateral differences were observed in controls. Although SIFN, THFN, and SRA/U did not correlate significantly with clinical severity, TRA/U was significantly inversely correlated with the Yanagihara score (r = -0.413, P = .02), which corresponds to a positive correlation with clinical severity. The Yanagihara score was the only independent predictor for TRA/U in multiple regression analysis (β = -0.425, P = .04). ROC analysis showed high diagnostic performance: AUC = 0.908 for SRA/U and 0.927 for TRA/U.
Conclusions: 3D-DESS-WE may be a valuable tool for the routine clinical assessment of BP.
Abbreviations: 3D-DESS-WE＝3D Double-Echo Steady-State with Water Excitation; 3D-PSIF＝3D reversed fast imaging in steady-state free precession.
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