3D T1-Weighted Black-Blood MRI in the Diagnosis and Follow-Up of Facial Neuritis: a Single-Center Prospective Study.

Purpose: This study aimed to evaluate the diagnostic performance of 3D T1-weighted black-blood (T1W BB) MRI compared to 3D T1-weighted turbo field echo (T1-TFE) in diagnosing facial neuritis (FN) and to investigate its role in disease monitoring.

Materials and methods: 22 patients with acute idiopathic FN were included in this prospective study. All patients underwent MRI within the first week of clinical presentation including 3D T1W BB and 3D T1-TFE sequences. Two neuroradiologists independently analyzed six facial nerve segments, evaluating contrast enhancement using a three-point grading scale (0-2). Diagnostic accuracy, sensitivity, specificity, and area under the curve (AUC) were compared between the two sequences. Follow-up MRI was performed in 8 patients to monitor temporal changes in nerve enhancement, and these findings were analyzed in relation to House-Brackmann (HB) scores.

Results: The sensitivity, specificity, and accuracy for FN detection were 97.7%, 93.2%, and 95.5% for 3D T1W BB, compared to 86.4%, 97.7%, and 92% for 3D T1-TFE, respectively. Sensitivity was significantly higher with 3D T1W BB (p < 0.05), while AUCs were higher but not significant for both readers. Mean enhancement grades in all affected nerve segments were significantly higher on 3D T1W BB (p < 0.05). Follow-up imaging showed enhancement reduction in 87.5% of patients, correlating with HB score improvements. Enhancement grades significantly correlated with HB scores on T1W BB but not on T1-TFE.

Conclusion: 3D T1W BB has comparable diagnostic performance with 3D T1-TFE for diagnosing FN and can be used as an effective tool in confirming the diagnosis and in follow-up.