MRI features of responsible contacts in vascular compressive trigeminal neuralgia and prediction modeling.

BACKGROUND: Multiple neurovascular contacts in patients with vascular compressive trigeminal neuralgia often challenge the diagnosis of responsible contacts. PURPOSE: To analyze the magnetic resonance imaging (MRI) features of responsible contacts and establish a predictive model to accurately pinpoint the responsible contacts. MATERIAL AND METHODS: Sixty-seven patients with unilateral trigeminal neuralgia were enrolled. A total of 153 definite contacts (45 responsible, 108 non-responsible) were analyzed for their MRI characteristics, including neurovascular compression (NVC) grading, distance from pons to contact (D(pons-contact)), vascular origin of compressing vessels, diameter of vessel (D(vessel)) and trigeminal nerve (D(trigeminal nerve)) at contact. The MRI characteristics of the responsible and non-responsible contacts were compared, and their diagnostic efficiencies were further evaluated using a receiver operating characteristic (ROC) curve. The significant MRI features were incorporated into the logistics regression analysis to build a predictive model for responsible contacts. RESULTS: Compared with non-responsible contacts, NVC grading and arterial compression ratio (84.44%) were significantly higher, D(pons-contact) was significantly lower at responsible contacts (P < 0.001, 0.002, and 0.033, respectively). NVC grading had a highest diagnostic area under the ROC curve (AUC) of 0.742, with a sensitivity of 64.44% and specificity of 75.00%. The logistic regression model showed a higher diagnostic efficiency, with an AUC of 0.808, sensitivity of 88.89%, and specificity of 62.04%. CONCLUSION: Contact degree and position are important MRI features in identifying the responsible contacts of the trigeminal neuralgia. The logistic predictive model based on D(pons-contact), NVC grading, and vascular origin can qualitatively improve the prediction of responsible contacts for radiologists.