Predictive Value of VIBE using Subtraction to Evaluate Idiopathic Facial Palsy after Starting Therapy

Abstract

Purpose To determine the predictive value of 3-dimensional spoiled gradient-echo volumetric interpolated breath-hold examination (VIBE) using subtraction to evaluate the short-term effect of therapy for facial palsy.

Materials and Methods We included 97 patients with idiopathic facial palsy (52 male, 45 female; aged 50.7 ± 19.4 years) who underwent MR imaging with a contrast agent after starting therapy. The mean interval between onset and therapy was 1.55 ± 1.69 days, between therapy and MR imaging was 3.19 ± 2.78 days, and between MR imaging and assessment of the therapeutic effect was 3.50 ± 0.71 days. The degree of therapeutic effect was determined using a 4-grade scale based on the House–Brackmann scale for grading facial nerve function. Two radiologists reviewed VIBE with pre- and postcontrast subtraction using the 4-point scale. We evaluated the diagnostic performance and compared the degree of therapeutic effect and enhancement of facial nerves that were divided into 5 segments bilaterally.

Results We identified 98 facial palsy initially and significant enhancement in 55 facial nerves after the start of therapy and residual palsy in 87. Sensitivity for all facial palsy was 62.0 %, specificity was 90.9 %, positive predictive value was 98.2 %, negative predictive value was 23.3 %, and accuracy was 65.3 %. Eleven patients recovered completely, 1 showed significant enhancement, and the remaining 10 did not show significant enhancement of the facial nerve.

Conclusion VIBE has a potential to predict the prognostic outcome and assess facial palsy after the start of therapy.

Key points: 

• Three-dimensional spoiled gradient-echo volumetric interpolated breath-hold examination (VIBE) using subtraction can be useful to predict residual facial palsy after initial therapy.

• Strong enhancement of the facial nerve on VIBE using subtraction was associated with residual facial palsy after the start of therapy.

• Patients with a favorable prognosis did not show strong enhancement.

Citation Format

• Tomita H, Detmar K, Nakajima Y et al. Predictive Value of VIBE using Subtraction to Evaluate Idiopathic Facial Palsy after Starting Therapy. Fortschr Röntgenstr 2020; 192: 1183 – 1189

Zusammenfassung

Ziel Prognostische Aussagekraft der 3D-VIBE-Subtraktionen (Spoiled Gradientenecho Volumetric Interpolated Breath-Hold-Examination) zur Bestimmung des Therapie-Kurzzeiteffektes bei Patienten mit Gesichtslähmung.

Material und Methoden Eingeschlossen wurden 97 Patienten mit idiopathischer Gesichtslähmung (52 Männer, 45 Frauen; Alter 50,7 ± 19,4 Jahre), bei denen ein MRT mit Kontrastmittel nach Therapiebeginn durchgeführt wurde. Das mittlere Intervall zwischen Erkrankung und Beginn der Therapie betrug 1,55 ± 1,69 Tage, zwischen Therapie und MRT-Bildgebung betrug das Intervall 3,19 ± 2,78 Tage und zwischen MRT-Bildgebung und der Bewertung der therapeutischen Wirkung 3,50 ± 0,71 Tage. Der Grad des therapeutischen Effekts wurde mittels einer 4-Punkte-Skala, basierend auf der House-Brackmann-Skala für die Einstufung der Gesichtsnervenfunktion, bestimmt. 2 Radiologen werteten die Subtraktionen aus der VIBE-Sequenz (vor und nach KM-Gabe) unter Verwendung der 4-Punkte-Skala aus. Wir beurteilten die diagnostische Aussagekraft und verglichen den Grad des therapeutischen Effekts sowie die Anreicherung der Fazialisnerven, welche in 5 Segmenten bilateral eingeteilt wurde.

Ergebnisse Wir fanden 98 Fazialisparesen vor und eine signifikante Anreicherung in 55 nach Therapiebeginn sowie eine Restlähmung in 87 Fazialisnerven. Die Sensitivität für die Gesichtslähmung betrug 62,0 %, die Spezifität 90,9 %, der positive prädiktive Wert 98,2 %, der negative prädiktive Wert 23,3 % und die Genauigkeit 65,3 %. 11 Patienten hatten eine komplette Remission, 1 Patient zeigte ein signifikantes Enhancement und die verbliebenen 10 Patienten zeigten keine signifikante Anreicherung des Fazialisnerven.

Schlussfolgerung VIBE hat das Potenzial, das therapeutische Ergebnis prognostisch einzuschätzen und den Grad der Gesichtslähmung nach Therapiebeginn zu beurteilen.

Kernaussagen: 

• Subtraktionen aus 3D-VIBE (Spoiled Gradientenecho Volumetric Interpolated Breath-Hold Examination) können für die Prognose bei idiopathischer Fazialisparese nach Therapiebeginn verwendet werden.

• Eine kräftige Anreicherung der Fazialisnerven in Subtraktionen aus VIBE-Sequenzen war mit einer unvollständigen Rückbildung der Fazialisparese assoziiert.

• Patienten mit gutem klinischem Verlauf zeigen kein starkes Enhancement.

Key words

MR-imaging - cerebral palsy - contrast agents

Publication History

Received: 20 January 2020

Accepted: 11 April 2020

Article published online:
09 June 2020

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