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Description : A systematic review on diagnostic test accuracy of magnetic resonance neurography versus clinical neurosensory assessment for post-traumatic trigeminal neuropathy in patients reporting neurosensory disturbance

Tags : diagnostic test,QST,MRN,nerve injuries

Published on : Nov 05, 2021 | Views : 2200 | Downloads : 0

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A systematic review on diagnostic test accuracy of magnetic resonance neurography versus clinical neurosensory assessment for post-traumatic trigeminal neuropathy in patients reporting neurosensory disturbance
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Procedure with risk of damage of peripheral trigeminal nerves: wisdom tooth extraction endodontic treatments placement of implants administration of local anesthesia ± neuropathic pain and phenomena such as allodynia and Hyperalgesia
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Currently diagnostic tools for PTTN: patient-reported neurosensory disturbances (NSD) qualitative or quantitative psychophysical neurosensory tests (NST) Electrophysiological tests difficult to apply in the trigeminal distribution cannot precisely depict the localization and extent of trauma Distinction of damage severity: medicolegal point of view a faster intervention, better neurosensory recovery
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Facial nerve electrodiagnostics
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quantitative sensory testing (QST) A neurosensory deficit is present or not unclear how these tests evolve in the transition from the acute to the chronic phases of trigeminal nerve damage unclear if they can predict prognosis and treatment outcomes in PTTN
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Magnetic resonance neurography (MRN) to enhance the visualization of the peripheral nervous system & its pathology potential to visualize and quantify: nerve injuries severity of damage
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Aim of study (main) to conduct a systematic review of diagnostic test accuracy (DTA) of MRN vs clinical neurosensory testing or patient-reported NSD in patients with PTTN. (Secondary) to identify currently used MRN sequences, their parameters and performance as well as how they correlate with nerve injury severity. (Finally) adding MRN to the diagnostic work-up has any impact on clinical decision-making?
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PICO (P) patients suffering from PTTN resulting in NSD within the trigeminal distribution (I) underwent MRI (C) comparison with clinical (neurological) examination or patient-reported NSD (O) to assess techniques reported, its diagnostic accuracy, performance and correlation with nerve injury severity
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PROSPERO An experienced librarian → co-create the search method Database: PubMed, Embase, Web of Science, and Cochrane Library
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Selection criteria original research articles without restrictions on language or publication date Type of study: cohort studies, Observational case–control, cross-sectional, randomized controlled trials (RCTs) and case series Patients: diagnosed with PTTN on the basis of sensory tests/ patient-reported NSD (MRN: index test)
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Exclusion criteria Reviews Animal trials Case reports Meta-analyses Systematic reviews
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literature search & deduplication: one person titles and abstracts screening: two individuals independently
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Risk of bias assessment
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Study characteristics most studies: high risk of bias but with low applicability concerns DTA-analysis nor a meta-analysis cannot be performed: low methodological quality widely varying methods → a broad overview of the study and MRN characteristics
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Table 3. Characteristics of included studies
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Table 4. MRI parameters for each study
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Discussion MRN correlates with: Clinical and surgical findings Neurosensory testing a guideline or framework → reproducibility Most research groups → 3 T scanners with T2 weighted gradient echo imaging Coil type differed Uniform fat suppression → evaluation of the peripheral nervous system Post-processing (Multiplanar reformatting) along the course of the nerve
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An isotropic voxel size further assess 3D improving resolution possibly reducing artifacts → a thin slice thickness (nerve branches often less than 2 mm in diameter) Standardization of SI calculations & determining cutoff value
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etiology of the PTTN (patient inclusion criteria) → region of interest where RSI values are measured → further complicating future comparison of studies → mapping of the whole nerve trajectory
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impact on clinical decision-making Cox et al (2016): substantial impact (one-third of patients) → change in treatment a cost–benefit analysis → adding MRN to the diagnostic work-up?
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Limitations The small number of articles Low quality of articles Different methodologies and results No randomized controlled trials → DTA could not be determined
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Limitations insufficient scientific base to support or refute the use of MRN in the diagnosis and grading of PTTN MRN seems promising in improving PTTN diagnostics treatment decision prediction of neurosensory recovery
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Suggestion prospective blinded DTA studies a rigorous and reproducible study design