Visualizing trigeminal neuralgia at 7 Tesla: Advancing etiological understanding and improving future clinical imaging protocols

项目摘要 三叉神经痛(TN)是迄今发现的最痛苦的疾病之一，影响到4.3%的患者 美国有10万人。在其最典型的形式中，它会导致一侧短暂发作强烈的休克样疼痛。 脸部的。虽然已知与三叉神经或第五颅神经有关，但其总的病因学 人们对此仍然知之甚少。许多药理学和外科手术方法被用来治疗 TN，具有不同程度的长期疗效，但考虑到TN疼痛可能是 由无数潜在异常中的任何一种引起的，这些异常可能并不总是可以使用电流 临床检查。临床上，磁共振成像(Mri)被用来检测神经血管。 压迫(NVC)，通常被认为是TN的主要原因，并排除其他潜在的可能性 病因，如损伤或多发性硬化症。然而，疼痛最终在近一半的患者中复发， NVC接受手术治疗，NVC通常在没有TN的人中被发现。尽管目前的磁共振成像 方案在NVC的术前评估中很重要，它们可能缺乏分辨率、量化 同时询问整个三叉神经感觉通路所需的准确性和范围，以及 与疼痛的感觉、评估和调节相关的大脑网络也可能有助于 TN.全面研究TN所涉及的区域和网络仍然是一个关键的需求，尚未得到满足 并可靠、准确地识别TN患者疼痛的真正原因。超高磁场下的磁共振成像 AS 7特斯拉(7T)提供更高的信噪比，可以产生分辨率精致的图像，可以 以前所未有的细节阐明微妙的解剖、血管、显微结构和功能变化。 因此，我们将对TN患者(一半患有NVC，一半患有NVC)进行系统的前瞻性研究 特发性)和匹配的健康对照组，使用最先进的、TN特异性的多模式7T磁共振成像方案 由高分辨率结构、血管、扩散和功能成像序列组成。我们建议 针对我们的中心假设的三个目标：1)开发新的成像技术以更好地可视化 TN涉及的所有可能的脑区；2)对7T进行定性和定量分析 多模式图像表征三叉神经感觉通路沿其全程的结构完整性 从三叉神经节到初级躯体感觉皮质的长度；3)进行全脑结构 和功能网络分析，以揭示与痛觉和 TN患者的调制；以及4)评估我们的7T结果到3台特斯拉临床扫描仪的翻译。 这项研究的成功完成应该会产生与病理生理学密切相关的成像标记。 并可能导致对TN的更全面的了解，最终导致更有针对性和 治疗这种痛苦的有效方法。

Project Summary Trigeminal Neuralgia (TN) is one of the most painful disorders ever identified and affects 4.3 out of every 100,000 people in the US. In its most typical form, it causes brief attacks of intense shock-like pain on one side of the face. Although it is known to be associated with the trigeminal or 5th cranial nerve, its overall etiology remains poorly understood. A multitude of pharmacological and surgical methods have been used to treat TN, with varying levels of long-term efficacy, but treatment remains challenging given that TN pain may be caused by any of a myriad of underlying abnormalities that may not always be identifiable using current clinical workups. Clinically, magnetic resonance imaging (MRI) is used to detect neurovascular compression (NVC), conventionally understood to be a main cause of TN, and to rule out other potential etiologies such as lesions or multiple sclerosis. However, pain eventually recurs in nearly half of patients whose NVC was treated surgically, and NVC is often identified in people who do not have TN. Although current MRI protocols are important in the pre-surgical assessment of NVC, they likely lack the resolution, quantitative accuracy, and scope required to simultaneously interrogate the entire trigeminal sensory pathway, as well as the brain networks associated with the sensation, evaluation, and modulation of pain that may also contribute to TN. There remains a critical unmet need to comprehensively study the regions and networks implicated in TN and reliably and accurately identify the true cause of pain in TN patients. MRI at ultrahigh magnetic fields such as 7 Tesla (7T) provides increased signal to noise ratio, which yields images with exquisite resolution that can elucidate subtle anatomical, vascular, microstructural, and functional alterations in unprecedented detail. Therefore, we will perform a systematic prospective study of TN patients (half with identified NVC and half idiopathic) and matched healthy controls using a state-of-the-art, TN-specific, multimodal 7T MRI protocol composed of high-resolution structural, vascular, diffusion, and functional imaging sequences. We propose three aims directed towards our central hypothesis: 1) To develop new imaging techniques to better visualize all possible brain regions implicated in TN; 2) To perform qualitative and quantitative analysis of 7T multimodal images to characterize the structural integrity of the trigeminal sensory pathway along its entire length from the trigeminal ganglion to the primary somatosensory cortex; 3) To perform whole-brain structural and functional network analyses to reveal abnormalities in networks associated with pain sensation and modulation in TN patients; and 4) To evaluate translation of our 7T findings to 3 Tesla clinical scanners. Successful completion of this study should yield imaging markers that are tightly linked to the pathophysiology of TN, and could lead to a more complete understanding of TN, ultimately resulting in more targeted and effective treatments for this painful affliction.