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Trigeminal neuralgia diffusivities using Gaussian process classification and merged group tractography.

David Qixiang Chen¹, Jidan Zhong², Powell P W Chu²

¹Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

|July 24, 2020

Summary

Diffusion tensor imaging reveals bilateral trigeminal pathway changes in trigeminal neuralgia (TN). This study shows abnormalities in affected and unaffected sides, offering new insights into TN

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Area of Science:

Neuroimaging
Diffusion Tensor Imaging
Machine Learning

Background:

Trigeminal neuralgia (TN) imaging traditionally focused on peripheral nerves due to segmentation challenges.
Previous studies identified diffusivity alterations in the trigeminal nerve but lacked a full pathway analysis.

Purpose of the Study:

To investigate diffusion tensor imaging (DTI) based diffusivity alterations across the entire trigeminal pathway in TN patients.
To utilize advanced tractography and machine learning to differentiate TN patients from controls and affected from unaffected sides.

Main Methods:

Selective Automated Group Integrated Tractography (SAGIT) applied to 36 TN patients and 36 controls.
Analysis of trigeminal nerve (CN V), pontine decussation (TPT), and thalamocortical fibers (S1) using DTI metrics.
Gaussian process classifiers trained to differentiate groups and sides based on tractography data.

Main Results:

Machine learning models accurately differentiated TN patients from controls (80% accuracy for CN V) and affected from unaffected sides (75% accuracy).
Bilateral abnormalities were detected throughout the trigeminal pathway, including TPT (98% accuracy for left-right classification) and S1 (87% accuracy for affected S1 radial diffusivity).
This study is the first to combine group-wise tractography, machine learning, and full trigeminal pathway analysis in TN.

Conclusions:

Trigeminal neuralgia is characterized by bilateral abnormalities across the entire trigeminal pathway, not just peripheral segments.
DTI and machine learning analysis of the complete trigeminal pathway provide significant diagnostic potential for TN.
Findings highlight the systemic nature of TN, affecting pathways from the nerve to the cortex.