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High-Resolution 7T MR Imaging of the Trochlear Nerve.

T Kumar1, G M Virador1, P Brahmbhatt1

  • 1From the Department of Radiology, Mayo Clinic, Jacksonville, Florida.

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|January 19, 2023
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Ultra-high-resolution 7T MRI reliably visualizes the trochlear nerve (cranial nerve IV) in 100% of cases. This advanced imaging technique aids in identifying normal anatomy and diagnosing trochlear nerve pathology.

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Area of Science:

  • Neuroradiology
  • Neuroimaging
  • Anatomy

Background:

  • The trochlear nerve (cranial nerve IV) presents challenges for identification on conventional MRI.
  • Advancements in 7 Tesla (7T) MRI offer enhanced signal-to-noise ratio for improved visualization of small neuroanatomical structures.

Purpose of the Study:

  • To evaluate the effectiveness of an ultra-high-resolution 7T MRI protocol for identifying the trochlear nerve.
  • To assess the normal anatomy of the trochlear nerve using 7T MRI.

Main Methods:

  • Review of coronal high-resolution 2D T2-weighted TSE images from a 7T epilepsy protocol in 50 subjects.
  • Independent radiologist assessment of trochlear nerve visualization across its brainstem, cisternal, tentorial, and cavernous segments.
  • Documentation of nerve visibility frequency and anatomical details, with joint review for disagreements.

Main Results:

  • The trochlear nerve was identified in all 100 nerves reviewed (50 subjects) across at least two segments.
  • Brainstem origins and cisternal segments were visualized in 65% and 93% of nerves, respectively.
  • The nerve was consistently identified at the trochlear groove (100%) and in the cavernous sinus (74%).

Conclusions:

  • Coronal high-resolution 2D TSE at 7T reliably visualizes the trochlear nerve throughout its entire course.
  • This 7T MRI protocol shows significant promise for imaging patients with suspected trochlear nerve pathology.