3D T1-Weighted Black-Blood MRI in the Diagnosis and Follow-Up of Facial Neuritis: a Single-Center Prospective Study

This study aimed to evaluate the diagnostic performance of 3D T1-weighted black-blood (T1W BB) MRI compared to 3D T1-weighted turbo field echo (T1-TFE) in diagnosing facial neuritis (FN) and to investigate its role in disease monitoring.

22 patients with acute idiopathic FN were included in this prospective study. All patients underwent MRI within the first week of clinical presentation including 3D T1W BB and 3D T1-TFE sequences. Two neuroradiologists independently analyzed six facial nerve segments, evaluating contrast enhancement using a three-point grading scale (0-2). Diagnostic accuracy, sensitivity, specificity, and area under the curve (AUC) were compared between the two sequences. Follow-up MRI was performed in 8 patients to monitor temporal changes in nerve enhancement, and these findings were analyzed in relation to House-Brackmann (HB) scores.

The sensitivity, specificity, and accuracy for FN detection were 97.7%, 93.2%, and 95.5% for 3D T1W BB, compared to 86.4%, 97.7%, and 92% for 3D T1-TFE, respectively. Sensitivity was significantly higher with 3D T1W BB (p < 0.05), while AUCs were higher but not significant for both readers. Mean enhancement grades in all affected nerve segments were significantly higher on 3D T1W BB (p < 0.05). Follow-up imaging showed enhancement reduction in 87.5% of patients, correlating with HB score improvements. Enhancement grades significantly correlated with HB scores on T1W BB but not on T1-TFE.

3D T1W BB has comparable diagnostic performance with 3D T1-TFE for diagnosing FN and can be used as an effective tool in confirming the diagnosis and in follow-up.