MR Imaging of the Extracranial Facial Nerve with the CISS Sequence.

BACKGROUND AND PURPOSE: MR imaging is not routinely used to image the extracranial facial nerve. The purpose of this study was to determine the extent to which this nerve can be visualized with a CISS sequence and to determine the feasibility of using that sequence for locating the nerve relative to tumor. MATERIALS AND METHODS: Thirty-two facial nerves in 16 healthy subjects and 4 facial nerves in 4 subjects with parotid gland tumors were imaged with an axial CISS sequence protocol that included 0.8-mm isotropic voxels on a 3T MR imaging system with a 64-channel head/neck coil. Four observers independently segmented the 32 healthy subject nerves. Segmentations were compared by calculating average Hausdorff distance values and Dice similarity coefficients. RESULTS: The primary bifurcation of the extracranial facial nerve into the superior temporofacial and inferior cervicofacial trunks was visible on all 128 segmentations. The mean of the average Hausdorff distances was 1.2 mm (range, 0.3-4.6 mm). Dice coefficients ranged from 0.40 to 0.82. The relative position of the facial nerve to the tumor could be inferred in all 4 tumor cases. CONCLUSIONS: The facial nerve can be seen on CISS images from the stylomastoid foramen to the temporofacial and cervicofacial trunks, proximal to the parotid plexus. Use of a CISS protocol is feasible in the clinical setting to determine the location of the facial nerve relative to tumor.

Standardization of Temporal Bone CT Planes across a Multisite Academic Institution.

BACKGROUND AND PURPOSE: Variable head positioning in the CT gantry results in variable and inconsistent temporal bone imaging planes. Our aim was to evaluate whether an automated postprocessing algorithm or an educational intervention with postprocessing by a technologist could result in consistent temporal bone image reformations into planes referenced to the lateral semicircular canal. MATERIALS AND METHODS: Instructions to reformat small-FOV images in planes referenced to the lateral semicircular canal were posted at 12 CT scanner consoles and e-mailed to 65 CT technologists at a single multisite institution. Automated reformatted images were also produced. The angles between the technologist- and automated-reformatted axial image planes and lateral semicircular canal planes were measured. Group differences were calculated with Mann-Whitney-Wilcoxon tests. Differences in homogeneity of variances were calculated with Fligner-Killeen tests. RESULTS: Two hundred ten temporal bones were imaged in 4 months following the intervention. Reformats by technologists were accurate in 87% of the axial and 81% of the coronal planes, with a trend toward improvement with time. Eighty percent of incorrectly reformatted images occurred at off-site, inpatient, and emergency department scanners. The error angle was significantly lower for technologist-reformatted images (median, 4.9°) than for acquisition plane images (median, 14.6°; P = 3 × 10-14) or automated-reformatted images (median, 13.8°; P = 9 × 10-13). The angle error variance was significantly more homogeneous for technologist-reformatted images (P = 3 × 10-8) and automated-reformatted images (P = 1 × 10-5) than for acquisition plane images. CONCLUSIONS: Both technologist and automated reformatting of temporal bone images resulted in significantly less imaging plane variance compared with images reformatted in the acquisition plane, but reformatting by technologists remains necessary at our institution given our preference for standardized planes referencing the lateral semicircular canals.

MR Imaging of the Facial Nerve through the Temporal Bone at 3T with a Noncontrast Ultrashort Echo Time Sequence.

The pointwise encoding time reduction with radial acquisition (PETRA) ultrashort echo time MR imaging sequence at 3T enables visualization of the facial nerve from the brain stem, through the temporal bone, to the stylomastoid foramen without intravenous contrast. Use of the PETRA sequence, or other ultrashort echo time sequences, should be considered in the MR imaging evaluation of certain skull base tumors and perhaps other facial nerve and temporal bone pathologies.

Spine Cryoablation: A Multimodality Image-Guided Approach for Tumors Adjacent to Major Neural Elements.

We report percutaneous cryoablation of spine tumors in 7 consecutive patients (5 men, 2 women [mean age, 47 years; range, 17-68 years]) by using intraprocedural image monitoring of ice ball margins to protect adjacent neural elements. Complete tumor ablation was achieved in all patients without neurologic complication. Pain relief was achieved in 4 of 5 (80%) patients; the patient with persistent pain was later found to have enlarging metastases at other sites.