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Research ArticleULTRA-HIGH-FIELD MRI/IMAGING OF EPILEPSY/DEMYELINATING DISEASES/INFLAMMATION/INFECTION

Assessment of Trigeminal Nerve Root Demyelination in Patients with Primary Trigeminal Neuralgia Using Macromolecular Proton Fraction Imaging

Elena A. Filimonova, Anton A. Pashkov, Vasily L. Yarnykh, Maria I. Schukina, Boris A. Zaitsev, Azniv V. Martirosyan, Galina I. Moysak and Jamil A. Rzaev
American Journal of Neuroradiology February 2025, DOI: https://doi.org/10.3174/ajnr.A8545
Elena A. Filimonova
aFrom the FSBI “Federal Center of Neurosurgery,” (E.A.F., A.A.P., M.I.S., B.A.Z., A.V.M., G.I.M., J.AR.), Novosibirsk, Russia
bDepartment of Neurosurgery (E.A.F., A.A.P., G.I.M., J.A.R.), Novosibirsk State Medical University, Novosibirsk, Russia
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Anton A. Pashkov
aFrom the FSBI “Federal Center of Neurosurgery,” (E.A.F., A.A.P., M.I.S., B.A.Z., A.V.M., G.I.M., J.AR.), Novosibirsk, Russia
bDepartment of Neurosurgery (E.A.F., A.A.P., G.I.M., J.A.R.), Novosibirsk State Medical University, Novosibirsk, Russia
cDepartment of Data Collection and Processing Systems (A.A.P.), Novosibirsk State Technical University, Novosibirsk, Russia
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Vasily L. Yarnykh
dDepartment of Radiology (V.L.Y.), University of Washington, Seattle, Washington
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Maria I. Schukina
aFrom the FSBI “Federal Center of Neurosurgery,” (E.A.F., A.A.P., M.I.S., B.A.Z., A.V.M., G.I.M., J.AR.), Novosibirsk, Russia
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Boris A. Zaitsev
aFrom the FSBI “Federal Center of Neurosurgery,” (E.A.F., A.A.P., M.I.S., B.A.Z., A.V.M., G.I.M., J.AR.), Novosibirsk, Russia
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Azniv V. Martirosyan
aFrom the FSBI “Federal Center of Neurosurgery,” (E.A.F., A.A.P., M.I.S., B.A.Z., A.V.M., G.I.M., J.AR.), Novosibirsk, Russia
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Galina I. Moysak
aFrom the FSBI “Federal Center of Neurosurgery,” (E.A.F., A.A.P., M.I.S., B.A.Z., A.V.M., G.I.M., J.AR.), Novosibirsk, Russia
bDepartment of Neurosurgery (E.A.F., A.A.P., G.I.M., J.A.R.), Novosibirsk State Medical University, Novosibirsk, Russia
eDepartment of Neuroscience (G.I.M., J.A.R.), Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
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Jamil A. Rzaev
aFrom the FSBI “Federal Center of Neurosurgery,” (E.A.F., A.A.P., M.I.S., B.A.Z., A.V.M., G.I.M., J.AR.), Novosibirsk, Russia
bDepartment of Neurosurgery (E.A.F., A.A.P., G.I.M., J.A.R.), Novosibirsk State Medical University, Novosibirsk, Russia
eDepartment of Neuroscience (G.I.M., J.A.R.), Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
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Abstract

BACKGROUND AND PURPOSE: Primary trigeminal neuralgia (PTN) is a prevalent chronic pain disorder. This condition is believed to be associated with demyelination of the trigeminal nerve. Previous studies in this field have focused on diffusion tensor imaging, which has limited sensitivity and specificity to myelin. In the present study, we assessed the trigeminal nerve root via the macromolecular proton fraction (MPF) mapping technique. MPF demonstrated strong correlations with myelin histology in a number of earlier animal studies and is currently viewed as a promising clinical myelin biomarker.

MATERIALS AND METHODS: We performed a prospective case-control study. Fifty-six patients with unilateral PTN and 27 healthy controls were included. All participants were evaluated by using high-resolution brain MR imaging, which included the MPF technique. MPF values from different parts of the trigeminal nerve root, such as the root entry zone (REZ) and central and lateral cisternal segments, were extracted. ANCOVAs were performed. Correlations between MPF values and Sindou grade, duration, and intensity of symptoms were also evaluated in patients with PTN.

RESULTS: A statistically significant decrease in the average MPF of the affected trigeminal nerve root was observed in the PTN group compared with the healthy control group (P < .01, false discovery rate [FDR] corrected). Specifically, reductions in the MPF values of the REZ and central cisternal parts of the affected trigeminal nerve root were found in patients with PTN (P < .01 and P < .05, respectively, FDR corrected). Furthermore, we identified a decrease in the average and REZ MPF values on the affected side compared with the contralateral side in patients with PTN (P < .05 and P < .001, respectively, FDR corrected). A negative correlation between MPF values in the REZ and Sindou grade was revealed (R = −0.35, adjusted P < .05).

CONCLUSIONS: Our preliminary results suggest that MPF could serve as a new neuroimaging biomarker of trigeminal nerve root impairment in patients with PTN and enable noninvasive detection of nerve root demyelination.

ABBREVIATIONS:

BPI
Brief Pain Inventory
FA
flip angle
FDR
false discovery rate
IQR
interquartile range
MD
mean between-group differences
MPF
macromolecular proton fraction
MT
magnetization transfer
PD
proton attenuation
PTN
primary trigeminal neuralgia
REZ
root entry zone
TN
trigeminal neuralgia

Footnotes

  • Software for MPF map reconstruction was distributed under support of the NIH High-Impact Neuroscience Research Resource grant R24NS104098.

  • Disclosure forms provided by the authors are available with the full text and PDF of this article at www.ajnr.org.

  • © 2025 by American Journal of Neuroradiology
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Cite this article
Elena A. Filimonova, Anton A. Pashkov, Vasily L. Yarnykh, Maria I. Schukina, Boris A. Zaitsev, Azniv V. Martirosyan, Galina I. Moysak, Jamil A. Rzaev
Assessment of Trigeminal Nerve Root Demyelination in Patients with Primary Trigeminal Neuralgia Using Macromolecular Proton Fraction Imaging
American Journal of Neuroradiology Feb 2025, DOI: 10.3174/ajnr.A8545

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Trigeminal nerve root assessment using MPF mapping
Elena A. Filimonova, Anton A. Pashkov, Vasily L. Yarnykh, Maria I. Schukina, Boris A. Zaitsev, Azniv V. Martirosyan, Galina I. Moysak, Jamil A. Rzaev
American Journal of Neuroradiology Feb 2025, DOI: 10.3174/ajnr.A8545
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