Predictive Value of VIBE using Subtraction to Evaluate Idiopathic Facial Palsy after Starting Therapy

• Published in: RöFo : Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebende Verfahren Vol. 192; no. 12; p. 1183
• Main Authors: Tomita, Hayato, Detmar, Klaus, Manava, Panagiota, Nakajima, Yasuo, Lell, Michael, Adamus, Ralf
• Format: Journal Article
• Language: English
• Published: Germany 01-12-2020
• Subjects: Adult; Aged; Breath Holding; Contrast Media; Facial Nerve - diagnostic imaging; Facial Paralysis - diagnostic imaging; Facial Paralysis - therapy; Female; Humans; Image Enhancement - methods; Imaging, Three-Dimensional - methods; Magnetic Resonance Imaging - methods; Male; Middle Aged; Neoplasm, Residual - diagnostic imaging; Prognosis; Sensitivity and Specificity; Subtraction Technique
• ISSN: 1438-9010
• DOI: 10.1055/a-1160-6047

To determine the predictive value of 3-dimensional spoiled gradient-echo volumetric interpolated breath-hold examination (VIBE) using subtraction to evaluate the short-term effect of therapy for facial palsy.
 We included 97 patients with idiopathic facial palsy (52 male, 45 female; aged 50.7 ± 19.4 years) who underwent MR imaging with a contrast agent after starting therapy. The mean interval between onset and therapy was 1.55 ± 1.69 days, between therapy and MR imaging was 3.19 ± 2.78 days, and between MR imaging and assessment of the therapeutic effect was 3.50 ± 0.71 days. The degree of therapeutic effect was determined using a 4-grade scale based on the House-Brackmann scale for grading facial nerve function. Two radiologists reviewed VIBE with pre- and postcontrast subtraction using the 4-point scale. We evaluated the diagnostic performance and compared the degree of therapeutic effect and enhancement of facial nerves that were divided into 5 segments bilaterally.
 We identified 98 facial palsy initially and significant enhancement in 55 facial nerves after the start of therapy and residual palsy in 87. Sensitivity for all facial palsy was 62.0 %, specificity was 90.9 %, positive predictive value was 98.2 %, negative predictive value was 23.3 %, and accuracy was 65.3 %. Eleven patients recovered completely, 1 showed significant enhancement, and the remaining 10 did not show significant enhancement of the facial nerve.
 VIBE has a potential to predict the prognostic outcome and assess facial palsy after the start of therapy.
  · Three-dimensional spoiled gradient-echo volumetric interpolated breath-hold examination (VIBE) using subtraction can be useful to predict residual facial palsy after initial therapy.. · Strong enhancement of the facial nerve on VIBE using subtraction was associated with residual facial palsy after the start of therapy.. · Patients with a favorable prognosis did not show strong enhancement..
· Tomita H, Detmar K, Nakajima Y et al. Predictive Value of VIBE using Subtraction to Evaluate Idiopathic Facial Palsy after Starting Therapy. Fortschr Röntgenstr 2020; 192: 1183 - 1189.