Trigeminal nerve and pathologies in magnetic resonance imaging - a pictorial review

Abstract

A variety of conditions may affect the trigeminal nerve. Magnetic resonance imaging is the modality of choice when trigeminal nerve pathology is suspected, and this modality plays an essential role in detecting causes. This review illustrates some of the pathological conditions relevant to the trigeminal nerve in magnetic resonance imaging.

Keywords: magnetic resonance imaging; trigeminal nerve pain.

Figure 1

A 36-year-old woman with diagnosis of multiple sclerosis. Sagittal FLAIR image reveals demyelinating lesions in the area of the trigeminal nucleus (arrows) and plaques at the callososeptal interface and the juxtacortical white matter (arrowheads)

Figure 2

An eight-year-old girl with brainstem glioma. Axial fat-suppressed, T2-weighted image shows a hyperintense mass expanding and infiltrating the pons (arrow)

Figure 3

A 56-year-old woman with brainstem infarction. A) Localised mild hyperintensity by area of infarction (arrow) on the left paramedian upper pons is seen on T2-weighted image. B) The DW image and ADC map (C) clearly show acute brainstem infarction by restricted diffusion

Figure 4

A 60-year-old woman with right trigeminal neuralgia. On axial DRIVE image (A), a venous structure (arrow) is seen indenting the right fifth nerve. Axial post-contrast 3D MP-RAGE image (B) shows neurovascular compression of the trigeminal nerve (arrow)

Figure 5

A 48-year-old man with trigeminal schwannoma. Axial DRIVE image (A) shows a dumbbell-shaped heterogeneous mass (arrow) crossing the prepontine cistern and Meckel’s cave along course of the left trigeminal nerve. Axial post-contrast T1-weighted image (B) shows heterogeneous enhancement of the lesion

Figure 6

A 36-year-old woman with trigeminal schwannoma. Axial post-contrast T1-weighted image shows heterogenous enhancing cystic and solid mass along the left trigeminal nerve (arrow)

Figure 7

A 58-year-old woman referred for left trigeminal neuralgia. Axial T2-weighted image (A) shows meningioma involving Meckel’s cave, cavernous sinus, and prepontine cistern (arrow). Axial post-contrast T1-weighted image (B) shows homogeneous enhancement of the lesion and dural tail (arrow)

Figure 8

A 46-year-old man referred for left trigeminal neuralgia. Axial DRIVE image (A) demonstrates an epidermoid cyst (arrows) in the left prepontine cistern. An epidermoid cyst appears bright on the DW image (B)

Figure 9

A 24-year-old woman with a diagnosis of carotid cavernous fistula. Axial T2-weighted image shows multiple signal void structures, indicating high flow in the right cavernous sinus (arrows)

Figure 10

A 44-year-old woman with pituitary adenoma. Coronal post- contrast T1-weighted image shows invasion of enhancing pituitary mass into the left cavernous sinus, displacing the cavernous internal carotid artery (arrow)

Figure 11

A 37-year-old man with petrous apicitis. Axial post-contrast T1-weighted image (A) with fat suppression shows diffuse enhancement throughout the left mastoid and middle ear petrous apex (arrowheads). There is also dural enhancement along the posterior margin of the petrous apex (arrow). Coronal post-contrast T1-weighted image (B) shows inflammation with extension into the bilateral cavernous sinus and Meckel’s cave (arrowheads)

Figure 12

A 49-year-old man with Wegener’s granulomatosis. Axial post-contrast T1-weighted image with fat suppression shows the diffuse dural thickening and enhancement with extension into the bilateral internal acoustic channel (arrowheads) and Meckel’s cave (arrows)

Figure 13

A 56-year-old woman with known diagnosis of squamous cell carcinoma of the skin, referred for right trigeminal neuralgia. Axial T2-weighted image (A) demonstrates cystic lesion in the right Meckel’s cave. Axial post-contrast T1-weighted image (B) shows peripheral contrast enhancement of the metastatic lesion (arrowhead)

Figure 14

A 12-year-old man with known diagnosis of Burkitt lymphoma. Coronal post-contrast T1-weighted image shows diffuse enhancement throughout the cisternal and Meckel’s cave segments of the trigeminal nerve (arrows)

Figure 15

A 58-year-old man with squamous cell carcinoma of the skin. Axial post-contrast T1-weighted image with fat suppression shows heterogenous enhancing cystic and solid mass along the trigeminal nerve and its branches (arrow)

Figure 16

A 13-year-old man with juvenile nasopharyngeal angiofibroma. Axial post-contrast T1-weighted image with fat suppression demonstrates marked homogeneous enhancement of the lesion (arrow) with extension medially into the sphenoid sinus (arrow) and laterally into the pterygopalatine fossa and infratemporal fossa (arrowhead)

Figure 17

A 65-year-old man with known diagnosis of bladder cancer. On axial post-contrast T1-weighted image, metastases in the left Meckel’s cave (arrow) and the left cerebellar hemisphere (arrowhead) are seen

Figure 18

A 64-year-old man with adenoid cystic carcinoma of the skin. Coronal post-contrast T1-weighted image with fat suppression shows enhancement and irregular thickening of the bilateral mandibular branch of the trigeminal nerve and widening of the foramen ovale (arrowheads). Abnormal enhancement seems to extend into the bilateral Meckel’s cave (arrows)

Figure 19

A 39-year-old man with nasopharyngeal carcinoma with perineural tumour spread. Coronal post-contrast T1-weighted image shows marked homogeneous enhancement of the lesion with extension superiorly into the foramen lacerum (asterisk) and cavernous sinus (arrow). Also note the abnormal thickening and enhancement of the right mandibular branch of the trigeminal nerve (arrowhead)

Figure 20

A 45-year-old man with chordoma. Axial T2-weighted image shows a clival chordoma with extension into the bilateral cavernous sinus and the right Meckel’s cave (arrows)

Figure 21

A 31-year-old man with fibrous dysplasia of the nasal cavity region. Lesion shows a heterogeneous low signal intensity on axial T2-weighted image (A) and significant narrowing of Meckel’s caves (arrows). Axial bone-window computed tomography image (B) demonstrates ground-glass lesion that expands the nasal cavity and narrows the right orbital fissure (arrowhead)