Read somewhere yesterday that only a “Thin Slice MRI” will show TN, and sometimes not even then. I have never heard of a thin slice MRI, is this something new?? Is it widely available? Many thanks
Hi there
I had a three cut MRI here in Australia but I must say I have not heard of a thin slice. I know there are different cuts they can do so maybe that’s what a thin slice is. Mine did not show any signs of TN, although it did pick up a lesion which was not picked up on a normal MRI.
Maybe ask your GP or specialist
Hope this is of some help
Andrea
Hi AliBaby
I am an MRI tech so I can try and answer any questions you have on this subject. We can change the slice thickness and spacing between slices when we are doing an image. When they say thin slice most likely they are referring to a 3mm slice it is very thin and the spaces between are as well it take longer to image than a regular image because you have to add triple the slices or more to cover all of the anatomy. It is not new the technology has always been there but it is not common and only used in certain cases. You can get it at any imaging center however the doctor needs to request it on the order so they can schedule you ample amount of time for the test. If you have any other questions please feel free to ask.
Shanday200 is right. Where I worked we usually did 5mm slices. Thin sliced meant 2-3mm slices depending on the diagnosis. Even though I'm a tech, I made the mistake of not double checking the script when I went to get my MRI and I got 5mm slices vs the 2mm that would have been better. But neurosurgeon wasn't very happy with the results but he doesn't believe you need to see a compression to do surgery, so he was ok with it not being thinner slices. You still see possible tumors and/or MS in 5mm sliced scans.
shanday200 said:
Hi AliBaby
I am an MRI tech so I can try and answer any questions you have on this subject. We can change the slice thickness and spacing between slices when we are doing an image. When they say thin slice most likely they are referring to a 3mm slice it is very thin and the spaces between are as well it take longer to image than a regular image because you have to add triple the slices or more to cover all of the anatomy. It is not new the technology has always been there but it is not common and only used in certain cases. You can get it at any imaging center however the doctor needs to request it on the order so they can schedule you ample amount of time for the test. If you have any other questions please feel free to ask.
Three to five mm slices are not adequate for detecting vascular compressions. Many veins or arteries that can compress the trigeminal nerve are less than 2 mm in diameter. The standard of practice for assessment of vascular compressions in TN is 0.66 mm thin-slice MRI performed with special magnet weightings to provide maximum clarity in the region of the brain stem. The procedure is performed both with and without contrast agent, and the images are re-constructed after the procedure, in a 3-D plot. The procedure is sometimes called "FIESTA" MRI.
Regards. Red
What do you do with a neurologist who refuses to do the Fiesta MRI, does one without contrast, it comes out clear and then refuses to send you to a neurosurgeon for a consult?
I've been dx'd with ATN. Be nice to know if I was a candidate for MVD surgery since my TN is worsening and the attacks are coming every few weeks now and lasting for longer periods of time with no breaks (or waves).
Thanks, Julie
Two thoughts, Jujubee:
(a) Fire the neurologist who refuses to use the recognized standard of practice for TN diagnosis, and tell him in no uncertain terms that you intend to down rate him in Internet doctor rating sites.
(b) After you find another neurologist, realize please that if you're dealing with Atypical (Type 2) TN, then MVD surgery is much more of a crap shoot than with Type 1. The only large scale study I've seen was done at Alleghenie General Hospital by the team trained by Peter Janetta. In that study, about 50% of MVDs were successful for procedures done with patients whose symptoms are dominated by ATN. Pain was still controlled after three years for only a third of that group.
If you can find a medication solution, I'd say it is likely to be a better option with lower risk.
Regards, Red
Thanks Red. Btw, nice to hear from you.
Richard A. "Red" Lawhern said:
Two thoughts, Jujubee:
(a) Fire the neurologist who refuses to use the recognized standard of practice for TN diagnosis, and tell him in no uncertain terms that you intend to down rate him in Internet doctor rating sites.
(b) After you find another neurologist, realize please that if you're dealing with Atypical (Type 2) TN, then MVD surgery is much more of a crap shoot than with Type 1. The only large scale study I've seen was done at Alleghenie General Hospital by the team trained by Peter Janetta. In that study, about 50% of MVDs were successful for procedures done with patients whose symptoms are dominated by ATN. Pain was still controlled after three years for only a third of that group.
If you can find a medication solution, I'd say it is likely to be a better option with lower risk.
Regards, Red
Red, just curious if you read my blog post of a study I posted and found online,done in Norway regarding MVD for tn1 and those suffering constant pain?
Would like to know your thoughts…
Haven't seen it, Mimi -- but I'll take a look at your blog and let you know.
Regards,Red
I read the article in your blog, Mimi, and featured it on the site. I also sent email to a prominent neurosurgeon who has been kind enough to support me in the past by lending his experience in research issues. His response was short but interesting.
The research results reported in your blog are significantly better for ATN patients than generally reported in the medical literature. However, as my neurosurgeon friend remarked, this and other articles like it have become a basis for advocating for MVD as an effective answer to facial pain which has a constant boring, burning character as one element -- particularly in patients whose MRI results are strongly suggestive of one or more vascular compressions. The objective of any surgical approach to trigeminal pain must always be to control or reduce the pain without introducing additional damage and worse longer-term pain.
The article seems to support the following conclusion, worded differently than the authors have done:
"MVD as a first surgical procedure has positive outcomes for many trigeminal neuralgia patients. Results are best for Type 1 TN patients with classic electric-shock pain symptoms accompanied by trigger zones. However, outcomes are almost as good for patients in whom pain is presently dominated by constant burning, boring, searing pain (Type 2 TN) -- IF their pain on initial presentation was characterized as paroxysmal volleys of electric-shock pain, and the constant component only developed or emerged later. MVD results are also consistently better for Type 2 patients in whom MRA imagery confirms the presence of vascular compressions.
Many neurosurgeons are resistant to performing MVD on patients whose constant pain emerged only after a previous ablative (destructive) surgical procedure such as Rhizotomy or Gamma Knife. For this latter category of patients, it may be more accurate to characterize the patient's post-procedure pain as trigeminal deafferentiation pain rather than TN, and to avoid further surgery of any type."
Feel free to comment.
Regards, Red
Thanks Red, everything you said as well as your neurosurgeon friend is exactly how I felt after reading. Feels good to have my opinion validated.
I’ve been researching quite a bit as “my” TN started as classic TN1 ( electric shock, triggers etc)
After several months on meds both 10 yrs ago as well as this time around, my TN goes bilateral ( which is another issue) but presents as TN2 ( constant boring horrid pain, ice pick in ear) that is my break through pain.
If I were to stop ALL meds I would be TN1 with the triggers.
I have an appointment with a neuro surgeon next month, so I am just trying to read/research all I can. I doubt I am a candidate, not really sure if I want to do surgery, I’m just trying to explore all options and be informed.
THANK–YOU for taking a look and sharing your insight always appreciated.