High-Resolution 7T MR Imaging of the Trochlear Nerve

• Published in: American journal of neuroradiology : AJNR Vol. 44; no. 2; pp. 186 - 191
• Main Authors: Kumar, T., Virador, G.M., Brahmbhatt, P., Bhatt, A.A., Middlebrooks, E.H., Desai, A., Agarwal, A., Vibhute, P., Gupta, V.
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01.02.2023
• Subjects: Brain Stem; Fellows' Journal Club; Head & Neck; Humans; Magnetic Resonance Imaging - methods; Trochlear Nerve - anatomy & histology; Trochlear Nerve - diagnostic imaging
• ISSN: 0195-6108; 1936-959X; 1936-959X
• DOI: 10.3174/ajnr.A7774

The trochlear nerve has traditionally been difficult to identify on MR imaging. The advent of 7T MR imaging promises to greatly benefit visualization of small structures due to gains in the signal-to-noise ratio allowing improved spatial resolution. We investigated the utility of a clinically feasible ultra-high-resolution 7T MR imaging protocol for identification of the trochlear nerve, as well as assessment of normal trochlear nerve anatomy. Coronal high-resolution 2D T2-weighted TSE images used in a 7T epilepsy protocol of 50 subjects at our institution were reviewed by 2 independent radiologists for visualization of the trochlear nerve at the nerve origin and cisternal, tentorial, and cavernous segments. The frequency of nerve visibility within these segments and their anatomy were documented, and disagreements were resolved by joint review. Of the 100 nerves reviewed in 50 subjects, at least 2 segments of the trochlear nerve from the brainstem to the cavernous sinus were identified in 100% of cases. The origins from the brainstem and cisternal segment were visible in 65% and 93% of nerves, respectively. The trochlear nerve was identified at the trochlear groove in 100% of cases and in the posterior wall of the cavernous sinus in 74% of cases. Coronal high-resolution 2D TSE at 7T reliably identified the trochlear nerve throughout its course and is a promising tool for imaging patients with suspected trochlear nerve pathology.