Diagnostic value of sDRICE post-processing in Brain Magnetic Resonance Imaging for the identification of neurovascular conflict

Abstract

The diagnosis of neurovascular conflict (NVC) syndromes requires high accuracy in visualizing the relationship between cranial nerves and vascular structures. Three-dimensional T2-weighted DRIVE sequences represent a well-established standard for the evaluation of the intracisternal course of cranial nerves; however, they show limitations in distinguishing arterial from venous components and in defining neurovascular contact points. The aim of this prospective study was to qualitatively assess the advantages of the sDRICE post-processing technique, obtained through voxel-by-voxel subtraction of DRIVE images from contrast-enhanced 3D T1-weighted images, compared with individual conventional sequences. Twenty-eight patients undergoing brain MRI for suspected NVC and other pathologies of the pontocerebellar compartment were analyzed. DRIVE, post-contrast 3D T1-weighted, and sDRICE images were evaluated by two radiologists and one MRI radiographer with expertise in MRI, in terms of image sharpness and signal-to-noise ratio (SNR), using a five-point qualitative scale. Statistical comparison using the Friedman test revealed significant differences among the three techniques, with significantly higher scores for sDRICE images in the visualization of cranial nerves and vascular structures (p < 0.05). sDRICE images demonstrated consistently high image quality and improved identification of the neurovascular conflict point. These findings suggest that the sDRICE technique represents an effective complementary tool in the evaluation of NVC, enhancing diagnostic accuracy and supporting preoperative planning.