Superior Visualization of Intracavernous Cranial Nerves with 3D T1 VIBE Compared with MPRAGE in Patients with Neuro-Ophthalmic Symptoms

BACKGROUND AND PURPOSE: To compare the visualization of intracavernous cranial nerve (CN) III, V₁, V₂, and VI between contrast-enhanced three-dimensional (3D), T1 volume-interpolated breath-hold examination (VIBE) and magnetization-prepared rapid-acquisition gradient-echo (MPRAGE) sequences in patients with neuro-ophthalmic symptoms. MATERIALS AND METHODS: This retrospective study analyzed 54 neuro-ophthalmic MRI examinations performed for one year. Contrast-enhanced 3D T1 VIBE and MPRAGE sequences with fat suppression were acquired coronally with 1.5-mm slice thickness. One neuroradiologist and two residents independently evaluated the degree of cavernous sinus enhancement and visualization of bilateral intracavernous CNs’ entire course. Wilcoxon signed-rank and weighted kappa tests were used for statistical analysis. RESULTS: VIBE demonstrated significantly higher visual conspicuity scores for all intracavernous CNs compared to MPRAGE across all readers (p<0.001). The visualization rates for the entire course of intracavernous CNs III, V₁, V₂, and VI were substantially higher on VIBE (96-98%, 65-70%, 61-72%, and 70-78%, respectively) than MPRAGE (69-74%, 6-9%, 35-44%, and 19-22%, respectively). Inter-reader agreement showed significant concordance for both cavernous sinus enhancement and intracavernous CN visualization (p<0.001). CONCLUSIONS: Contrast-enhanced 3D T1 VIBE sequence provides superior visualization and significantly higher detection rates of intracavernous CNs compared to MPRAGE, with excellent inter-reader agreement. These findings suggest that VIBE should be the preferred sequence for evaluating intracavernous CNs in patients with neuro-ophthalmic symptoms.