Injury to the facial nerve is a major risk during parotid surgery; pre-operative identification of its course is key to minimising complications. Unfortunately, conventional MRI sequences offer insufficient resolution whilst conventional ‘positive-contrast’ neurographic methods suffer from artifacts and inconsistent quality. We propose an approach to imaging the extracranial facial nerve at high resolution using variable flip angle turbo spin echo imaging. This method depicts the nerve as a low-signal structure (‘black nerve’) against the high-signal parotid parenchyma (‘white parotid’). We show that this ‘negative-contrast’ method outperforms a widely-used positive-contrast neurographic sequence and might be further improved using gadolinium-based contrast agent.
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