Which imaging modality is commonly used to evaluate trigeminal neuralgia for vascular compression?

• A. CT without contrast
• B. Nuclear medicine scan
• C. MRI with high-resolution sequences and MR angiography
• D. Plain X-ray

Answer: (C)

Evaluating trigeminal neuralgia caused by a blood vessel compressing the nerve requires imaging that shows both the nerve and adjacent vessels in detail. MRI with high-resolution 3D T2-weighted sequences (such as CISS or FIESTA) provides exceptional contrast between the trigeminal nerve and cerebrospinal fluid, making the nerve’s course visible. When you add MR angiography, you can map the surrounding arteries and veins to see if a vessel is looping around or indenting the nerve—exactly what vascular compression means. This combination not only confirms a neurovascular conflict but also guides surgical planning, such as microvascular decompression. CT without contrast can’t reliably visualize the soft tissues or the nerve-vessel relationship; nuclear medicine studies assess function rather than anatomy; plain X-ray provides little useful information about neural structures or vascular contacts.