Published October 2, 2008 as 10.3174/ajnr.A1281 The Jugular Foramen: Imaging Strategy and ORIGINAL RESEARCH Detailed Anatomy at 3T J. Linn BACKGROUND AND PURPOSE: The purpose of this study was to assess how well the anatomy of the F. Peters jugular foramen (JF) could be displayed by 3T MR imaging by using a 3D contrast-enhanced fast imaging employing steady-state acquisition sequence (CE-FIESTA) and a 3D contrast-enhanced MR B. Moriggl angiographic sequence (CE-MRA). T.P. Naidich H. Bru¨ ckmann MATERIALS AND METHODS: Twenty-five patients free of skull base lesions were imaged on a 3T MR imaging scanner using CE-FIESTA and CE-MRA. Two readers analyzed the images in collaboration, I. Yousry with the following objectives: 1) to score the success with which these sequences depicted the glossopharyngeal (CNIX) and vagus (CNX) nerves, their ganglia, and the spinal root of the accessory nerve (spCNXI) within the JF, and 2) to determine the value of anatomic landmarks for the in vivo identification of these structures. RESULTS: CE-FIESTA and CE-MRA displayed CNIX in 90% and 100% of cases, respectively, CNX in 94% and 100%, and spCNXI in 51% and 0% of cases. The superior ganglion of CNIX was discernible in 89.8% and 87.8%; the inferior ganglion of CNIX, in 73% and 100%; and the superior ganglion of CNX, in 98% and 100% of cases. Landmarks useful for identifying these structures were the inferior petrosal sinus and the external opening of the cochlear aqueduct. CONCLUSIONS: This study protocol is excellent for displaying the complex anatomy of the JF and related structures. It is expected to aid in detecting small pathologies affecting the JF and in planning the best surgical approach to lesions affecting the JF. he jugular foramen (JF) is a bony channel that transmits dural sheath as CNX, but remains separate from it.4 Just infe- Tvessels and cranial nerves IX, X, and XI (CNIX, CNX, and rior to its dural meatus, CNIX turns forward and then sharply CNXI) through the skull base into the carotid space.1 It can be downward forming the so-called “genu” of CNIX.1 divided into 3 compartments1: 1) a neural compartment, con- Despite extensive cadaveric dissection studies, which have HEAD & NECK taining the CNIX to CNXI; 2) a larger venous compartment addressed the anatomy of the JF, many details on the in vivo (sigmoid part), containing the sigmoid sinus; and 3) a smaller anatomy of the JF remain unclear.1-7 Due to its complexity, to venous compartment (petrosal part), containing the inferior our knowledge, the JF anatomy has not yet been systematically petrosal sinus. The sigmoid and the petrosal parts are sepa- evaluated in imaging studies, though this knowledge would be rated by bony processes: the intrajugular processes, which highly important for presurgical planning. originate from the opposing surfaces of the temporal and oc- To date, high-resolution MR imaging provides a noninva- ORIGINAL RESEARCH cipital bones, as well as by a dural septum, which connects sive tool, which should enable us to depict the exact location of these 2 bony structures.1 the intraforaminal structures in vivo. Recent studies showed The lower cranial nerves enter the JF via 2 dural meatuses: that contrast-enhanced steady-state and MR angiography the glossopharyngeal meatus for the glossopharyngeal nerve (MRA) sequences are suitable techniques to image the intrafo- (CNIX) and the vagal meatus for both the vagus nerve (CNX) 7,8 and the accessory nerve (CNXI). CNIX and CNX each possess raminal segments of other cranial nerves, but not yet CNIX– both a superior (supCNIX and supCNX) and an inferior CNXI. Therefore, we hypothesized that a contrast-enhanced ganglion (infCNIX and infCNX). While the supCNIX, the 3D fast imaging employing steady-state acquisition sequence infCNIX, and the supCNX lie within the JF, the infCNIX is (CE-FIESTA) and a high-resolution contrast-enhanced gradi- located more caudally.2,3 The cranial nerve roots of CNXI ent-echo MRA (CE-MRA) technique, performed on a 3T MR (crCNXI) intermingle with the roots of CNX within the JF, so imaging scanner, should be valuable for the identification of their fibers are classified together as the CNX/XI complex.1 the JF and its contents. The spinal root of CNXI (spCNXI) traverses the JF in the same Thus, we aimed to determine the potential of these se- quences in providing detailed information on the MR imaging Received June 10, 2008; accepted July 12. anatomy of the JF. From the Department of Neuroradiology (J.L., F.P., H.B., I.Y.), University Hospital Munich, Munich, Germany; Institute of Anatomy, Histology, and Embryology (B.M.), Medical Uni- versity Innsbruck, Austria; and Department of Radiology, Section of Neuroradiology (T.P.N.), Materials and Methods Mount Sinai Medical Center, New York, NY. Patients Paper previously presented in part at: European Congress of Radiology, March 8, 2008; Vienna, Austria; Deutschen Ro¨ntgenkongress, October 17–19, 2008; Berlin, Germany; and The study group comprised 25 patients (16 women; mean age, 50 Ϯ Jahrestagung der Deutschen Gesellschaft fu¨r Neurochirurgie, September 20, 2008; Wu¨rz- 17 years) in whom contrast-enhanced MR imaging was performed for burg, Germany. unrelated reasons and who agreed to undergo additional CE-FIESTA Please address correspondence to Jennifer Linn, MD, Department of Neuroradiology, and CE-MRA sequences. None of these patients had known clinical University Hospital Munich, Marchioninistr 15, D-81377 Munich, Germany; e-mail: [email protected] abnormalities affecting the skull base or the infratentorial region. Fur- DOI 10.3174/ajnr.A1281 thermore, we present 1 illustrative case of a patient with a meningi- AJNR Am J Neuroradiol ●:● ͉ ● 2009 ͉ www.ajnr.org 1 Copyright 2008 by American Society of Neuroradiology. Table 1: Sequence parameters CE-FIESTA CE-MRA TR (s) 4.5 6.6 TE (s) 1.8 2.3 FOV (mm) 160 180 Flip angle (°) 50 20 Matrix (mm) 256 ϫ 256 450 ϫ 450 Section thickness (mm) 0.6 0.8 NEX 2 1.15 Resolution (mm) 0.6 ϫ 0.6 ϫ 0.6 0.4 ϫ 0.4 ϫ 0.8 Duration (min:s) 7:45 7:15 Note:—CE-FIESTA indicates contrast-enhanced fast imaging employing steady-state ac- quisition; CE-MRA, contrast-enhanced MR angiography. oma affecting the lower cranial nerves and the JF to illustrate the clinical relevance of these MR images. The study was approved by the review board of our department and conformed to the Helsinki declaration. All patients gave in- formed consent to participate before beginning the study. Fig 1. Petrosal and sigmoid parts of the JF. Axial CE-MRA image demonstrates the petrosal and sigmoid parts of the JF as well as the cranial nerves within the intrajugular MR Imaging compartment. The thick white arrow marks the right interjugular process of the occipital Imaging was performed on a 3T MR imaging scanner by using an bone; the black arrow depicts the dural septum between the petrosal and sigmoid part of the JF. Asterisks mark the drainage of the inferior petrosal sinus into the jugular bulb 8-channel high-definition head coil (GE Healthcare, Milwaukee, between CNIX anterolaterally (dotted arrows) and the CNX/XI complex at the level of the Wis). The imaging protocol consisted of a CE-MRA and a CE-FIESTA supCNX posteromedially (thin white arrow). 1 indicates the ICA; 2, the inferior petrosal sequence. The CE-MRA was performed first and started 30 seconds sinus; 3, the sigmoid sinus. after the administration of 0.1-mmol/kg gadobenate dimeglumine (sequence parameters are given in Table 1). The infCNIX was identified by its anatomic location approxi- mately 3 mm inferior to the supCNIX.3 The supCNX was identified Image Analysis by its position immediately caudal and dorsal to the supCNIX.2,3 The The 3D datasets from both sequences were analyzed collaboratively infCNX was not assessed in this study because it lies further caudally by 2 experienced neuroradiologists on a standard workstation by us- along the course of CNX and not within the JF.1,3 ing the multiplanar reconstruction function. Ratings were reached by Cochlear Aqueduct. The maximal width of the external opening consensus. The left and right sides of each patient were assessed of the cochlear aqueduct was measured on an oblique plane that was separately. reconstructed parallel to the course of the aqueduct. The length of the The certainty of identifying each anatomic structure was scored cochlear aqueduct was measured from the external opening of the on both MR images separately and recorded on an arbitrary scale of aqueduct as far proximal as the aqueduct could be traced toward the 0–2 (identified with certainty, 2; most probably identified, 1; and not cochlea (length of the aqueduct). identified, 09). Adjacent Cranial Nerves: CNVII and CNXII. The certainty of Intraforaminal Compartments. To assess the value of the 2 se- identifying the facial nerve (CNVII) in its course through the tempo- quences in depicting the different intraforaminal compartments, we ral bone to the parotid gland and of the canalicular segment of the identified the intrajugular processes of the temporal and occipital hypoglossal nerve (CNXII) was assessed. Furthermore, we evaluated bones and the dural septum between them. The maximum antero- whether a single or a duplicated hypoglossal canal was present. posterior and transverse dimensions of the sigmoid compartment and the maximum diameter of the inferior petrosal sinus proximal to Statistical Analysis its drainage into the petrosal portion of the JF were measured on To compare the value of the 2 sequences for the identification of each transverse reconstructed planes of the CE-MRA. anatomic structure, we performed the Fisher exact probability test.