The Radiopaedia Reading Room Podcast 74. Skull base MRI protocols
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Feb 2, 2026 
Daniel Gewolb, neuroradiologist and convener, leads the discussion. Francis Deng, neuroradiologist expert in neurovascular compression, focuses on high-resolution T2 and MRA fusion for trigeminal neuralgia. Jennifer Gillespie, skull base radiologist, covers osteomyelitis, perineural spread, and CSF leak imaging. They explore targeted MRI/CT strategies for trigeminal pain, infection versus tumor, pulsatile tinnitus, and leak localization.
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A Naughty Skiing Moment
- Frank Gaillard describes sneaking under ropes to ski a short patch of untouched powder and losing his lift ticket when caught by ski patrol.
- His eldest son was so disappointed he wouldn't speak to Frank for half an hour, illustrating personal rule-breaking consequences.
Protocol For Neurovascular Compression
- Use a high-resolution 3D heavily T2-weighted (e.g., CISS/Fiesta/KISS) sequence pre-contrast for neurovascular compression assessment.
- Add a TOF MRA and high-resolution post-contrast 3D T1 with fat suppression to distinguish arteries from enhancing veins and masses.
Look For Nerve Deformation Not Just Contact
- For trigeminal neuralgia, look beyond contact and assess for displacement, deformation, or atrophy of the nerve at the root entry zone.
- Also ensure imaging covers the skull base and face to exclude secondary causes like mass or inflammation.