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Duraffourg M, Rougereau G, Fawaz R, Ltaief A, Jacquesson T, Freydier M, Baude C, Robert R, Mertens P. Lumbosacral plexus and pudendal nerve magnetic resonance tractography: A systematic review of the clinical applications for pudendal neuralgia. Magn Reson Imaging 2024; 112:18-26. [PMID: 38797289 DOI: 10.1016/j.mri.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
Diffusion tensor imaging (DTI) is commonly used to establish three-dimensional mapping of white-matter bundles in the supraspinal central nervous system. DTI has also been the subject of many studies on cranial and peripheral nerves. This non-invasive imaging technique enables virtual dissection of nerves in vivo and provides specific measurements of microstructural integrity. Adverse effects on the lumbosacral plexus may be traumatic, compressive, tumoral, or malformative and thus require dedicated treatment. DTI could lead to new perspectives in pudendal neuralgia diagnosis and management. We performed a systematic review of all articles or posters reporting results and protocols for lumbosacral plexus mapping using the DTI technique between January 2011 and December 2023. Twenty-nine articles published were included. Ten studies with a total of 351 participants were able to track the lumbosacral plexus in a physiological context and 19 studies with a total of 402 subjects tracked lumbosacral plexus in a pathological context. Tractography was performed on a 1.5T or 3T MRI system. DTI applied to the lumbosacral plexus and pudendal nerve is feasible but no microstructural normative value has been proposed for the pudendal nerve. The most frequently tracking parameters used in our review are: 3T MRI, b-value of 800 s/mm2, 33 directions, 3 × 3 × 3 mm3, AF threshold of 0.1, minimum fiber length of 10 mm, bending angle of 30°, and 3DT2 TSE anatomical resolution. Increased use of DTI could lead to new perspectives in the management of pudendal neuralgia due to entrapment syndrome, whether at the diagnostic, prognostic, or preoperative planning level. Prospective studies of healthy subjects and patients with the optimal acquisition parameters described above are needed to establish the accuracy of MR tractography for diagnosing pudendal neuralgia and other intrapelvic nerve entrapments.
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Affiliation(s)
- M Duraffourg
- Unité de Neuromodulation Polyvalente, Service de Neurochirurgie fonctionnelle de la moelle et des nerfs périphériques - Hospices Civils de Lyon, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Centre d'Évaluation et de Traitement de la Douleur, Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France
| | - G Rougereau
- Service de chirurgie orthopédique et traumatologique Hôpital Pitié Salpetrière, Paris, France
| | - R Fawaz
- Unité de Neuromodulation Polyvalente, Service de Neurochirurgie fonctionnelle de la moelle et des nerfs périphériques - Hospices Civils de Lyon, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Centre d'Évaluation et de Traitement de la Douleur, Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Service de Neurochirurgie - Hôpital d'Instruction des Armées Percy, Clamart, France.
| | - A Ltaief
- Service d'imagerie médicale et interventionnelle - Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - T Jacquesson
- Service de Neurochirurgie crânienne générale, tumorale et vasculaire - Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France
| | - M Freydier
- Centre d'Évaluation et de Traitement de la Douleur - Centre Hospitalier de Macon, Macon, France; Centre d'Évaluation et de Traitement de la Douleur - Médipôle Hôpital Mutualiste, Villeurbanne, France
| | - C Baude
- Centre d'Évaluation et de Traitement de la Douleur - Médipôle Hôpital Mutualiste, Villeurbanne, France
| | - R Robert
- Service de chirurgie - Hôpital Privé du Confluent, Nantes, France; Faculté de Médecine de Nantes, Nantes, France
| | - P Mertens
- Unité de Neuromodulation Polyvalente, Service de Neurochirurgie fonctionnelle de la moelle et des nerfs périphériques - Hospices Civils de Lyon, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Centre d'Évaluation et de Traitement de la Douleur, Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France
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Weedall AD, Dallaway A, Hattersley J, Diokno M, Hutchinson CE, Wilson AJ, Wayte SC. Changes in lumbar muscle diffusion tensor indices with age. BJR Open 2024; 6:tzae002. [PMID: 38371493 PMCID: PMC10873271 DOI: 10.1093/bjro/tzae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/10/2024] [Indexed: 02/20/2024] Open
Abstract
Objective To investigate differences in diffusion tensor imaging (DTI) parameters and proton density fat fraction (PDFF) in the spinal muscles of younger and older adult males. Methods Twelve younger (19-30 years) and 12 older (61-81years) healthy, physically active male participants underwent T1W, T2W, Dixon and DTI of the lumbar spine. The eigenvalues (λ1, λ2, and λ3), fractional anisotropy (FA), and mean diffusivity (MD) from the DTI together with the PDFF were determined in the multifidus, medial and lateral erector spinae (ESmed, ESlat), and quadratus lumborum (QL) muscles. A two-way ANOVA was used to investigate differences with age and muscle and t-tests for differences in individual muscles with age. Results The ANOVA gave significant differences with age for all DTI parameters and the PDFF (P < .01) and with muscle (P < .01) for all DTI parameters except for λ1 and for the PDFF. The mean of the eigenvalues and MD were lower and the FA higher in the older age group with differences reaching statistical significance for all DTI measures for ESlat and QL (P < .01) but only in ESmed for λ3 and MD (P < .05). Conclusions Differences in DTI parameters of muscle with age result from changes in both in the intra- and extra-cellular space and cannot be uniquely explained in terms of fibre length and diameter. Advances in knowledge Previous studies looking at age have used small groups with uneven age spacing. Our study uses two well defined and separated age groups.
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Affiliation(s)
- Andrew D Weedall
- Radiology Physics, Department of Clinical Physics and Bioengineering, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, United Kingdom
| | - Alexander Dallaway
- Centre for Physical Activity, Sport and Exercise Sciences, Coventry University, Coventry, CV1 5FB, United Kingdom
- Present Address: Faculty of Education, Health and Wellbeing, School of Health and Society, University of Wolverhampton, Wolverhampton, WV1 1LY, United Kingdom
| | - John Hattersley
- Human Metabolic Research Unit, Department of Research and Development, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, United Kingdom
- School of Engineering, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Michael Diokno
- Radiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, United Kingdom
| | - Charles E Hutchinson
- Radiology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Adrian J Wilson
- Human Metabolic Research Unit, Department of Research and Development, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, United Kingdom
- Department of Physics, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Sarah C Wayte
- Radiology Physics, Department of Clinical Physics and Bioengineering, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, United Kingdom
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Pinto da Silva FH, Dos Santos Silva J, Pereira de Barros LF, Souza RDF, Landeiro JA, Rueda Lopes FC, da Silva MB, Fonseca GVDS, Acioly MA. Use of diffusion tensor imaging as a prognostic biomarker after decompression surgery for carpal tunnel syndrome. Acta Radiol 2023; 64:1109-1115. [PMID: 35876308 DOI: 10.1177/02841851221113518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Magnetic resonance diffusion tensor imaging (MR-DTI) has been increasingly applied for carpal tunnel syndrome (CTS) diagnosis, but relatively little is known about the effect of CTS treatment on median nerve (MN) integrity and functional outcome prediction. PURPOSE To assess how structural changes in MR-DTI of the MN correlates with symptom severity, functional status, and electrophysiological parameters in patients suffering from CTS before and after decompression surgery. MATERIAL AND METHODS Nine wrists were prospectively enrolled to perform MR-DTI pre- and postoperatively. The apparent diffusion coefficients (ADC) and fractional anisotropy (FA) of the MN were examined in three different regions-distal radioulnar joint, pisiform bone, and hamate bone-and correlated with clinical and electrophysiological parameters. RESULTS Postoperatively, mean Boston Carpal Tunnel Questionnaire scores decreased 1.55 points (range = 0.08-3; P = 0.0172) and 1.01 points (-0.13 to 1.88; P = 0.0381) in the symptomatic and functional domains, respectively. Postoperative clinical improvement was reflected in proximal FA elevation (P = 0.0078), but not in diffusivity in comparison to baseline examination. Preoperative electrophysiological parameters were correlated with a reduction in the pre- (sensory latencies [rho = -0.6826; P = 0.0312]) and postoperative (motor latencies [rho = -0.7488; P = 0.0325]) distal FA values. Higher sensory amplitudes indicated higher postoperative proximal FA values (rho = 0.7618; P = 0.0280) and lower postoperative proximal ADC values (rho = -0.9047; P = 0.0020). CONCLUSION Our study demonstrated that pre- and postoperative proximal FA values are useful biomarkers for the structural evaluation of the MN in patients with CTS. Symptomatic improvement can be better predicted by analyzing FA changes.
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Affiliation(s)
- Fábio Henrique Pinto da Silva
- Division of Neurosurgery, 282806Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil
- Postgraduation Program in Neurology, Federal University of the State of Rio de Janeiro (UNIRIO)
| | | | | | - Renan de Freitas Souza
- Division of Neurosurgery, 219791Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
| | - José Alberto Landeiro
- Division of Neurosurgery, 219791Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
| | - Fernanda Cristina Rueda Lopes
- Division of Radiology, 455295DASA, Rio de Janeiro, Brazil
- Division of Radiology, Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
| | | | | | - Marcus André Acioly
- Postgraduation Program in Neurology, Federal University of the State of Rio de Janeiro (UNIRIO)
- Division of Neurosurgery, 219791Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
- Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Evans AG, Morgan MD, Aiken BA, Assi PE, Joseph JT, Kesayan T, Mioton LM, Esteve IVM, Hill JB, Thayer WP, Al Kassis S. Can Diffusion Tensor Imaging Apparent Diffusion Coefficient Diagnose Carpal Tunnel Syndrome? A Systematic Review and Meta-Analysis. Hand (N Y) 2023; 18:91S-99S. [PMID: 35695339 PMCID: PMC9896277 DOI: 10.1177/15589447221096706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Magnetic resonance diffusion tensor imaging (DTI) can detect microstructural changes in peripheral nerves. Studies have reported that the median nerve apparent diffusion coefficient (ADC), a quantification of water molecule diffusion direction, is sensitive in diagnosing carpal tunnel syndrome (CTS). Five databases were searched for studies using ADC to investigate CTS. Apparent diffusion coefficient (measured in mm2/s) were pooled in random-effects meta-analyses. Twenty-two studies met criteria yielding 592 patients with CTS and 414 controls. Median nerve ADC were measured at the level of the distal radioulnar joint (CTS ADC: 1.11, 95% CI: 1.07-1.15, I2 = 54%; control ADC: 1.04, 95% CI: 1.01-1.07, I2 = 57%), pisiform (CTS ADC: 1.39, 95% CI: 1.37-1.42, I2 = 0%; control ADC: 1.27, 95% CI: 1.23-1.31, I2 = 59%), hamate (CTS ADC: 1.40, 95% CI: 1.36-1.43, I2 = 58%; control ADC: 1.27, 95% CI: 1.25-1.28, I2 = 47%), and as an combination of several measurements (CTS ADC: 1.40, 95% CI: 1.37-1.47, I2 = 100%; control ADC: 1.39, 95% CI: 1.24-1.53, I2 = 100%). Median nerve ADC is decreased in individuals with CTS compared to controls at the levels of the hamate and pisiform. ADC cut-offs to diagnose CTS should be established according to these anatomic levels and can be improved through additional studies that include use of a wrist coil.
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Affiliation(s)
- Adam G. Evans
- Meharry Medical College,
Nashville, TN, USA
- Vanderbilt University Medical
Center, Nashville, TN, USA
| | | | | | | | | | - Tigran Kesayan
- Vanderbilt University Medical
Center, Nashville, TN, USA
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Sprenger-Svačina A, Haensch J, Weiss K, Große Hokamp N, Maintz D, Schlamann M, Fink GR, Schloss N, Laukamp K, Wunderlich G, Lehmann HC, Lichtenstein T. MRI correlates of motoneuron loss in SMA. J Neurol 2023; 270:503-510. [PMID: 36180649 PMCID: PMC9813025 DOI: 10.1007/s00415-022-11326-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is currently explored as supplemental tool to monitor disease progression and treatment response in various neuromuscular disorders. We here assessed the utility of a multi-parametric magnetic resonance imaging (MRI) protocol including quantitative water T2 mapping, Dixon-based proton density fat fraction (PDFF) estimation and diffusion tensor imaging (DTI) to detect loss of spinal motor neurons and subsequent muscle damage in adult SMA patients. METHODS Sixteen SMA patients and 13 age-matched controls were enrolled in this prospective, longitudinal study. All participants underwent MRI imaging including measurements of Dixon-based PDFF and DTI of the sciatic nerve. SMA patients furthermore underwent measurements of muscle water T2 (T2w) of the biceps femoris muscle (BFM) and quadriceps femoris muscle (QFM). Ten participants returned for a second scan six months later. MRI parameter were correlated with clinical data. All patients were on nusinersen treatment. RESULTS There were significantly higher intramuscular fat fractions in the BFM and QFM of SMA patients compared to healthy controls at baseline and after 6 months. Furthermore, T2 values significantly correlated positively with intramuscular fat fractions. The Hammersmith functional motor scale significantly correlated with the QFM's intramuscular fat fractions. DTI scans of the sciatic nerve were not significantly different between the two groups. CONCLUSION This study demonstrates that, water T2 mapping and Dixon-based PDFF estimation may distinguish between adult SMA patients and controls, due to massive intramuscular fat accumulation in SMA. More extensive long-term studies are warranted to further evaluate these two modalities as surrogate markers in SMA patients during treatment.
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Affiliation(s)
- Alina Sprenger-Svačina
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Johannes Haensch
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kilian Weiss
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Philips GmbH Market DACH, Hamburg, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany
| | - Natalie Schloss
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kai Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gilbert Wunderlich
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Helmar C Lehmann
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Thorsten Lichtenstein
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Pušnik L, Serša I, Umek N, Cvetko E, Snoj Ž. Correlation between diffusion tensor indices and fascicular morphometric parameters of peripheral nerve. Front Physiol 2023; 14:1070227. [PMID: 36909220 PMCID: PMC9995878 DOI: 10.3389/fphys.2023.1070227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction: Diffusion tensor imaging (DTI) is a magnetic resonance imaging (MRI) technique that measures the anisotropy of water diffusion. Clinical magnetic resonance imaging scanners enable visualization of the structural integrity of larger axonal bundles in the central nervous system and smaller structures like peripheral nerves; however, their resolution for the depiction of nerve fascicular morphology is limited. Accordingly, high-field strength MRI and strong magnetic field gradients are needed to depict the fascicular pattern. The study aimed to quantify diffusion tensor indices with high-field strength MRI within different anatomical compartments of the median nerve and determine if they correlate with nerve structure at the fascicular level. Methods: Three-dimensional pulsed gradient spin-echo (PGSE) imaging sequence in 19 different gradient directions and b value 1,150 s/mm2 was performed on a 9.4T wide-bore vertical superconducting magnet. Nine-millimeter-long segments of five median nerve samples were obtained from fresh cadavers and acquired in sixteen 0.625 mm thick slices. Each nerve sample had the fascicles, perineurium, and interfascicular epineurium segmented. The diffusion tensor was calculated from the region-average diffusion-weighted signals for all diffusion gradient directions. Subsequently, correlations between diffusion tensor indices of segmentations and nerve structure at the fascicular level (number of fascicles, fascicular ratio, and cross-sectional area of fascicles or nerve) were assessed. The acquired diffusion tensor imaging data was employed for display with trajectories and diffusion ellipsoids. Results: The nerve fascicles proved to be the most anisotropic nerve compartment with fractional anisotropy 0.44 ± 0.05. In the interfascicular epineurium, the diffusion was more prominent in orthogonal directions with fractional anisotropy 0.13 ± 0.02. Diffusion tensor indices within the fascicles and perineurium differed significantly between the subjects (p < 0.0001); however, there were no differences within the interfascicular epineurium (p ≥ 0.37). There were no correlations between diffusion tensor indices and nerve structure at the fascicular level (p ≥ 0.29). Conclusion: High-field strength MRI enabled the depiction of the anisotropic diffusion within the fascicles and perineurium. Diffusion tensor indices of the peripheral nerve did not correlate with nerve structure at the fascicular level. Future studies should investigate the relationship between diffusion tensor indices at the fascicular level and axon- and myelin-related parameters.
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Affiliation(s)
- Luka Pušnik
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Igor Serša
- Jožef Stefan Institute, Ljubljana, Slovenia
| | - Nejc Umek
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Erika Cvetko
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Žiga Snoj
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Awais K, Snoj Ž, Cvetko E, Serša I. Diffusion Tensor Imaging of a Median Nerve by Magnetic Resonance: A Pilot Study. Life (Basel) 2022; 12:life12050748. [PMID: 35629414 PMCID: PMC9143877 DOI: 10.3390/life12050748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 12/03/2022] Open
Abstract
The magnetic resonance Diffusion Tensor Imaging (DTI) is a powerful extension of Diffusion Weighted Imaging (DWI) utilizing multiple bipolar gradients, allowing for the evaluation of the microstructural environment of the highly anisotropic tissues. DTI was predominantly used for the assessment of the central nervous system (CNS), but with the advancement in magnetic resonance (MR) hardware and software, it has now become possible to image the peripheral nerves which were difficult to evaluate previously because of their small caliber. This study focuses on the assessment of the human median peripheral nerve ex vivo by DTI microscopy at 9.4 T magnetic field which allowed the evaluation of diffusion eigenvalues, the mean diffusivity and the fractional anisotropy at 35 μm in-plane resolution. The resolution was sufficient for clear depiction of all nerve anatomical structures and therefore further image analysis allowed the obtaining of average values for DT parameters in nerve fascicles (intrafascicular region and perineurium) as well as in the surrounding epineurium. The results confirmed the highest fractional anisotropy of 0.33 and principal diffusion eigenvalue of 1.0 × 10−9 m2/s in the intrafascicular region, somewhat lower values of 0.27 and 0.95 × 10−9 m2/s in the perineurium region and close to isotropic with very slow diffusion (0.15 and 0.05 × 10−9 m2/s) in the epineurium region.
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Affiliation(s)
- Kanza Awais
- Jožef Stefan International Postgraduate School, 1000 Ljubljana, Slovenia;
| | - Žiga Snoj
- Department of Radiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Erika Cvetko
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Igor Serša
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Jožef Stefan Institute, 1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +386-1-477-3696
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Funahasi T, Suzuki T, Hayakawa K, Nakane T, Maeda A, Kuroiwa T, Kawano Y, Iwamoto T, Fujita N. Visualization of the morphological changes in the median nerve after carpal tunnel release using three-dimensional magnetic resonance imaging. Eur Radiol 2022; 32:3016-3023. [DOI: 10.1007/s00330-021-08447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/16/2021] [Accepted: 10/27/2021] [Indexed: 11/04/2022]
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Aggarwal A, Das CJ, Khanna N, Sharma R, Srivastava DN, Goyal V, Netaji A. Role of diffusion tensor imaging in the evaluation of ulnar nerve involvement in leprosy. Br J Radiol 2022; 95:20210290. [PMID: 34558292 PMCID: PMC8722232 DOI: 10.1259/bjr.20210290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Early detection of peripheral neuropathy is extremely important as leprosy is one of the treatable causes of peripheral neuropathy. The study was undertaken to assess the role of diffusion tensor imaging (DTI) in ulnar neuropathy in leprosy patients. METHODS This was a case-control study including 38 patients (72 nerves) and 5 controls (10 nerves) done between January 2017 and June 2019. Skin biopsy proven cases of leprosy, having symptoms of ulnar neuropathy (proven on nerve conduction study) were included. MRI was performed on a 3 T MR system. Mean cross-sectional area, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of ulnar nerve at cubital tunnel were calculated. Additional ancillary findings and appearance of base sequences were evaluated. RESULTS Ulnar nerve showed thickening with altered T2W signal in all the affected nerves, having an average cross-sectional area of 0.26 cm2. Low FA with mean of 0.397 ± 0.19 and high ADC with mean of 1.28 ± 0.427 x 10 -3 mm2/s of ulnar nerve in retrocondylar groove was obtained. In the control group, mean cross-sectional area was 0.71cm2 with mean FA and ADC of 0.53 ± 0.088 and 1.03 ± 0.24 x 10 -3 mm2/s respectively. Statistically no significant difference was seen in diseased and control group. Cut-off to detect neuropathy for FA and ADC is 0.4835 and 1.1020 × 10 -3 mm2/s respectively. CONCLUSION DTI though is challenging in peripheral nerves, however, is proving to be a powerful complementary tool for assessment of peripheral neuropathy. Our study validates its utility in infective neuropathies. ADVANCES IN KNOWLEDGE 1. DTI is a potential complementary tool for detection of peripheral neuropathies and can be incorporated in standard MR neurography protocol.2. In leprosy-related ulnar neuropathy, altered signal intensity with thickening or abscess of the nerve is appreciated along with locoregional nodes and secondary denervation changes along with reduction of FA and rise in ADC value.3. Best cut-offs obtained in our study for FA and ADC are 0.4835 and 1.1020 × 10 -3 mm2/s respectively.
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Affiliation(s)
| | | | - Neena Khanna
- Department of Dermatology, AIIMS, New Delhi, India
| | - Raju Sharma
- Department of Radiology, AIIMS, New Delhi, India
| | | | - Vinay Goyal
- Department of Neurology, AIIMS, New Delhi, India
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El Basset ASA, Saeed AHM, Tawfik MH, El Hady MSA. Value of diffusion tensor imaging and tractography in unilateral lumbar disc prolapse. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-020-00380-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Conventional MR imaging is not enough for evaluation of symptomatic foraminal stenosis, because there is high incidence of false-positive results in asymptomatic elderly patients. Conventional MR cannot quantitatively assess the severity of the nerve lesion. DTI is a non-invasive way to effectively trace the nerve fiber bundle and quantitatively evaluate the nerve injury. DTI with fiber tracking may describe abnormalities beyond the resolution of conventional MR techniques. The aim of this work was to compare between the mean values of diffusion parameters such as fractional anisotropy and apparent diffusion coefficient of the compressed lumbar spinal nerve roots and of the contralateral normal nerve roots. Correlate these parameters with the severity of neurological symptoms. This is a prospective study that was conducted on 50 patients with symptomatic unilateral posterolateral lumbar disc prolapse at a university hospital. They were investigated with diffusion tensor imaging with tractography on a 1.5-T MR. The changes in the mean fractional anisotropy and apparent diffusion coefficient values of the compressed nerves and the relationship between these changes and the severity of the neurological side effects using Japanese Orthopedic Association score and visual analogue scale were investigated.
Results
The mean fractional anisotropy values were significantly lower (p ≤ 0.001), and mean apparent diffusion coefficient values were significantly higher (p ≤ 0.001) in compressed nerves than in contralateral intact nerves. There were strong correlations between the DTI parameters and the severity of the neurological symptoms as assessed using the Japanese Orthopedic Association score and the visual analogue scale.
Conclusion
In patients with lumbar disc prolapse, radicular diffusion parameters are affected in the compressed roots in comparison to the healthy roots and this affection is correlated with the degree of prolapse and with the severity of neurological symptoms. DTI with fiber tracking provide clinically relevant information and describe abnormalities beyond the resolution of conventional MR techniques.
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11
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Rojoa D, Raheman F, Rassam J, Wade RG. Meta-analysis of the normal diffusion tensor imaging values of the median nerve and how they change in carpal tunnel syndrome. Sci Rep 2021; 11:20935. [PMID: 34686721 PMCID: PMC8536657 DOI: 10.1038/s41598-021-00353-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023] Open
Abstract
Carpal tunnel syndrome (CTS) leads to distortion of axonal architecture, demyelination and fibrosis within the median nerve. Diffusion tensor imaging (DTI) characterises tissue microstructure and generates reproducible proxy measures of nerve 'health' which are sensitive to myelination, axon diameter, fiber density and organisation. This meta-analysis summarises the normal DTI values of the median nerve, and how they change in CTS. This systematic review included studies reporting DTI of the median nerve at the level of the wrist in adults. The primary outcome was to determine the normal fractional anisotropy (FA) and mean diffusivity (MD) of the median nerve. Secondarily, we show how the FA and MD differ between asymptomatic adults and patients with CTS, and how these differences are independent of the acquisition methods. We included 32 studies of 2643 wrists, belonging to 1575 asymptomatic adults and 1068 patients with CTS. The normal FA was 0.58 (95% CI 0.56, 0.59) and the normal MD was 1.138 × 10-3 mm2/s (95% CI 1.101, 1.174). Patients with CTS had a significantly lower FA than controls (mean difference 0.12 [95% CI 0.09, 0.16]). Similarly, the median nerve of patients with CTS had a significantly higher mean diffusivity (mean difference 0.16 × 10-3 mm2/s [95% CI 0.05, 0.27]). The differences were independent of experimental factors. We provide summary estimates of the normal FA and MD of the median nerve in asymptomatic adults. Furthermore, we show that diffusion throughout the length of the median nerve becomes more isotropic in patients with CTS.
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Affiliation(s)
- Djamila Rojoa
- grid.419248.20000 0004 0400 6485Department of Plastic and Reconstructive Surgery, Leicester Royal Infirmary, Leicester, UK
| | - Firas Raheman
- grid.419248.20000 0004 0400 6485Department of Plastic and Reconstructive Surgery, Leicester Royal Infirmary, Leicester, UK
| | - Joseph Rassam
- grid.419248.20000 0004 0400 6485Department of Plastic and Reconstructive Surgery, Leicester Royal Infirmary, Leicester, UK
| | - Ryckie G. Wade
- grid.415967.80000 0000 9965 1030Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK ,grid.9909.90000 0004 1936 8403Leeds Institute for Medical Research, Advanced Imaging Centre, University of Leeds, Leeds, LS1 3EX UK
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12
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Silvera J, Masmejean E. Preoperative imaging assessment of the paralytic upper limb. HAND SURGERY & REHABILITATION 2021; 41S:S16-S22. [PMID: 34481127 DOI: 10.1016/j.hansur.2020.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/26/2022]
Abstract
Imaging has become an essential tool in the study of the posttraumatic paralytic upper limb, in addition to the clinical examination and electroneuromyography. Upper extremity surgeons must be aware of how these different techniques contribute to the initial and preoperative assessment of nervous injuries. We review the appearance of traumatic nerve damage and muscle denervation during the initial injury assessment, focusing on the main aspects of brachial plexus injuries, paralysis after shoulder dislocation and traumatic damage to the radial nerve. Finally, we discuss the role of imaging for preoperative assessment of musculotendinous and osteoarticular palliative surgeries.
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Affiliation(s)
- J Silvera
- IMPC Bachaumont, 6 Rue Bachaumont, 75002 Paris, France; Research Unit, Clinique Blomet, 136 bis Rue Blomet, 75015 Paris, France.
| | - E Masmejean
- Research Unit, Clinique Blomet, 136 bis Rue Blomet, 75015 Paris, France; University of Paris, Medical School, 12, Rue de l'Ecole de Médecine, 75006 Paris, France; Hand, Upper Limb & Peripheral Nerve Surgery Service, Georges-Pompidou European Hospital (HEGP), 20, Rue Leblanc, 75015 Paris, France
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13
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Lemos N, Melo HJF, Sermer C, Fernandes G, Ribeiro A, Nascimento G, Luo ZC, Girão MJBC, Goldman SM. Lumbosacral plexus MR tractography: A novel diagnostic tool for extraspinal sciatica and pudendal neuralgia? Magn Reson Imaging 2021; 83:107-113. [PMID: 34400289 DOI: 10.1016/j.mri.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/10/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diagnosing extraspinal sciatica and pudendal neuralgia remains a clinical challenge. MRI and MR Neurography (MRN) are currently the standard techniques used to support the diagnosis of extraspinal lumbosacral plexus entrapments; however, for the intrapelvic portions of the lumbosacral plexus their accuracy is still limited. MR Tractography (MRT) feasibility to image the lumbosacral plexus has been demosntrated, but its clinical applications have yet to be determined. PURPOSE To correlate MRT with intraoperative findings in patients undergoing laparoscopic treatment of intrapelvic entrapments of the lumbosacral plexus and compare its accuracy with Neuropelveological clinical assessment and MRN. MATERIALS AND METHODS This is a retrospective analysis of MRT reconstructions of diffusion tensor imaging (DTI) sequences acquired for the MRN collected from a cohort of 13 patients undergoing laparoscopic detrapment of the lumbosacral plexus. The primary outcome of this study was the correlation of MRT reconstruction with intraoperative findings. Secondary outcomes included the correlation of MRN, preoperative Neuropelveological clinical diagnoses and the diffusion-weighted imaging (DWI) fractional anisotropy (FA) and Apparent Diffusion Coefficient (ADC) in patients undergoing pelvic MRI and MRN for the investigation of intrapelvic nerve entrapments. RESULTS MRT correlated with intraoperative findings in 11 of 13 patients (85%). Neuropelveological clinical assessment was able to accurately diagnose a pelvic nerve entrapment in 12/13 patients (92%) and MRN agreed with surgical findings in only 2/13 (15%) patients. MRT was significantly superior to MRN (p < 0.001). FA and ADC did not correlate with the identification of a nerve entrapment, likely due to limitations regarding the placement of the seedpoints. CONCLUSIONS This initial, retrospective analysis, suggests that MRT is superior to MRN at diagnosing intrapelvic entrapments of the lumbosacral plexus. A prospective, double-blinded study is underway to validate this data, but these initial findings show great potential for MRT as a diagnostic tool for extraspinal sciatica and pudendal neuralgia. Clinical Trials Registry: U1111-1261-4910 (REBEC - Brazilian Registry for Clinical Trials).
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Affiliation(s)
- Nucelio Lemos
- Department of Obstetrics and Gynecology of Women's College Hospital and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada; Department of Gynecology, Escola Paulista de Medicina, Federal University of São Paulo, Brazil; Department of Neuropelveology and Advanced Pelvic Surgery, Increasing - Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil.
| | - Homero J F Melo
- Instituto de Educação Superior IMEB (IMEB-IES), Brasilia, Brazil
| | - Corey Sermer
- Department of Obstetrics and Gynecology of Women's College Hospital and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Gustavo Fernandes
- Department of Gynecology, Escola Paulista de Medicina, Federal University of São Paulo, Brazil; Department of Neuropelveology and Advanced Pelvic Surgery, Increasing - Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil; Department of Obstetrics and Gynecology, Santa Casa School of Medical Sciences, São Paulo, Brazil
| | - Augusta Ribeiro
- Department of Gynecology, Escola Paulista de Medicina, Federal University of São Paulo, Brazil; Department of Neuropelveology and Advanced Pelvic Surgery, Increasing - Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil
| | - Geovanne Nascimento
- Department of Magnetic Resonance Imaging, CURA- Centro de Ultrassonografia e Radiologia Aplicada, São Paulo, SP, Brazil
| | - Zhong Cheng Luo
- Lunenfeld-Tanenbaum Research Institute, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Manoel J B C Girão
- Department of Gynecology, Escola Paulista de Medicina, Federal University of São Paulo, Brazil
| | - Suzan Menasce Goldman
- Department of Magnetic Resonance Imaging, CURA- Centro de Ultrassonografia e Radiologia Aplicada, São Paulo, SP, Brazil; Department of Radiology, Escola Paulista de Medicina, Federal University of São Paulo, Brazil
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14
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Park SY, Koh SH, Lee IJ, Lee K, Lee Y. Determination of optimum pixel size and slice thickness for tractography and ulnar nerve diffusion tensor imaging at the cubital tunnel using 3T MRI. Acta Radiol 2021; 62:1063-1071. [PMID: 32854528 DOI: 10.1177/0284185120951965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Small peripheral nerve tractography is challenging because of the trade-off among resolution, image acquisition time, and signal-to-noise ratio. PURPOSE To optimize pixel size and slice thickness parameters for fiber tractography and diffusion tensor imaging (DTI) of the ulnar nerve at the cubital tunnel using 3T magnetic resonance imaging (MRI). MATERIAL AND METHODS Fifteen healthy volunteers (mean age 30 ± 6.8 years) were recruited prospectively. Axial T2-weighted and DTI scans were acquired, covering the cubital tunnel, using different pixel sizes and slice thicknesses. Three-dimensional (3D) nerve tractography was evaluated for the median number and length of the reconstructed fiber tracts and visual score from 0 to 5. Two-dimensional (2D) cross-sectional DTI was evaluated for fractional anisotropy (FA) values throughout the length of the ulnar nerve. RESULTS A pixel size of 1.3 mm2 revealed the highest number of reconstructed nerve fibers compared to that of 1.1 mm2 (P = 0.048), with a good visual score. A slice thickness of 4 mm had the highest number of reconstructed nerve fibers and visual score compared with other thicknesses (all P < 0.05). In 2D cross-sectional images, the median FA values were in the range of 0.40-0.63 at the proximal, central, and distal portions of the cubital tunnel. Inter-observer agreement for all parameters was good to excellent. CONCLUSION For fiber tractography and DTI of the ulnar nerve at the cubital tunnel, optimal image quality was obtained using a 1.3-mm2 pixel size and 4-mm slice thickness under MR parameters of this study at 3T.
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Affiliation(s)
- Sun-Young Park
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Sung Hye Koh
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - In Jae Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Kwanseop Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Yul Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
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Celli V, Ciulla S, Dolciami M, Satta S, Ercolani G, Porpora MG, Catalano C, Manganaro L. Magnetic Resonance Imaging in endometriosis-associated pain. Minerva Obstet Gynecol 2021; 73:553-571. [PMID: 33904689 DOI: 10.23736/s2724-606x.21.04782-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Endometriosis affects 10%-15% of women in reproductive age and may cause no-cyclic chronic pelvic pain, dysmenorrhea, dyspareunia, urinary tract symptoms, and it is frequently associated with infertility. The peak of incidence is between 24 and 29 years old and the clinical diagnosis of endometriosis is generally delayed by 6-7 years. Laparoscopy with surgical biopsies is the "gold standard" for the diagnosis of endometriosis, with histological verification of endometrial ectopic glands and/or stroma. However, nowadays two different non-invasive modalities are routinely used for a presumptive diagnosis: Transvaginal Ultrasound (TVUS) and Magnetic Resonance Imaging (MRI). EVIDENCE ACQUISITION A structured search using PubMed was performed starting from October 2020 and including all relevant original and review articles published since 2000. The search used the following key word combinations: "Endometriosis MRI" AND "DIE and MRI" (45); "MRI endometriosis and Pelvic Pain" OR "Endometriosis and MRI technical development" (296). Ultimately, 87 articles were deemed relevant and used as the literature basis of this review. EVIDENCE SYNTHESIS TVUS represents the first imaging approach for endometriosis showing a good diagnostic performance but it is highly operator dependent. MRI is a second level examination often used in complex cases indeterminate after TVUS and in pre-operative planning. MRI is considered the best imaging technique for mapping endometriosis since it provides a more reliable map of deep infiltrating endometriosis than physical examination and transvaginal ultrasound. We have analyzed and described the main forms of endometriosis: adnexal endometriosis, adenomyosis, peritoneal implants and deep infiltrating endometriosis, showing their appearance in the two imaging modalities. CONCLUSIONS Endometriosis is one of the most common gynecologic disorders correlated to chronic pelvic pain whose treatment is still today complex and controversial. In this context, MRI has become an important additional non-invasive tool to investigate cases of chronic pelvic pain related to deep infiltrating endometriosis (DIE) with or without neural involvement.
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Affiliation(s)
- Veronica Celli
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Sandra Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Miriam Dolciami
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Serena Satta
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Maria G Porpora
- Department of Maternal and Child Health and Urological Sciences, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy - lucia.manganaro@uniroma1
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16
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Irimia A, Van Horn JD. Mapping the rest of the human connectome: Atlasing the spinal cord and peripheral nervous system. Neuroimage 2021; 225:117478. [PMID: 33160086 PMCID: PMC8485987 DOI: 10.1016/j.neuroimage.2020.117478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/15/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022] Open
Abstract
The emergence of diffusion, structural, and functional neuroimaging methods has enabled major multi-site efforts to map the human connectome, which has heretofore been defined as containing all neural connections in the central nervous system (CNS). However, these efforts are not structured to examine the richness and complexity of the peripheral nervous system (PNS), which arguably forms the (neglected) rest of the connectome. Despite increasing interest in an atlas of the spinal cord (SC) and PNS which is simultaneously stereotactic, interactive, electronically dissectible, scalable, population-based and deformable, little attention has thus far been devoted to this task of critical importance. Nevertheless, the atlasing of these complete neural structures is essential for neurosurgical planning, neurological localization, and for mapping those components of the human connectome located outside of the CNS. Here we recommend a modification to the definition of the human connectome to include the SC and PNS, and argue for the creation of an inclusive atlas to complement current efforts to map the brain's human connectome, to enhance clinical education, and to assist progress in neuroscience research. In addition to providing a critical overview of existing neuroimaging techniques, image processing methodologies and algorithmic advances which can be combined for the creation of a full connectome atlas, we outline a blueprint for ultimately mapping the entire human nervous system and, thereby, for filling a critical gap in our scientific knowledge of neural connectivity.
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Affiliation(s)
- Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue, Los Angeles CA 90089, United States; Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA 90089, United States.
| | - John Darrell Van Horn
- Department of Psychology, University of Virginia, 485 McCormick Road, Gilmer Hall, Room 102, Charlottesville, Virginia 22903, United States; School of Data Science, University of Virginia, Dell 1, Charlottesville, Virginia 22903, United States.
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17
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Role of diffusion tensor imaging of sciatic nerve in symptomatic patients with inconclusive lumbar MRI. Eur J Radiol 2020; 131:109249. [DOI: 10.1016/j.ejrad.2020.109249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/08/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022]
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18
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Norimoto M, Eguchi Y, Kanamoto H, Oikawa Y, Matsumoto K, Masuda Y, Furuya T, Orita S, Inage K, Maki S, Shiga Y, Kinoshita H, Abe K, Inoue M, Umimura T, Sato T, Sato M, Suzuki M, Enomoto K, Ohtori S. Diffusion Tensor Imaging of the Spinal Canal in Quantitative Assessment of Patients with Lumbar Spinal Canal Stenosis. Asian Spine J 2020; 15:207-215. [PMID: 32872759 PMCID: PMC8055456 DOI: 10.31616/asj.2020.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/10/2020] [Indexed: 12/05/2022] Open
Abstract
Study Design Retrospective observational study. Purpose Lumbar spinal stenosis (LSS) has traditionally been evaluated morphologically, there is a paucity of literature on quantitative assessment of LSS. The purpose of this study was to investigate whether intraspinal diffusion tensor imaging (DTI) parameters such as apparent diffusion coefficient (ADC) and fractional anisotropy (FA) are useful for assessing LSS. Overview of Literature Quantitative assessment of LSS is challenging. Methods Study participants comprised five healthy volunteers (mean age, 27.2 years) and 27 patients with LSS (mean age, 58.4 years) who were individually assessed using 3.0 Tesla magnetic resonance imaging. Intraspinal ADC and FA values of 10 intervertebral discs from healthy volunteers and 52 intervertebral discs from LSS patients were measured. Also, intraspinal canal area, Schizas classification (A: normal, B: mild stenosis, C: severe stenosis) and correlations with symptoms were investigated. Clinical symptoms were checked for the presence of low back pain (LBP), intermittent claudication (IMC), and bladder and bowel dysfunction (BBD). Results Compared to healthy individuals, LSS patients had significantly lower ADC (p<0.05) and significantly higher FA values (p<0.01). In Schizas classification, stenosis worsened from A to C. ADC values decreased significantly while FA values increased significantly in that order (p<0.05). A positive correlation was found between intraspinal canal area and ADC values (r=0.63, p<0.01) and a negative correlation between intraspinal canal area and FA values (p=−0.61, p<0.01). No correlations were noted between LBP and ADC or FA values. On the other hand, ADC values were significantly lower (p<0.05) and FA values were significantly higher (p<0.05) in patients with IMC or BBD. Conclusions Intraspinal DTI parameters such as ADC and FA values were associated with the Schizas classification, intraspinal canal area, and clinical symptoms, suggesting that ADC and FA may be useful for quantitative assessment of LSS.
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Affiliation(s)
- Masaki Norimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, Yotsukaido, Japan
| | | | - Yasuhiro Oikawa
- Department of Orthopaedic Surgery, Chiba Children's Hospital, Chiba, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Koki Abe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomotaka Umimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keigo Enomoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Does the increased motion probing gradient directional diffusion tensor imaging of lumbar nerves using multi-band SENSE improve the visualization and accuracy of FA values? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1693-1701. [PMID: 32367162 DOI: 10.1007/s00586-020-06430-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/24/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Diffusion tensor imaging (DTI) is useful to evaluate lumbar nerves visually and quantitatively. Multi-band sensitivity encoding (MB-SENSE) is a technique to reduce the scan time. This study aimed to investigate if super-multi-gradient DTI with multi-band sensitivity encoding (MB-SENSE) is better in evaluating lumbar nerves than the conventional method. METHODS The participants were 12 healthy volunteers (mean age 33.6 years). In all subjects, DTI was performed using echo planar imaging with different motion probing gradient (MPG) directions (15 without MB, and 15, 32, 64, and 128 with MB) and the lumbar nerve roots were visualized with tractography. In the five groups, we evaluated the resultant DTI both visually and quantitatively. For visual measures, we counted the number of fluffs and disruptions of the nerve fibers. For quantitative measures, the fractional anisotropy (FA) and standard deviation of the fractional anisotropy (FA-SD) values at two regions (proximal and distal) of the lumbar nerve roots were quantified and compared. RESULTS Among the five groups, the number of fluffs decreased as the number of MPG directions increased. However, the number of disruptions showed no significant differences. The FA-SD values decreased as the number of MPG directions increased, indicating that the signal variation was reduced with multi-gradient directional DTI. CONCLUSION High-resolution multi-directional DTI with MB-SENSE may be useful to visualize nerve entrapments and may allow for more accurate DTI parameter quantification with opportunities for clinical diagnostic applications.
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20
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Edward R, Abdelalim AM, Ashour AS, Afifi L, Al-Athwari A. A study of diffusion tensor imaging of median nerve in diabetic peripheral neuropathy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00172-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Objective
To evaluate the role of diffusion tensor imaging (DTI) in the evaluation of diabetic peripheral neuropathy (DPN) compared to clinical scores and nerve conduction studies (NCS).
Patients and methods
We included 30 patients with diabetes mellitus complaining of neuropathy symptoms and 15 healthy volunteers. All subjects underwent evaluation using 1.5-T DTI of median nerves and NCS. Patients underwent clinical evaluation using the Neuropathy Deficit Score (NDS), Neuropathy Impairment Score in the Lower Limbs (NIS-LL), and Diabetic Neuropathy Examination (DNE) score.
Results
We found statistically significant differences between healthy volunteers and patients in fractional anisotropy (FA) of the distal segment (P = 0.016) and whole median nerve (P = 0.024), apparent diffusion coefficient (ADC) of proximal (P = 0.027) and distal (P < 0.001) segments, and whole median nerve (P = 0.019). Distal segment FA was significantly correlated with NDS (P = 0.003), DNEs (P = 0.003), sensory amplitude (P = 0.048), and motor CV (P = 0.020). Distal segment ADC was significantly correlated with NDS (P = 0.007), NIS-LL (P = 0.003), DNEs (P = 0.01), and sensory amplitude (P = 0.032). The best cut-off value of distal segment for FA was 0.45 (87% sensitivity, 80% specificity) and of distal segment ADC was 1.217 (80% sensitivity and specificity).
Conclusions
Our results suggest that 1.5-T DTI examination of the median nerve can provide useful non-invasive information in patients with DPN.
Trial registration
ClinicalTrials.gov, NCT03934970. Registered on May 1, 2019
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Intervertebral Disc Diseases PART 2: A Review of the Current Diagnostic and Treatment Strategies for Intervertebral Disc Disease. Int J Mol Sci 2020; 21:ijms21062135. [PMID: 32244936 PMCID: PMC7139690 DOI: 10.3390/ijms21062135] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/12/2020] [Accepted: 03/18/2020] [Indexed: 12/25/2022] Open
Abstract
With an aging population, there is a proportional increase in the prevalence of intervertebral disc diseases. Intervertebral disc diseases are the leading cause of lower back pain and disability. With a high prevalence of asymptomatic intervertebral disc diseases, there is a need for accurate diagnosis, which is key to management. A thorough understanding of the pathophysiology and clinical manifestation aids in understanding the natural history of these conditions. Recent developments in radiological and biomarker investigations have potential to provide noninvasive alternatives to the gold standard, invasive discogram. There is a large volume of literature on the management of intervertebral disc diseases, which we categorized into five headings: (a) Relief of pain by conservative management, (b) restorative treatment by molecular therapy, (c) reconstructive treatment by percutaneous intervertebral disc techniques, (d) relieving compression and replacement surgery, and (e) rigid fusion surgery. This review article aims to provide an overview on various current diagnostic and treatment options and discuss the interplay between each arms of these scientific and treatment advancements, hence providing an outlook of their potential future developments and collaborations in the management of intervertebral disc diseases.
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Abstract
Nerve imaging is an important component in the assessment of patients presenting with suspected peripheral nerve pathology. Although magnetic resonance neurography and ultrasound are the most commonly utilized techniques, several promising new modalities are on the horizon. Nerve imaging is useful in localizing the nerve injury, determining the severity, providing prognostic information, helping establish the diagnosis, and helping guide surgical decision making. The focus of this article is imaging of damaged nerves, focusing on nerve injuries and entrapment neuropathies.
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Affiliation(s)
- David A Purger
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sarada Sakamuri
- Department of Neurology and Neurological Sciences, 213 Quarry Road, MC 5979, Palo Alto, CA 94304, USA
| | - Nicholas F Hug
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sandip Biswal
- Department of Radiology, Stanford University, 300 Pasteur Drive, S-068B, Stanford, CA 94305, USA
| | - Thomas J Wilson
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, R293, Stanford, CA 94305, USA.
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Shi Y, Zou Y, Feng Y, Dou W, Ding H, Wang C, Zhao F, Shi H. A quantitative and clinical evaluation of nerve roots in lumbosacral radiculopathy using diffusion tensor imaging. Jpn J Radiol 2019; 38:222-230. [PMID: 31865529 DOI: 10.1007/s11604-019-00913-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/15/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to investigate the relationship between the fractional anisotropy (FA) values of compressed nerves derived in diffusion tensor imaging (DTI) and the corresponding clinical symptoms for quantitative and clinical evaluation in patients with lumbosacral radiculopathy. METHODS Thirty-six patients and ten volunteers participated in the study and measured with DTI. The resultant FA values for L5-S1 lumbar nerve roots were calculated at three sub-regions. Additionally, the DTI relevant tractography was also performed on L4-S1 nerve roots. Clinical symptoms were performed by Japanese Orthopedic Association (JOA) scoring for each patient and volunteer. RESULTS The FA values of the nerves at the symptomatic side were significantly lower than those at the asymptomatic side (p < 0.001). Diffusion tensor tractography distinctly showed abnormalities in the symptomatic nerve tracts. There was a significant correlation between JOA scores and the FA values of the compressed nerves at middle and distal sub-regions (p < 0.005). CONCLUSION The clinical symptoms associated robustly with the DTI derived FA values of the compressed nerves in patients with lumbosacral radiculopathy. Therefore, the FA values can be a potential clinical tool to evaluate the nerve roots in lumbosacral radiculopathy quantitatively.
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Affiliation(s)
- Yin Shi
- The Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
| | - Yuefen Zou
- The Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
| | - Yang Feng
- The Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
| | - Weiqiang Dou
- GE Healthcare, MR Research, Beijing, People's Republic of China
| | - Hongyuan Ding
- The Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
| | - Chuanbing Wang
- The Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
| | - Feng Zhao
- The Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Haibin Shi
- The Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China.
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Utility of diffusion tensor imaging for guiding the treatment of lumbar disc herniation by percutaneous transforaminal endoscopic discectomy. Sci Rep 2019; 9:18753. [PMID: 31822704 PMCID: PMC6904469 DOI: 10.1038/s41598-019-55064-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/23/2019] [Indexed: 12/02/2022] Open
Abstract
The purpose of this study was to evaluate the utility of diffusion tensor imaging (DTI) for guiding the treatment of lumbar disc herniation (LDH) by percutaneous transforaminal endoscopic discectomy (PTED). We collected the clinical data of a total of 19 patients: 10 with unilateral S1 nerve root injury, 6 with unilateral L5 nerve root injury, and 3 with unilateral L5 and S1 nerve root injury. All patients underwent DTI before surgery, 3 days post-surgery, 30 days post-surgery, and 90 days post-surgery. The comparison of the fractional anisotropy (FA) values of compressed lateral nerve roots before surgery and 3, 30, and 90 days post-surgery demonstrated the recovery of nerve roots to be a dynamic process. A significant difference was found in the FA values between compressed lateral nerve roots preoperatively and normal lateral nerve roots before surgery, 3 days post-surgery and 30 days post-surgery (p < 0.05). There was no significant difference in FA values between compressed lateral nerve roots and normal ones 90 days post-surgery (p > 0.05). DTI can be used for the accurate diagnosis of LDH, as well as for postoperative evaluation and prognosis, and it is thus useful for the selection of surgical timing.
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Hughes SW, Hellyer PJ, Sharp DJ, Newbould RD, Patel MC, Strutton PH. Diffusion tensor imaging reveals changes in microstructural integrity along compressed nerve roots that correlate with chronic pain symptoms and motor deficiencies in elderly stenosis patients. NEUROIMAGE-CLINICAL 2019; 23:101880. [PMID: 31200150 PMCID: PMC6562326 DOI: 10.1016/j.nicl.2019.101880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 04/15/2019] [Accepted: 05/25/2019] [Indexed: 11/17/2022]
Abstract
Age-related degenerative changes in the lumbar spine frequently result in nerve root compression causing severe pain and disability. Given the increasing incidence of lumbar spinal disorders in the aging population and the discrepancies between the use of current diagnostic imaging tools and clinical symptoms, novel methods of nerve root assessment are needed. We investigated elderly patients with stenosis at L4-L5 or L5-S1 levels. Diffusion tensor imaging (DTI) was used to quantify microstructure in compressed L5 nerve roots and investigate relationships to clinical symptoms and motor neurophysiology. DTI metrics (i.e. FA, MD, AD and RD) were measured at proximal, mid and distal segments along compressed (i.e. L5) and intact (i.e. L4 or S1) nerve roots. FA was significantly reduced in compressed nerve roots and MD, AD and RD were significantly elevated in the most proximal segment of the nerve root studied. FA was significantly correlated with electrophysiological measures of root function: minimum F-wave latency and peripheral motor conduction time (PMCT). In addition, FA along the compressed root also correlated with leg pain and depression score. There was also a relationship between RD and anxiety, leg pain and disability score and AD correlated with depression score. Taken together, these data show that DTI metrics are sensitive to nerve root compression in patients with stenosis as a result of age-related lumbar degeneration. Critically, they show that the changes in microstructural integrity along compressed L5 nerve roots are closely related to a number of clinical symptoms associated with the development of chronic pain as well as neurophysiological assessments of motor function. These inherent relationships between nerve root damage and phenotype suggest that the use DTI is a promising method as a way to stratify treatment selection and predict outcomes. DTI can be used to quantify lumbar spinal nerve root compression in elderly patients. Diffusion parameters correlate with functional neurophysiology and clinical symptoms. DTI has the potential to be used to predict treatment outcomes.
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Affiliation(s)
- S W Hughes
- The Nick Davey Laboratory, Division of Surgery, Imperial College London, UK
| | - P J Hellyer
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK; Department of Bioengineering, Imperial College London, UK
| | - D J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK
| | | | - M C Patel
- Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - P H Strutton
- The Nick Davey Laboratory, Division of Surgery, Imperial College London, UK.
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Baro V, Landi A, Brigadoi S, Castellaro M, Moretto M, Anglani M, Ermani M, Causin F, Zanoletti E, Denaro L, Bertoldo A, d'Avella D. Preoperative Prediction of Facial Nerve in Patients with Vestibular Schwannomas: The Role of Diffusion Tensor Imaging—A Systematic Review. World Neurosurg 2019; 125:24-31. [DOI: 10.1016/j.wneu.2019.01.099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 11/26/2022]
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Hsu YC, Yang FC, Hsu HH, Huang GS. Diffusion tensor imaging findings of the median nerve before and after carpal tunnel corticosteroid injection in patients with carpal tunnel syndrome: a preliminary study. Acta Radiol 2019; 60:347-355. [PMID: 29979105 DOI: 10.1177/0284185118784977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Corticosteroid injections are a popular technique for carpal tunnel syndrome (CTS) treatment and are believed to provide rapid symptom relief. PURPOSE To use magnetic resonance diffusion tensor imaging (MR-DTI) to determine the association between diffusion values of the median nerve (MN) at several anatomic locations and symptom relief in patients with CTS following corticosteroid injection. MATERIAL AND METHODS MR-DTI was performed on 15 wrists of 12 patients with CTS before and two weeks after ultrasound-guided corticosteroid injections. We recorded the patients' clinical data including sex, age, side of injection, satisfaction, and symptom relief. Satisfaction and symptom relief were rated using a Likert scale and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scale. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the MN at the levels of the distal radioulnar joint (DRUJ), pisiform bone, and hamate bone were determined. RESULTS All patients had ≥50% satisfaction on the injection side. In comparison with baseline values, post-injection ADC was significantly lower ( P = 0.001) but FA was not significantly higher ( P = 0.11) at the pisiform bone level on the injected wrists. At the DRUJ and hamate bone levels, no obvious inter-scan change in FA and ADC ( P > 0.05) was observed. The decrease in ADC at the pisiform bone level strongly correlated with the decrease in BCTQ scores (r = 0.628; P = 0.012). CONCLUSION Symptom relief in patients with CTS receiving corticosteroid injection is related to the change in ADC of the median nerve at the level of the pisiform bone, as determined using MR-DTI.
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Affiliation(s)
- Yi-Chih Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsian-He Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Diffusion tensor imaging (DTI) and Tractography of the spinal cord in pediatric population with spinal lipomas: preliminary study. Childs Nerv Syst 2019; 35:129-137. [PMID: 30073389 DOI: 10.1007/s00381-018-3935-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/25/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE Diffusion tensor imaging (DTI) allows studying the micro and macro architecture. One of the major challenges in dysraphism is to know the morphologic organization of the spinal cord. In a preliminary work, spinal lipoma was chosen for analyzing the micro-architecture parameters and fiber morphology of the spinal cord by DTI with tractography. METHODS Twelve patients (0-8 years) related to spinal lipomas treated between May 2017 and March 2018 were included. Tractography reconstruction of the conus medullaris of 12 patients were obtained using the MedINRIA software. The diffusion parameters have been calculated by Osirix DTImap plugin. RESULTS We found a significant difference in the FA (p = 0.024) between two age groups (< 24 months old and > 24 months old). However, no significant differences in the mean values of FA, RD, and MD between the level of the lipoma and the level above were noted. The tractography obtained in each case was coherent with morphologic sequences and reproducible. The conus medullaris was deformed and shifted. Destruction or disorganization of fibers and any passing inside the lipomas was not observed. CONCLUSIONS Tractography of the conus medullaris in a very young pediatric population (0-8 years old) with a spinal lipoma is possible, reproductive, and allows visualization of the spinal cord within the dysraphism. Analysis of the FA shows that the presence of a lipoma seems to have an effect on the myelination of the conus medullaris. It is during the probable myelination phase that the majority of symptoms appear. Is the myelination per se the cause?
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Role of diffusion tensor imaging in carpal tunnel syndrome: A case control comparative study to electrophysiological tests and clinical assessment. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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The Multidisciplinary Approach to the Diagnosis and Management of Nonobstetric Traumatic Brachial Plexus Injuries. AJR Am J Roentgenol 2018; 211:1319-1331. [DOI: 10.2214/ajr.18.19887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Liu C, Li HW, Wang L, Zhu L, Jiang XF, Yang MJ, Li B, Zhang C, Yang HF, Xu XX. Optimal parameters and location for diffusion tensor imaging in the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Radiol 2018; 73:1058.e11-1058.e19. [PMID: 30314809 DOI: 10.1016/j.crad.2018.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 08/28/2018] [Indexed: 12/31/2022]
Abstract
AIM To assess the diagnostic value of the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of diffusion tensor imaging (DTI) at several anatomical locations in patients with carpal tunnel syndrome (CTS) to explore the optimal parameters and measurement location. MATERIALS AND METHODS A search was conducted using the PubMed, EBSCO, Ovid, Web of Science, and Cochrane databases to identify articles relevant to this study published before September 2017. Studies were selected and included according to strict eligibility criteria. Mean differences (MD) and 95% confidence intervals (CIs) were used to compare FA and ADC values between CTS patients and healthy subjects. Potential publication bias was investigated. RESULTS Eleven studies involving 349 CTS wrists and 278 controls were selected for the meta-analysis. A notable MD: was found for lowered FA at the level of the pisiform bone for CTS versus controls (MD: -0.11, 95% confidence interval [CI]: -1.14 to -0.07, z=5.83, p<0.001). A higher ADC was found at the pisiform bone and hamate bone levels for CTS versus controls (P: MD: 0.15, 95% CI: 0.10 to 0.20, z=5.98, p<0.001, H: MD: 0.15; 95% CI: 0.09 to 0.21, z=4.67, p<0.001). CONCLUSIONS The meta-analysis demonstrated a significant FA reduction and ADC increase in CTS patients. This result supports the use of DTI parameters in differentiating CTS patients from health subjects. The anatomical site for FA at the pisiform and ADC at the pisiform and hamate levels were more accessible than other sites for the diagnosis of CTS patients.
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Affiliation(s)
- C Liu
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City 637000, Sichuan Province, China
| | - H W Li
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City 637000, Sichuan Province, China
| | - L Wang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City 637000, Sichuan Province, China
| | - L Zhu
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City 637000, Sichuan Province, China
| | - X F Jiang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City 637000, Sichuan Province, China
| | - M J Yang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City 637000, Sichuan Province, China
| | - B Li
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City 637000, Sichuan Province, China
| | - C Zhang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City 637000, Sichuan Province, China
| | - H F Yang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City 637000, Sichuan Province, China
| | - X X Xu
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City 637000, Sichuan Province, China.
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Keller S, Wang ZJ, Golsari A, Kim AC, Kooijman H, Adam G, Yamamura J. Feasibility of peripheral nerve MR neurography using diffusion tensor imaging adapted to skeletal muscle disease. Acta Radiol 2018; 59:560-568. [PMID: 28795588 DOI: 10.1177/0284185117726100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Diffusion tensor imaging (DTI) of peripheral nerves may provide additional information about nerve involvement in muscular disorders, but is considered difficult due to different optimal scan parameters tailored to magnetic resonance (MR) signal properties of muscle and neural tissues. Purpose To assess the feasibility of sciatic nerve DTI using two different approaches of region of interest (ROI)-localization in DTI scans with b-values 500 s/mm2, in participants with muscular disorders and in controls. Material and Methods DTI of the thigh was conducted on a 3T system in ten patients (6 men, 4 women; mean age =54 ± 15 years) with neuromuscular disorders and ten controls. T1-weighted (T1W) images were co-registered to fractional anisotropy (FA) color-encoded images. The apparent diffusion coefficient (ADC), FA, and fiber track length (FTL) were analyzed by two operators using a freehand ROI and a single-point ROI covering the sciatic nerve. Interclass correlation coefficient (ICC) and Bland-Altman analysis were used for evaluation of inter-operator and inter-technical agreement, respectively. Results Three-dimensional visualization of sciatic nerve fiber was achievable using both techniques. The ICC of DTI metrics showed excellent inter-operator agreement both in patients and controls. Bland-Altman analysis revealed good agreement of both techniques. A maximum FTL was achieved using the single-point ROI technique, but with a lower inter-operator agreement (ICC = 0.99 vs. 0.83). The ADC and maximum FTL were significantly decreased in patients compared to controls. Conclusion Both ROI localization techniques are feasible to analyze the sciatic nerve in the setting of muscular disease. A maximum FTL is reached using the single-point ROI, however, at the cost of lower inter-operator agreement.
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Affiliation(s)
- Sarah Keller
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Zhiyue J Wang
- Childrens Medical Center Dallas, Department of Radiology, University of Texas Southwestern Medical Center, TX, USA
| | - Amir Golsari
- Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne Catherine Kim
- The Permanente Medical Group, Department Stroke and Neurovascular Imaging, San Francisco, CA, USA
| | - Hendrik Kooijman
- Philips Medical Systems, MR Clinical Science SMC, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Cingoz M, Kandemirli SG, Alis DC, Samanci C, Kandemirli GC, Adatepe NU. Evaluation of median nerve by shear wave elastography and diffusion tensor imaging in carpal tunnel syndrome. Eur J Radiol 2018; 101:59-64. [PMID: 29571802 DOI: 10.1016/j.ejrad.2018.02.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/23/2018] [Accepted: 02/06/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE The aim of the current study is to investigate the diagnostic role of shear-wave elastography and diffusion tensor imaging in patients with carpal tunnel syndrome. MATERIAL AND METHODS The study included a total of 77 wrists; 18 normal, 35 wrists with mild, 9 wrists with moderate and 15 wrists with severe carpal tunnel syndrome. Elastography of the median nerve was performed by defining the boundaries of a segment of the nerve at sagittal plane at the level of proximal carpal row. Additionally, the cross-sectional area of the median nerve was evaluated. Fractional anisotropy and apparent diffusion coefficient measurements were carried out by placing region-of-interest at three levels: at pisiform bone (carpal tunnel inlet), mid carpal tunnel, and hook of hamate (carpal tunnel outlet). RESULTS Patients with carpal tunnel syndrome had higher elasticity values of median nerve (53.0 kPa; IQR 40.8-77.0 kPa) compared to control subjects. (36.8 kPa; IQR 31.0-39.9 kPa) Patients with moderate-severe carpal tunnel syndrome had higher elasticity values (82 kPa; IQR 64.0-95.5 kPa) compared to patients with mild carpal tunnel syndrome. (44 kPa; IQR 32.5-59.5 kPa) Patients with carpal tunnel syndrome had lower fractional anisotropy at mid-carpal level (0.382; IQR 0.330-0.495) compared to the control group. (0.494; IQR 0.434-0.537) Patients with moderate-severe carpal tunnel syndrome had lower fractional anisotropy values (0.366; IQR 0.331-0.407) and higher apparent diffusion coefficient values (1.509 mm2/s; IQR 1.374-1.733 mm2/s) compared to patients with mild carpal tunnel syndrome. (0,423; IQR 0.324-0.526 and 1.293 mm2/s; IQR 0.967-1.514 mm2/s) CONCLUSION: Shear-wave elastography and diffusion tensor imaging are helpful imaging modalities in diagnosing carpal tunnel syndrome and assessing its severity.
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Affiliation(s)
- Mehmet Cingoz
- Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Turkey
| | | | - Deniz Can Alis
- Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Turkey
| | - Cesur Samanci
- Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Turkey
| | - Guzin Cakir Kandemirli
- Taksim Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Turkey
| | - Nurten Uzun Adatepe
- Istanbul University, Cerrahpasa Medical Faculty, Department of Neurology, Turkey
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Eguchi Y, Kanamoto H, Oikawa Y, Suzuki M, Yamanaka H, Tamai H, Kobayashi T, Orita S, Yamauchi K, Suzuki M, Inage K, Aoki Y, Watanabe A, Furuya T, Koda M, Takahashi K, Ohtori S. Recent advances in magnetic resonance neuroimaging of lumbar nerve to clinical applications: A review of clinical studies utilizing Diffusion Tensor Imaging and Diffusion-weighted magnetic resonance neurography. Spine Surg Relat Res 2017; 1:61-71. [PMID: 31440614 PMCID: PMC6698557 DOI: 10.22603/ssrr.1.2016-0015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/30/2016] [Indexed: 11/05/2022] Open
Abstract
Much progress has been made in neuroimaging with Magnetic Resonance neurography and Diffusion Tensor Imaging (DTI) owing to higher magnetic fields and improvements in pulse sequence technology. Reports on lumbar nerve DTI have also increased considerably. Many studies have shown that the use of DTI in lumbar nerve lesions, such as lumbar foraminal stenosis and lumbar disc herniation, makes it possible to capture images of interruptions of tractography at stenotic sties, enabling the diagnosis of stenosis. DTI can also reveal significant decreases in fractional anisotropy (FA) with significant increases in apparent diffusion coefficient (ADC) values in compression lesions. FA values have higher accuracy than ADC values. Furthermore, strong correlations exist between FA values and indications of neurological severity, including the Japanese Orthopedic Association (JOA) score, the Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire (RDQ) in patients with lumbar disc herniation-induced radiculopathy. Most lumbar DTI has become 3T; 3T MRI has made it possible to take high-resolution DTI measurements in a short period of time. However, increased motion artifacts in the magnetic susceptibility effect lead to signal irregularities and image distortion. In the future, high-resolution DTI with reduced field-of-view may become useful in clinical applications, since visualization of nerve lesions and quantification of DTI parameters could allow more accurate diagnoses of lumbar nerve dysfunctions. Future translational studies will be necessary to successfully bring MR neuroimaging of lumbar nerve into clinical use.
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Affiliation(s)
- Yawara Eguchi
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Japan
| | - Hirohito Kanamoto
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Yasuhiro Oikawa
- Division of Orthopaedic Surgery, Chiba Children's Hospital, Japan
| | - Munetaka Suzuki
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Japan
| | - Hajime Yamanaka
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Japan
| | - Hiroshi Tamai
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Japan
| | - Tatsuya Kobayashi
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Kazuyo Yamauchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Miyako Suzuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Japan
| | - Takeo Furuya
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Kazuhisa Takahashi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
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Kanamoto H, Eguchi Y, Oikawa Y, Orita S, Inage K, Fujimoto K, Shiga Y, Abe K, Inoue M, Kinoshita H, Matsumoto K, Masuda Y, Furuya T, Koda M, Aoki Y, Watanabe A, Takahashi K, Ohtori S. Visualization of lumbar nerves using reduced field of view diffusion tensor imaging in healthy volunteers and patients with degenerative lumbar disorders. Br J Radiol 2017; 90:20160929. [PMID: 28937274 PMCID: PMC6047648 DOI: 10.1259/bjr.20160929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 08/08/2017] [Accepted: 08/31/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We investigated high resolution diffusion tensor imaging (DTI) of lumbar nerves with reduced field of view (rFOV) using 3 T MRI. METHODS DTI measured with rFOV was compared with conventional FOV (cFOV) 3.0 T MRI in 5 healthy volunteers and 10 patients with degenerative lumbar disorders. The intracanal, foramina and extraforamina of the L5 nerve were established as the regions of interest and fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) values were measured. Image quality for tractography and FA maps and ADC maps, interindividual and intraindividual reliability of FA and ADC, and signal-to-noise (SNR) were studied. RESULTS Both of image qualities with tractography, FA map and ADC map showed that lumbar nerves were more clearly imaged with the rFOV. Intraindividual reliability was higher with rFOV compared with the conventional method for ADC values, while interindividual reliability was higher for both FA values and ADC values with the rFOV method over the conventional method (p < 0.05). Significantly higher SNR was obtained with rFOV compared with cFOV in the spinal canal (p < 0.05). CONCLUSION rFOV enabled clearer imaging of the lumbar nerve, allowing for more accurate measurement of FA and ADC values. Significantly higher SNR was obtained with rFOV compared with cFOV in the spinal canal. To our knowledge, this research showed for the first time the usefulness of rFOV in patients with degenerative lumbar disorders. High resolution DTI using rFOV may become useful in clinical applications because visualization of nerve entrapments and quantification of DTI parameters may allow more accurate diagnoses of lumbar nerve dysfunction. Advances in knowledge: Compared with traditional methods, rFOV allows for clear imaging of the lumbar nerve and enables accurate measurements of the FA and ADC values. High-resolution DTI with rFOV may be used to visualize nerve entrapments and allow for more accurate diagnosis of DTI parameter quantification with opportunities for clinical applications.
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Affiliation(s)
- Hirohito Kanamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Shimoshizu National HospitalShikawatashi, Yotsukaido,Shimoshizu National HospitalShikawatashi, Yotsukaido, Shimoshizu National HospitalShikawatashi, Yotsukaido, Chiba, Japan
| | - Yasuhiro Oikawa
- Division of Orthopaedic Surgery, Chiba Children’s Hospital, Heta-Chou, Midori-ku,Chiba Children’s Hospital, Heta-Chou, Midori-ku, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Kazuki Fujimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Hideyuki Kinoshita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Inohana, Chuo-ku,Chiba University Hospital, Inohana, Chuo-ku, Chiba, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, Inohana, Chuo-ku,Chiba University Hospital, Inohana, Chuo-ku, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical CenterOkayamadai, Togane,Eastern Chiba Medical CenterOkayamadai, Togane, Eastern Chiba Medical CenterOkayamadai, Togane, Chiba, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical CenterOkayamadai, Togane,Eastern Chiba Medical CenterOkayamadai, Togane, Eastern Chiba Medical CenterOkayamadai, Togane, Chiba, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
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Klauser AS, Abd Ellah M, Kremser C, Taljanovic M, Schmidle G, Gabl M, Cartes-Zumelzu F, Steiger R, Gizewski ER. Carpal tunnel syndrome assessment with diffusion tensor imaging: Value of fractional anisotropy and apparent diffusion coefficient. Eur Radiol 2017; 28:1111-1117. [PMID: 28956129 DOI: 10.1007/s00330-017-5046-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/15/2017] [Accepted: 08/21/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To quantitatively assess carpal tunnel syndrome (CTS) with DTI by evaluating two approaches to determine cut-off values. METHODS In forty patients with CTS diagnosis confirmed by nerve conduction studies (NCs) and 14 healthy subjects (mean age 58.54 and 57.8 years), cross-sectional area (CSA), apparent diffusion coefficient (ADC) and fractional anisotropy (FA) at single and multiple levels with intraobserver agreement were evaluated. RESULTS Maximum and mean CSA and FA showed significant differences between healthy subjects and patients (12.85 mm2 vs. 28.18 mm2, p < 0.001, and 0.613 vs. 0.524, p=0.007, respectively) (10.12 mm2 vs. 19.9 mm2, p<0.001 and 0.617 vs. 0.54, p=0.003, respectively), but not maximum and mean ADC (p > 0.05). For cut-off values, mean and maximum CSA showed the same sensitivity and specificity (93.3 %). However, mean FA showed better sensitivity than maximum FA (82.6 % vs. 73.9 %), but lower specificity (66.7 % vs. 80 %), and significant correlation for maximum CSA, 97 % (p < 0.01), with good correlation for maximum ADC and FA, 84.5 % (p < 0.01) and 62 % (p=0.056), respectively. CONCLUSIONS CSA and FA showed significant differences between healthy subjects and patients. Single measurement at maximum CSA is suitable for FA determination. Key Points • DTI showed that FA is stronger than ADC for CTS diagnosis. • Single- and multiple-level approaches were compared to determine FA and ADC. • Single-level evaluation at the thickest MN cross-sectional area is sufficient.
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Affiliation(s)
- A S Klauser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Abd Ellah
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
- Department of Diagnostic Radiology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
| | - C Kremser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Taljanovic
- Department of Medical Imaging, University of Arizona, College of Medicine, Banner- University Medical Center, Tucson, USA
| | - G Schmidle
- Department for Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - M Gabl
- Department for Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - F Cartes-Zumelzu
- Department of Neuroradiology, Neuroimaging core facility, Medical University of Innsbruck, Innsbruck, Austria
| | - R Steiger
- Department of Neuroradiology, Neuroimaging core facility, Medical University of Innsbruck, Innsbruck, Austria
| | - E R Gizewski
- Department of Neuroradiology, Neuroimaging core facility, Medical University of Innsbruck, Innsbruck, Austria
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Zhang J, Zhang F, Xiao F, Xiong Z, Liu D, Hua T, Indima N, Tang G. Quantitative Evaluation of the Compressed L5 and S1 Nerve Roots in Unilateral Lumbar Disc Herniation by Using Diffusion Tensor Imaging. Clin Neuroradiol 2017; 28:529-537. [DOI: 10.1007/s00062-017-0621-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/03/2017] [Indexed: 02/06/2023]
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Chiou SY, Hellyer PJ, Sharp DJ, Newbould RD, Patel MC, Strutton PH. Relationships between the integrity and function of lumbar nerve roots as assessed by diffusion tensor imaging and neurophysiology. Neuroradiology 2017; 59:893-903. [PMID: 28744730 PMCID: PMC5559579 DOI: 10.1007/s00234-017-1869-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/14/2017] [Indexed: 01/02/2023]
Abstract
Purpose Diffusion tensor imaging (DTI) has shown promise in the measurement of peripheral nerve integrity, although the optimal way to apply the technique for the study of lumbar spinal nerves is unclear. The aims of this study are to use an improved DTI acquisition to investigate lumbar nerve root integrity and correlate this with functional measures using neurophysiology. Methods Twenty healthy volunteers underwent 3 T DTI of the L5/S1 area. Regions of interest were applied to L5 and S1 nerve roots, and DTI metrics (fractional anisotropy, mean, axial and radial diffusivity) were derived. Neurophysiological measures were obtained from muscles innervated by L5/S1 nerves; these included the slope of motor-evoked potential input-output curves, F-wave latency, maximal motor response, and central and peripheral motor conduction times. Results DTI metrics were similar between the left and right sides and between vertebral levels. Conversely, significant differences in DTI measures were seen along the course of the nerves. Regression analyses revealed that DTI metrics of the L5 nerve correlated with neurophysiological measures from the muscle innervated by it. Conclusion The current findings suggest that DTI has the potential to be used for assessing lumbar spinal nerve integrity and that parameters derived from DTI provide quantitative information which reflects their function.
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Affiliation(s)
- S Y Chiou
- The Nick Davey Laboratory, Division of Surgery, Human Performance Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - P J Hellyer
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK.,Department of Bioengineering, Imperial College London, London, UK
| | - D J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK
| | | | - M C Patel
- Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - P H Strutton
- The Nick Davey Laboratory, Division of Surgery, Human Performance Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
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Manoliu A, Ho M, Piccirelli M, Nanz D, Filli L, Dappa E, Liu W, Ettlin DA, Boss A, Andreisek G, Kuhn FP. Simultaneous multislice readout-segmented echo planar imaging for accelerated diffusion tensor imaging of the mandibular nerve: A feasibility study. J Magn Reson Imaging 2017; 46:663-677. [DOI: 10.1002/jmri.25603] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 12/05/2016] [Indexed: 01/10/2023] Open
Affiliation(s)
- Andrei Manoliu
- Institute for Diagnostic and Interventional Radiology, Department of Radiology; University Hospital Zurich, University of Zurich; Zurich Switzerland
- Psychiatric University Hospital, Department of Psychiatry, Psychotherapy and Psychosomatics; University of Zurich; Zurich Switzerland
| | - Michael Ho
- Institute for Diagnostic and Interventional Radiology, Department of Radiology; University Hospital Zurich, University of Zurich; Zurich Switzerland
| | - Marco Piccirelli
- Department of Neuroradiology, University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - Daniel Nanz
- Institute for Diagnostic and Interventional Radiology, Department of Radiology; University Hospital Zurich, University of Zurich; Zurich Switzerland
| | - Lukas Filli
- Institute for Diagnostic and Interventional Radiology, Department of Radiology; University Hospital Zurich, University of Zurich; Zurich Switzerland
| | - Evelyn Dappa
- Institute for Diagnostic and Interventional Radiology, Department of Radiology; University Hospital Zurich, University of Zurich; Zurich Switzerland
| | - Wei Liu
- Siemens Shenzhen Magnetic Resonance Ltd; Shenzhen China
| | | | - Andreas Boss
- Institute for Diagnostic and Interventional Radiology, Department of Radiology; University Hospital Zurich, University of Zurich; Zurich Switzerland
| | - Gustav Andreisek
- Institute for Diagnostic and Interventional Radiology, Department of Radiology; University Hospital Zurich, University of Zurich; Zurich Switzerland
| | - Felix P. Kuhn
- Institute for Diagnostic and Interventional Radiology, Department of Radiology; University Hospital Zurich, University of Zurich; Zurich Switzerland
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Byval'tsev VA, Kalinin AA, Stepanov IA, Pestryakov YY, Shepelev VV. [Analysis of the results of total cervical disc arthroplasty using a M6-C prosthesis: a multicenter study]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2017; 81:46-55. [PMID: 29076467 DOI: 10.17116/neiro201781546-55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Cervical spondylosis and intervertebral disc (IVD) degeneration are the most common cause for compression of the spinal cord and/or its roots. Total IVD arthroplasty, as a modern alternative to surgical treatment of IVD degeneration, is gaining popularity in many neurosurgical clinics around the world. Aim - the study aim was to conduct a multicenter analysis of cervical spine arthroplasty with an IVD prosthesis M6-C ('Spinal Kinetics', USA). MATERIAL AND METHODS The study included 112 patients (77 males and 35 females). All patients underwent single-level discectomy with implantation of the artificial IVD prosthesis M6-C. The follow-up period was up to 36 months. Dynamic assessment of the prosthesis was based on clinical parameters (pain intensity in the cervical spine and upper extremities (visual analog scale - VAS); quality of life (Neck Disability Index - NDI)); and subjective satisfaction with the results of surgical treatment (Macnab scale) and instrumental data (range of motion in the operated spinal motion segment, degree of heterotopic ossification (McAfee-Suchomel classification), and time course of degenerative changes in the adjacent segments).
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Affiliation(s)
- V A Byval'tsev
- Irkutsk State Medical University, Irkutsk, Russia; Railway Clinical Hospital, Irkutsk-Passenger Station, Irkutsk, Russia; Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia; Irkutsk State Medical Academy of Postgraduate Education', Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia; Railway Clinical Hospital, Irkutsk-Passenger Station, Irkutsk, Russia; Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
| | - I A Stepanov
- Irkutsk State Medical University, Irkutsk, Russia
| | | | - V V Shepelev
- 1477th Naval Clinical Hospital of the Ministry of Defense of the Russian Federation, Vladivostok, Russia
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Ikeda M, Okada M, Toyama M, Uemura T, Takamatsu K, Nakamura H. Comparison of Median Nerve Cross-sectional Area on 3-T MRI in Patients With Carpal Tunnel Syndrome. Orthopedics 2017; 40:e77-e81. [PMID: 27648575 DOI: 10.3928/01477447-20160915-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/28/2016] [Indexed: 02/03/2023]
Abstract
This study correlated morphologic abnormalities of idiopathic carpal tunnel syndrome (CTS) with the severity of CTS using 3-T magnetic resonance imaging (MRI). The relationship of the severity of CTS and the cross-sectional area of the median nerve (CSA) was assessed at several levels. Seventy wrists of 35 patients (27 women and 8 men) with unilateral idiopathic CTS underwent nerve conduction study and 3-T MRI of the wrist. The CSA at 4 levels (distal radioulnar joint, body of scaphoid, tubercule of scaphoid, and hook of hamate) and the thickness of the transverse carpal ligament at 3 levels in both affected and unaffected hands were measured using 3-T MRI and correlated with the severity of CTS assessed with distal motor latency. The CSA in the affected hand at the scaphoid body level was significantly higher than in the unaffected hand. The CSA at the scaphoid body level was positively correlated with distal motor latency in the affected hand. The CSA in the affected hand at the scaphoid tubercule level was significantly lower than in the unaffected hand. The CSA had a negative correlation with distal motor latency at the scaphoid tubercule level. The CSA at the distal radioulnar joint and the hamate hook was not significantly different between the affected hand and the unaffected hand. The CSA at the distal radioulnar joint level and hook level were not correlated significantly with distal motor latency in the affected hand. The mean CSA of the affected hand at the scaphoid body level was highest in 4 levels. [Orthopedics. 2017; 40(1):e77-e81.].
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Razek AAKA, Shabana AAE, El Saied TO, Alrefey N. Diffusion tensor imaging of mild-moderate carpal tunnel syndrome: correlation with nerve conduction study and clinical tests. Clin Rheumatol 2016; 36:2319-2324. [DOI: 10.1007/s10067-016-3463-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/13/2016] [Accepted: 10/24/2016] [Indexed: 02/07/2023]
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Bao H, Wu C, Wang S, Wang G, Zhang X, Zhang X, Wu L. Diffusion-weighted magnetic resonance neurography for the diagnosis of carpal tunnel syndrome: a pilot study. Clin Radiol 2016; 72:165-169. [PMID: 27771047 DOI: 10.1016/j.crad.2016.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/27/2022]
Abstract
AIM To investigate the applicability of diffusion-weighted magnetic resonance neurography (DW-MRN) in the diagnosis of carpal tunnel syndrome (CTS). MATERIALS AND METHODS In total, 47 patients with CTS (69 wrists) and 19 normal participants (38 wrists) was included in this study. Cross-sectional area (CSA) and apparent diffusion coefficient (ADC) values of the median nerves in the carpal tunnel were determined using DW-MRN. Receiver operating characteristic (ROC) analysis was performed. RESULTS No significant differences in age or body mass index (BMI) were observed between the control and CTS groups. DW-MRN imaging showed obvious hyperintensity in the lesions in CTS wrists, while other nerve regions were related to slight hyperintensity. Interobserver variability analysis indicated excellent agreement regarding both the CSA and ADC measurements for the control and CTS groups. Both the mean CSA and ADC values of the median nerves in carpal tunnel in the CTS group were significantly higher than the control group. According to the ROC analysis, the CSA cut-off value was 11.7 mm2, and sensitivity and specificity were 66.7% and 89.5%, respectively. Conversely, the median nerve ADC cut-off value was 1.047×10-3 mm2/s. The sensitivity and specificity were 91.3% and 76.3.9%, respectively. CONCLUSION DW-MRN represents a highly reproducible diagnostic technique for CTS. The ADC value of median nerves in the carpal tunnel is significantly higher in CTS patients, which provides a potential powerful tool for the disease diagnosis.
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Affiliation(s)
- H Bao
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, 324 Jingwu Rd, Jinan 250021, Shandong, PR China
| | - C Wu
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, 324 Jingwu Rd, Jinan 250021, Shandong, PR China
| | - S Wang
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, 324 Jingwu Rd, Jinan 250021, Shandong, PR China
| | - G Wang
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, 324 Jingwu Rd, Jinan 250021, Shandong, PR China.
| | - X Zhang
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, 324 Jingwu Rd, Jinan 250021, Shandong, PR China
| | - X Zhang
- Department of Radiology, Shandong Chest Hospital, Jinan 250021, Shandong, PR China
| | - L Wu
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, 324 Jingwu Rd, Jinan 250021, Shandong, PR China
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Makino H, Seki S, Kawaguchi Y, Nakano M, Kimura T. A novel nerve root anomaly with unpredictable morphology on diffusion tensor imaging in the lumbar spine: A case report. J Orthop Sci 2016; 21:698-701. [PMID: 26740450 DOI: 10.1016/j.jos.2015.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/22/2015] [Accepted: 03/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194, Japan.
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194, Japan
| | - Masato Nakano
- Department of Orthopaedic Surgery, Takaoka City Hospital, 4-1 Takaramachi, Takaoka, Toyama 933-8550, Japan
| | - Tomoatsu Kimura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194, Japan
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Attyé A, Troprès I, Rouchy RC, Righini C, Espinoza S, Kastler A, Krainik A. Diffusion MRI: literature review in salivary gland tumors. Oral Dis 2016; 23:572-575. [DOI: 10.1111/odi.12543] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 11/30/2022]
Affiliation(s)
- A Attyé
- Department of Neuroradiology and MRI; Grenoble Alpes University Hospital - SFR RMN Neurosciences; Grenoble France
- University Grenoble Alpes; IRMaGe; Grenoble France
| | - I Troprès
- Inserm US 17; CNRS; IRMaGe; Grenoble France
| | - R-C Rouchy
- Department of Neuroradiology and MRI; Grenoble Alpes University Hospital - SFR RMN Neurosciences; Grenoble France
| | - C Righini
- Department of Otology; Grenoble Alpes University Hospital; Grenoble France
| | - S Espinoza
- Georges Pompidou European Hospital; Paris France
| | - A Kastler
- Department of Neuroradiology and MRI; Grenoble Alpes University Hospital - SFR RMN Neurosciences; Grenoble France
- University Grenoble Alpes; IRMaGe; Grenoble France
| | - A Krainik
- Department of Neuroradiology and MRI; Grenoble Alpes University Hospital - SFR RMN Neurosciences; Grenoble France
- University Grenoble Alpes; IRMaGe; Grenoble France
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Chen HB, Zhong ZW, Li CS, Bai B. Enough positive rate of paraspinal mapping and diffusion tensor imaging with levels which should be decompressed in lumbar spinal stenosis. J Orthop Sci 2016; 21:431-438. [PMID: 27188929 DOI: 10.1016/j.jos.2016.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 04/12/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In lumbar spinal stenosis, correlating symptoms and physical examination findings with decompression levels based on common imaging is not reliable. Paraspinal mapping (PM) and diffusion tensor imaging (DTI) may be possible to prevent the false positive occurrences with MRI and show clear benefits to reduce the decompression levels of lumbar spinal stenosis than conventional magnetic resonance imaging (MRI) + neurogenic examination (NE). However, they must have enough positive rate with levels which should be decompressed at first. The study aimed to confirm that the positive of DTI and PM is enough in levels which should be decompressed in lumbar spinal stenosis. MATERIALS AND METHODS The study analyzed the positive of DTI and PM as well as compared the preoperation scores to the postoperation scores, which were assessed preoperatively and at 2 weeks, 3 months 6 months, and 12 months postoperatively. RESULTS 96 patients underwent the single level decompression surgery. The positive rate among PM, DTI, and (PM or DTI) was 76%, 98%, 100%, respectively. All post-operative Oswestry Disability Index (ODI), visual analog scale for back pain (VAS-BP) and visual analog scale for leg pain (VAS-LP) scores at 2 weeks postoperatively were measured improvement than the preoperative ODI, VAS-BP and VAS-LP scores with statistically significance (p-value = 0.000, p-value = 0.000, p-value = 0.000, respectively). CONCLUSIONS In degenetive lumbar spinal stenosis, the positive rate of (DTI or PM) is enough in levels which should be decompressed, thence using the PM and DTI to determine decompression levels will not miss the level which should be operated.
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Affiliation(s)
- Hua-Biao Chen
- Departments of Orthopaedic, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou 510120, People's Republic of China.
| | - Zhi-Wei Zhong
- Departments of Radiology, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou 510120, People's Republic of China.
| | - Chun-Sheng Li
- Departments of Radiology, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou 510120, People's Republic of China.
| | - Bo Bai
- Departments of Orthopaedic, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou 510120, People's Republic of China; Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou 510120, People's Republic of China.
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Chen HB, Wan Q, Xu QF, Chen Y, Bai B. Reducing surgical levels by paraspinal mapping and diffusion tensor imaging techniques in lumbar spinal stenosis. J Orthop Surg Res 2016; 11:47. [PMID: 27113931 PMCID: PMC4845428 DOI: 10.1186/s13018-016-0382-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Correlating symptoms and physical examination findings with surgical levels based on common imaging results is not reliable. In patients who have no concordance between radiological and clinical symptoms, the surgical levels determined by conventional magnetic resonance imaging (MRI) and neurogenic examination (NE) may lead to a more extensive surgery and significant complications. We aimed to confirm that whether the use of diffusion tensor imaging (DTI) and paraspinal mapping (PM) techniques can further prevent the occurrence of false positives with conventional MRI, distinguish which are clinically relevant from levels of cauda equina and/or nerve root lesions based on MRI, and determine and reduce the decompression levels of lumbar spinal stenosis than MRI + NE, while ensuring or improving surgical outcomes. METHODS We compared the data between patients who underwent MRI + (PM or DTI) and patients who underwent conventional MRI + NE to determine levels of decompression for the treatment of lumbar spinal stenosis. Outcome measures were assessed at 2 weeks, 3 months, 6 months, and 12 months postoperatively. RESULTS One hundred fourteen patients (59 in the control group, 54 in the experimental group) underwent decompression. The levels of decompression determined by MRI + (PM or DTI) in the experimental group were significantly less than that determined by MRI + NE in the control group (p = 0.000). The surgical time, blood loss, and surgical transfusion were significantly less in the experimental group (p = 0.001, p = 0.011, p = 0.001, respectively). There were no differences in improvement of the visual analog scale back and leg pain (VAS-BP, VAS-LP) scores and Oswestry Disability Index (ODI) scores at 2 weeks, 3 months, 6 months, and 12 months after operation between the experimental and control groups. CONCLUSIONS MRI + (PM or DTI) showed clear benefits in determining decompression levels of lumbar spinal stenosis than MRI + NE. In patients with lumbar spinal stenosis, the use of PM and DTI techniques reduces decompression levels and increases safety and benefits of surgery.
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Affiliation(s)
- Hua-Biao Chen
- Department of Orthopaedic, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China
| | - Qi Wan
- Department of Radiology, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China
| | - Qi-Feng Xu
- Department of Electromyography, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China
| | - Yi Chen
- Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China
| | - Bo Bai
- Department of Orthopaedic, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China. .,Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China.
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Discrimination between Lumbar Intraspinal Stenosis and Foraminal Stenosis using Diffusion Tensor Imaging Parameters: Preliminary Results. Asian Spine J 2016; 10:327-34. [PMID: 27114775 PMCID: PMC4843071 DOI: 10.4184/asj.2016.10.2.327] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/24/2015] [Accepted: 09/24/2015] [Indexed: 11/21/2022] Open
Abstract
Study Design Retrospective observational study. Purpose To examine fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) values of damaged nerves to discriminate between lumbar intraspinal stenosis (IS) and foraminal stenosis (FS) using diffusion tensor imaging (DTI) Overview of Literature It is important in the selection of surgical procedure to discriminate between lumbar IS and FS, but such discrimination is difficult. Methods There were 9 cases of IS, 7 cases of FS, and 5 healthy controls. The regions of interest were established in the lumbar intraspinal zone (Iz), nerve root (N), and extraforaminal zone (Ez). The FA and ADC values were measured on the affected and unaffected sides of the nerves. The FA ratio and the ADC ratio were calculated as the affected side/unaffected side ×100 (%). Results In the Ez, the FA value was significantly lower in FS than in IS (p<0.01). FA ratio was significantly lower in FS than in IS for the Ez (p<0.01). In the Iz, the ADC value was significantly higher in IS than FS (p<0.01). ADC ratio was significantly higher in FS than in IS for the N and Ez (p<0.05). For the Ez, receiver operating characteristic analysis of parameters revealed that the FA values showed a higher accuracy for the diagnosis of FS than the ADC values, and the FA value cut-off value was 0.42 (sensitivity: 85.7%, false positive: 11.1%) and the FA ratio cut-off value was 83.9% (sensitivity: 85.7%, false positive: 22.2%). Conclusions The low FA value in the extraforaminal zone suggests the presence of foraminal stenosis. When the FA value and FA ratio cut-off value were established as 0.42 and 83.9%, respectively, the accuracy was high for the diagnosis of foraminal stenosis. It may be possible to use DTI parameters to help in the discrimination between IS and FS.
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Wang H, Ma J, Zhao L, Wang Y, Jia X. Utility of MRI Diffusion Tensor Imaging in Carpal Tunnel Syndrome: A Meta-Analysis. Med Sci Monit 2016; 22:736-42. [PMID: 26942911 PMCID: PMC4784544 DOI: 10.12659/msm.895758] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND After successful utilization of diffusion tensor imaging (DTI) in detecting brain pathologies, it is now being examined for use in the detection of peripheral neuropathies. The aim of this meta-analysis was to evaluate the diagnostic potentials of DTI in carpal tunnel syndrome (CTS). MATERIAL AND METHODS The literature search was performed in multiple electronic databases using a keyword search and final selection of the studies was based on predetermined inclusion and exclusion criteria. We performed a meta-analyses of mean differences in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) between CTS patient and healthy subjects. Publication bias detection was done with Begg's test and sensitivity analyses were performed to explore the source/s of higher heterogeneity and the authenticity of results. RESULTS FA was significantly lower in CTS patients in comparison with healthy subjects (mean and the difference [95% confidence interval] was -0.06 [-0.10, -0.02] (p=0.003). The ADC was significantly higher in CTS patients (mean difference [95% CI] was 0.10 [0.02, 0.18], p=0.02). Overall sensitivity of FA-based diagnosis was 82.82%, with 77.83% specificity. CONCLUSIONS DTI can be a valuable tool in diagnosing CTS.
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Affiliation(s)
- Hong Wang
- Department of Radiology, Second Affiliated Hospital, Xin-jiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Jingxu Ma
- Department of Radiology, Second Affiliated Hospital, Xin-jiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Liping Zhao
- Department of Radiology, Second Affiliated Hospital, Xin-jiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Yunling Wang
- Department of Radiology, Second Affiliated Hospital, Xin-jiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Xiaowen Jia
- Department of Radiology, Second Affiliated Hospital, Xin-jiang Medical University, Urumqi, Xinjiang, China (mainland)
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Kanamoto H, Eguchi Y, Suzuki M, Oikawa Y, Yamanaka H, Tamai H, Kobayashi T, Orita S, Yamauchi K, Suzuki M, Aoki Y, Watanabe A, Takahashi K, Ohtori S. The diagnosis of double-crush lesion in the L5 lumbar nerve using diffusion tensor imaging. Spine J 2016; 16:315-21. [PMID: 26592484 DOI: 10.1016/j.spinee.2015.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/07/2015] [Accepted: 11/04/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A double-crush lesion is a condition in which the lumbar nerve is compressed both medially and laterally in the spinal canal, where diagnosis can be very difficult, and is a factor leading to poor surgical success rates. PURPOSE Diffusion tensor imaging (DTI) was used to determine DTI parameter fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) in both intraspinal column lesions alone and in double-crush lesions. STUDY DESIGN This study used a prospective study. PATIENT SAMPLE Of the 56 cases (mean age: 72.2 years) that underwent laminectomy for lumbar spinal stenosis at our clinic between April 2013 to March, 2015, 10 cases with L5 radiculopathy caused by L4-L5 stenosis (Intraspinal stenosis group (Group I); mean age: 74.7 years), and 5 cases with persistent symptoms caused by L5 foraminal stenosis despite L4-L5 decompression surgery (Double-crush group (Group D); mean age: 77.6 years) were targeted. One patient in Group D was diagnosed through microendoscopic intrapedicular partial pediculotomy and the remaining four cases by nerve root infiltration. Five healthy cases (mean age: 54 years) were studied as controls. OUTCOME MEASURES Intraspinal zone (Iz), nerve root (N), and extraforaminal zone (Ez) were established as the regions of interest, and the L5 nerve FA and ADC values were determined on the affected side. METHODS Diffusion tensor imaging was performed prospectively by 1.5T magnetic resonance imaging before surgery, and DTI parameters of L5 nerve were evaluated in all patients and healthy volunteers. Student t test was used for group comparisons, and a p<.05 was considered statistically significant. RESULTS Fractional anisotropy values (Iz, N, Ez) were 0.415, 0.448, and 0.517, respectively, increasing as sites became more distal. Group I values were 0.335, 0.393, and 0.484, and Group D values were 0.296, 0.367, and 0.360. Compared with the healthy volunteers, Group D had significantly lower Iz (p<.05) and Ez (p<.001) values, while Group I had significantly lower Iz (p<.05) values. In Group D, Ez FA values were significantly lower (p<.001) than in Group I. Apparent diffusion coefficient values (Iz, N, Ez) in the healthy control group were 1.270 mm2/s, 1.151 mm2/s, and 0.937 mm2/s with values decreasing as sites grew distal. In Group I, the ADC values were 1.406 mm2/s, 1.184 mm2/s, and 1.001 mm2/s, while in Group D they were 1.551 mm2/s, 1.412 mm2/s, and 1.329 mm2/s. Compared with the healthy volunteers, Iz (p<.05) and Ez (p<.05) values were significantly higher in Group D. The N (p<.01) and Ez (p<.001) ADC values were significantly higher in Group D than in Group I. CONCLUSIONS Depending on where the nerve was compressed, changes in DTI parameters revealed nerve damage (low FA values and increased ADC) in the intraspinal canal in the Intraspinal Group, and over a widespread area in the Double-crush Group spanning the medial to lateral spinal canal. Our research suggests that in cases where double crush is suspected before surgery, failed back surgery syndrome may be prevented by evaluating DTI images.
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Affiliation(s)
- Hirohito Kanamoto
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Yotsukaido, Chiba 284-0003, Japan.
| | - Munetaka Suzuki
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Yasuhiro Oikawa
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba 299-0111, Japan
| | - Hajime Yamanaka
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Hiroshi Tamai
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Tatsuya Kobayashi
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Chiba, Japan
| | - Kazuyo Yamauchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Chiba, Japan
| | - Miyako Suzuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba 283-686, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba 283-686, Japan
| | - Kazuhisa Takahashi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Chiba, Japan
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