1
|
Bergmeister KD, Harhaus L. The Promise of Personalized Peripheral Nerve Surgery. J Pers Med 2024; 14:608. [PMID: 38929829 PMCID: PMC11205052 DOI: 10.3390/jpm14060608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
In peripheral nerve surgery, neuropathology and neural anatomy intersect with the complexities of injury and dysfunction [...].
Collapse
Affiliation(s)
- Konstantin Davide Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Aesthetic and Reconstructive Surgery, Karl Landsteiner University of Health Sciences, University Hospital St. Poelten, 3100 Krems, Austria
| | - Leila Harhaus
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Heidelberg, Germany;
- Department of Hand Surgery, Peripheral Nerve Surgery and Rehabilitation, BG Trauma Center, Ludwigshafen, Germany
| |
Collapse
|
2
|
Jende JME, Heutehaus L, Preisner F, Verez Sola CM, Mooshage CM, Heiland S, Rupp R, Bendszus M, Weidner N, Kurz FT, Franz S. Magnetic resonance neurography in spinal cord injury: Imaging findings and clinical significance. Eur J Neurol 2024; 31:e16198. [PMID: 38235932 DOI: 10.1111/ene.16198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/10/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND AND PURPOSE It is unknown whether changes to the peripheral nervous system following spinal cord injury (SCI) are relevant for functional recovery or the development of neuropathic pain below the level of injury. Magnetic resonance neurography (MRN) at 3 T allows detection and localization of structural and functional nerve damage. This study aimed to combine MRN and clinical assessments in individuals with chronic SCI and nondisabled controls. METHODS Twenty participants with chronic SCI and 20 controls matched for gender, age, and body mass index underwent MRN of the L5 dorsal root ganglia (DRG) and the sciatic nerve. DRG volume, sciatic nerve mean cross-sectional area (CSA), fascicular lesion load, and fractional anisotropy (FA), a marker for functional nerve integrity, were calculated. Results were correlated with clinical assessments and nerve conduction studies. RESULTS Sciatic nerve CSA and lesion load were higher (21.29 ± 5.82 mm2 vs. 14.08 ± 4.62 mm2 , p < 0.001; and 8.70 ± 7.47% vs. 3.60 ± 2.45%, p < 0.001) in individuals with SCI compared to controls, whereas FA was lower (0.55 ± 0.11 vs. 0.63 ± 0.08, p = 0.022). DRG volumes were larger in individuals with SCI who suffered from neuropathic pain compared to those without neuropathic pain (223.7 ± 53.08 mm3 vs. 159.7 ± 55.66 mm3 , p = 0.043). Sciatic MRN parameters correlated with electrophysiological results but did not correlate with the extent of myelopathy or clinical severity of SCI. CONCLUSIONS Individuals with chronic SCI are subject to a decline of structural peripheral nerve integrity that may occur independently from the clinical severity of SCI. Larger volumes of DRG in SCI with neuropathic pain support existing evidence from animal studies on SCI-related neuropathic pain.
Collapse
Affiliation(s)
- Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Laura Heutehaus
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Preisner
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Christoph M Mooshage
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Research Center, Heidelberg, Germany
| | - Steffen Franz
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
- Department for Spinal Cord Injury, Allgemeine Unfallversicherungsanstalt - Austrain Workers' Compensation Board, Rehabilitation Center Weisser Hof, Klosterneuburg, Austria
| |
Collapse
|
3
|
Telleman JA, Sneag DB, Visser LH. The role of imaging in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:19-42. [PMID: 38697740 DOI: 10.1016/b978-0-323-90108-6.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Electrodiagnostic testing (EDX) has been the diagnostic tool of choice in peripheral nerve disease for many years, but in recent years, peripheral nerve imaging has been used ever more frequently in daily clinical practice. Nerve ultrasound and magnetic resonance (MR) neurography are able to visualize nerve structures reliably. These techniques can aid in localizing nerve pathology and can reveal significant anatomical abnormalities underlying nerve pathology that may have been otherwise undetected by EDX. As such, nerve ultrasound and MR neurography can significantly improve diagnostic accuracy and can have a significant effect on treatment strategy. In this chapter, the basic principles and recent developments of these techniques will be discussed, as well as their potential application in several types of peripheral nerve disease, such as carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), radial neuropathy, brachial and lumbosacral plexopathy, neuralgic amyotrophy (NA), fibular, tibial, sciatic, femoral neuropathy, meralgia paresthetica, peripheral nerve trauma, tumors, and inflammatory neuropathies.
Collapse
Affiliation(s)
- Johan A Telleman
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Leo H Visser
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| |
Collapse
|
4
|
Raman spectroscopy and sciatic functional index (SFI) after low-level laser therapy (LLLT) in a rat sciatic nerve crush injury model. Lasers Med Sci 2022; 37:2957-2971. [PMID: 35503388 DOI: 10.1007/s10103-022-03565-5] [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: 02/24/2022] [Accepted: 04/23/2022] [Indexed: 10/18/2022]
Abstract
Axonotmesis causes sensorimotor and neurofunctional deficits, and its regeneration can occur slowly or not occur if not treated appropriately. Low-level laser therapy (LLLT) promotes nerve regeneration with the proliferation of myelinating Schwann cells to recover the myelin sheath and the production of glycoproteins for endoneurium reconstruction. This study aimed to evaluate the effects of LLLT on sciatic nerve regeneration after compression injury by means of the sciatic functional index (SFI) and Raman spectroscopy (RS). For this, 64 Wistar rats were divided into two groups according to the length of treatment: 14 days (n = 32) and 21 days (n = 32). These two groups were subdivided into four sub-groups of eight animals each (control 1; control 2; laser 660 nm; laser 808 nm). All animals had surgical exposure to the sciatic nerve, and only control 1 did not suffer nerve damage. To cause the lesion in the sciatic nerve, compression was applied with a Kelly clamp for 6 s. The evaluation of sensory deficit was performed by the painful exteroceptive sensitivity (PES) and neuromotor tests by the SFI. Laser 660 nm and laser 808 nm sub-groups were irradiated daily (100 mW, 40 s, energy density of 133 J/cm2). The sciatic nerve segment was removed for RS analysis. The animals showed accentuated sensory and neurofunctional deficit after injury and their rehabilitation occurred more effectively in the sub-groups treated with 660 nm laser. Control 2 sub-group did not obtain functional recovery of gait. The RS identified sphingolipids (718, 1065, and 1440 cm-1) and collagen (700, 852, 1004, 1270, and 1660 cm-1) as biomolecular characteristics of sciatic nerves. Principal component analysis revealed important differences among sub-groups and a directly proportional correlation with SFI, mainly in the sub-group laser 660 nm treated for 21 days. In the axonotmesis-type lesion model presented herein, the 660 nm laser was more efficient in neurofunctional recovery, and the Raman spectra of lipid and protein properties were attributed to the basic biochemical composition of the sciatic nerve.
Collapse
|
5
|
Aggarwal A, Chhabra A. Magnetic resonance neurography: is it so complicated that it needs a touch of genius? Eur Radiol 2022; 32:3912-3914. [PMID: 35103831 DOI: 10.1007/s00330-021-08525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 11/04/2022]
Abstract
KEY POINTS • Neuropathy imaging is not that complicated or illusive that it needs a touch of genius.• By gaining MR imaging expertise of peripheral nerve lesions and using knowledge of common clinical patterns and diseases, general radiology practitioners can prudently participate in the multidisciplinary care for appropriate and timely management of peripheral neuropathy patients.
Collapse
Affiliation(s)
| | - Avneesh Chhabra
- Radiology & Orthopaedic Surgery, UTSW, TX, 75390-9178, Dallas, USA. .,Musculoskeletal Radiology UT Southwestern Medical Centre, 5323 Harry Hines Blvd, TX, Dallas, USA. .,Johns Hopkins University, Baltimore, MD, USA. .,Walton Centre for Neuroscience, Liverpool, UK.
| |
Collapse
|
6
|
Lichtenstein T, Sprenger A, Weiss K, Große Hokamp N, Maintz D, Schlamann M, Fink GR, Lehmann HC, Henning TD. MRI DTI and PDFF as Biomarkers for Lower Motor Neuron Degeneration in ALS. Front Neurosci 2021; 15:682126. [PMID: 34512239 PMCID: PMC8428530 DOI: 10.3389/fnins.2021.682126] [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] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the utility of nerve magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), and muscle MRI multi-echo Dixon for assessing lower motor neuron (LMN) degeneration in amyotrophic lateral sclerosis (ALS). Methods In this prospective observational cohort study, 14 patients with ALS and 13 healthy controls underwent a multiparametric MRI protocol, including DTI of the sciatic nerve and assessment of muscle proton density fat fraction of the biceps femoris and the quadriceps femoris muscles by a multi-echo Dixon sequence. Results In ALS patients, mean fractional anisotropy values of the sciatic nerve were significantly lower than those of healthy controls. The quadriceps femoris, but not the biceps femoris muscle, showed significantly higher intramuscular fat fractions in ALS. Interpretation Our study provides evidence that multiparametric MRI protocols might help estimate structural nerve damage and neurogenic muscle changes in ALS.
Collapse
Affiliation(s)
- Thorsten Lichtenstein
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alina Sprenger
- Department of Neurology, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Kilian Weiss
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Philips Healthcare, 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, University Hospital of Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Helmar C Lehmann
- Department of Neurology, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Tobias D Henning
- Department of Neuroradiology, Center Hospital Luxembourg, Luxembourg City, Luxembourg
| |
Collapse
|
7
|
Chalian M, Hoang D, Rozen S, Chhabra A. Role of magnetic resonance neurography in intercostal neuralgia; diagnostic utility and efficacy. Br J Radiol 2021; 94:20200603. [PMID: 33960822 DOI: 10.1259/bjr.20200603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the utility and efficacy of MR neurography (MRN) in the diagnostic work-up for intercostal neuralgia and to assess the treatment course and outcomes in MRN-imaged clinically suspected intercostal neuropathy cases of chronic chest and abdominal wall pain syndromes. METHODS Following a retrospective cross-sectional study, a consecutive series of patients who underwent MRN of torso for suspected intercostal neuralgia were included. Patient demographics, pain location/level/duration, previous work-up for the same indication, MRN imaging results, and MRN cost per patient were recorded. An inter-reader reliability assessment was performed on the MRN findings using Cohen's weighted κ analysis. Post-MRN treatment choice, as well as success rates of MRN directed perineural injections and surgical management were also evaluated. RESULTS A total of 28 patients (mean ± SD age, 48.3 ± 18.0 years, female/male = 3.0) were included. Pain and/or numbness in the right upper quadrant were the most common complaints. The mean maximum pain level experienced was 7.4 ± 2.5 on a 1 (lowest pain level) - 10 (highest pain level) visual analog scale. The duration of pain before MRN work-up was 36.9 ± 37.9 months. The patients had seen an average of 5 ± 2.8 physicians for such syndromes. 20 (71%) patients had one or multiple other imaging studies for prior work-up. MRN identified positive intercostal nerve abnormality in 19 cases with clinical symptoms of intercostal neuralgia. From the inter-reader reliability assessment, a Cohen's weighted κ value of 0.78 was obtained. The costs of work-up was about one-third with MRN for diagnostic purposes with less financial and psychological harm. Among the MRN-positive cases, 9/19 patients received perineural injections, of which 6 reported improvement after their first round, lasting an average of 41.1 ± 83 days. Among the nine MRN-negative cases, two received perineural injections, of which none reported improvement. Surgical management was mostly successful with a positive outcome in six out of seven operated cases (85.7%). CONCLUSION MRN is useful in diagnostic algorithm of intercostal neuralgia and MRN-positive cases demonstrate favorable treatment response to perineural injections and subsequent surgical management. ADVANCES IN KNOWLEDGE The use of MRN in intercostal neuralgia is an application that has not been previously explored in the literature. This study demonstrates that MRN offers superior visualization of pathology in intercostal neuralgia and confirms that treatment directed at MRN identified neuropathy results in good outcomes while maintaining cost efficiency.
Collapse
Affiliation(s)
- Majid Chalian
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, Seattle, WA, USA
| | - Diana Hoang
- Department of Radiology, Musculoskeletal Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shai Rozen
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Department of Radiology, Musculoskeletal Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Orthopedics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
8
|
[Peripheral nerve reconstruction - diagnostics as a basis for decision-making: report of the Consensus Workshop at the 35th Meeting of the DAM]. HANDCHIR MIKROCHIR P 2021; 53:168-174. [PMID: 33860493 DOI: 10.1055/a-1307-3963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In the early stage of nerve lesions, the clinical differentiation between neurapraxia, axonotmesis and neurotmesis often presents a big challenge. Especially in the early stage, however, it is crucial to correctly classify the type of damage because this is what essentially determines the therapeutic concept, in particular the surgical approach and, therefore, the prognosis. A precise diagnosis not only requires detailed clinical assessment and medical history taking, but also the use of additional electrophysiological (functional) and/or imaging examinations. Electrophysiological diagnostic tests may provide information ion localization, severity, course, type of damage and incipient or past reinnervation. Preoperative functional diagnostic measures should include neurography, needle electromyography (EMG) and, if needed, evoked potentials (EP), while imaging procedures should include neural sonography and magnetic resonance imaging (MRI). As a complimentary procedure, EMG may also be performed during surgery.
Collapse
|
9
|
Ku V, Cox C, Mikeska A, MacKay B. Magnetic Resonance Neurography for Evaluation of Peripheral Nerves. J Brachial Plex Peripher Nerve Inj 2021; 16:e17-e23. [PMID: 34007307 PMCID: PMC8121558 DOI: 10.1055/s-0041-1729176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/29/2021] [Indexed: 12/17/2022] Open
Abstract
Peripheral nerve injuries (PNIs) continue to present both diagnostic and treatment challenges. While nerve transections are typically a straightforward diagnosis, other types of PNIs, such as chronic or traumatic nerve compression, may be more difficult to evaluate due to their varied presentation and limitations of current diagnostic tools. As a result, diagnosis may be delayed, and these patients may go on to develop progressive symptoms, impeding normal activity. In the past, PNIs were diagnosed by history and clinical examination alone or techniques that raised concerns regarding accuracy, invasiveness, or operator dependency. Magnetic resonance neurography (MRN) has been increasingly utilized in clinical settings due to its ability to visualize complex nerve structures along their entire pathway and distinguish nerves from surrounding vasculature and tissue in a noninvasive manner. In this review, we discuss the clinical applications of MRN in the diagnosis, as well as pre- and postsurgical assessments of patients with peripheral neuropathies.
Collapse
Affiliation(s)
- Vanessa Ku
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| | - Cameron Cox
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| | - Andrew Mikeska
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| | - Brendan MacKay
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
- Department of Orthopaedic Surgery, University Medical Center, Lubbock, Texas, United States
| |
Collapse
|
10
|
Update in the evaluation of peripheral nerves by MRI, from morphological to functional neurography. RADIOLOGIA 2020; 62:90-101. [PMID: 31611009 DOI: 10.1016/j.rx.2019.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/28/2019] [Accepted: 06/24/2019] [Indexed: 12/11/2022]
Abstract
Imaging studies of peripheral nerves have increased considerably in the last ten years. In addition to the classical and still valid study by ultrasound, new neurographic techniques developed from conventional morphological sequences (including 3D isotropic studies with fat suppression) are making it possible to assess different peripheral nerves and plexuses, including small sensory and/or motor branches, with great precision. Diffusion-weighted sequences and diffusion tensor imaging have opened a new horizon in neurographic studies. This new approach provides morphological and functional information about the internal structure and pathophysiology of the peripheral nerves and diseases that involve them. This update reviews the different MR neurography techniques available for the study of the peripheral nerves, with special emphasis on new sequences based on diffusion.
Collapse
|
11
|
Update in the evaluation of peripheral nerves by MRI, from morphological to functional neurography. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2019.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
12
|
Choi JS, Seo HG, Oh BM, Choi H, Cheon GJ, Lee SU, Lee SH. 18 F-FDG uptake in denervated muscles of patients with peripheral nerve injury. Ann Clin Transl Neurol 2019; 6:2175-2185. [PMID: 31588693 PMCID: PMC6856607 DOI: 10.1002/acn3.50899] [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: 05/26/2019] [Revised: 08/08/2019] [Accepted: 09/01/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We aimed to investigate the clinical significance of increased uptake in 18 F-fluorodeoxyglucose positron emission tomography in patients with peripheral nerve lesions. METHODS We selected patients with unilateral peripheral nerve lesions confirmed with electromyography who had undergone 18 F-fluorodeoxyglucose positron emission tomography covering the lesions. In the denervated muscles and their contralateral corresponding pairs, a mean (SUVmean) and maximum standardized uptake value (SUVmax) were obtained from 18 F-fluorodeoxyglucose positron emission tomography images. We analyzed the difference in these values between the denervated and normal muscles. The lesion-to-normal ratio of the SUVmean (LNRmean) between each muscle pair was also obtained. Subgroup analysis was performed to find whether these three parameters were related to severity, abundance of abnormal spontaneous activity, and etiology. RESULTS Twenty-three patients with 38 denervated muscles were included. Compared to their normal counterparts, the denervated muscles showed significantly higher SUVmax (1.33 ± 0.49 vs. 1.10 ± 0.37, n = 38, P < 0.001) and SUVmean (0.91 ± 0.31 vs. 0.77 ± 0.28, n = 38, P < 0.001). The muscles with severe neuropathy showed significantly higher LNRmean than those with mild neuropathy (1.30 ± 0.36, n = 19 vs. 1.11 ± 0.24, n = 19; P = 0.046), and the muscles with traumatic neuropathy showed significantly higher LNRmean than those with nontraumatic neuropathy (1.32 ± 0.28, n = 13 vs. 1.14 ± 0.33, n = 23; P = 0.015). INTERPRETATION Denervated muscles with peripheral nerve injury showed higher uptake than normal muscles in 18 F-fluorodeoxyglucose positron emission tomography, and this was associated with severity and etiology.
Collapse
Affiliation(s)
- Ji Soo Choi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| |
Collapse
|
13
|
Abstract
CLINICAL ISSUE Neurogenic myopathies are primary diseases of the nervous system, which secondarily result in denervation of the target musculature. The spectrum of potential causes is manifold ranging from acute traumatic injuries and chronic compression to neurodegenerative, inflammatory, metabolic and neoplastic processes. STANDARD DIAGNOSTIC METHODS The medical history, clinical neurological examination, and electrophysiological tests including electromyography and nerve conduction studies are crucial in diagnosing neuropathic myopathies. Electromyography is the gold standard for diagnosing muscle denervation. METHODICAL INNOVATIONS Additional imaging methods and magnetic resonance imaging (MRI) in particular, are capable of contributing valuable information. The MRI examination of denervated musculature shows edema, an increase in the apparent diffusion coefficient (ADC) and hyperperfusion. Chronic denervation results in fatty degeneration and atrophy of affected muscles, which are also detectable by MRI. PERFORMANCE Although the MRI findings in muscle denervation are relatively unspecific, they show a high sensitivity, comparable to electromyography. Dedicated MR neurography may often visualize the underlying lesion(s) of the innervating nerve(s). ACHIEVEMENTS Besides high sensitivity, comparable to electromyography, MRI is capable of evaluating muscles which are inaccessible for needle electromyography. Due to its non-invasive character, MRI is ideal for follow-up examinations. PRACTICAL RECOMMENDATIONS The use of MRI is often a meaningful addition to the diagnostics of neurogenic myopathies. The extent and distribution pattern of muscular alterations often provide information on the localization of the causative nerve damage. A correct diagnosis or at least a narrowing down of possible differential diagnoses can often be achieved using MRI.
Collapse
Affiliation(s)
- M Wolf
- Abteilung für Neuroradiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - C Wolf
- Neurologie, Reha-Zentrum Gernsbach, Gernsbach, Deutschland
| | - M-A Weber
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| |
Collapse
|
14
|
Martín Noguerol T, Barousse R, Gómez Cabrera M, Socolovsky M, Bencardino JT, Luna A. Functional MR Neurography in Evaluation of Peripheral Nerve Trauma and Postsurgical Assessment. Radiographics 2019; 39:427-446. [DOI: 10.1148/rg.2019180112] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
15
|
Garg B, Manhas V, Vardhan A, Srivastava DN, Das CJ, Vibha D, Gupta V, Malhotra R, Kotwal P. Thumb Opposition Recovery Following Surgery for Severe Carpal Tunnel Syndrome: A Clinical, Radiological, and Electrophysiological Pilot Study. J Hand Surg Am 2019; 44:157.e1-157.e5. [PMID: 29934085 DOI: 10.1016/j.jhsa.2018.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 03/31/2018] [Accepted: 05/01/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To objectively assess recovery of thumb opposition in patients with carpal tunnel syndrome (CTS) after open carpal tunnel release and to evaluate electrophysiological and magnetic resonance (MR) neurography findings as predictors of thumb opposition recovery. METHODS A total of 22 patients with severe CTS and thenar atrophy were included in this study. A detailed clinical, electrophysiological, and MR neurography evaluation was done both before and after surgery at 6 months to assess thumb opposition recovery. RESULTS The median duration of symptoms was 12 months (interquartile range, 12-20 months). The compound muscle action potential of the abductor pollisis brevis (CMAP-APB) also showed statistically significant improvement of 0.5 + 0.2 mV after surgery. Tip-tip pulp pinch strength increased from 1.2 ± 0.4 to 2.0 ± 0.4 kg at 6-month follow-up, lateral pulp pinch strength increased from 1.9 ± 0.6 to 2.8 ± 0.9 kg at 6-month follow-up, and 3-point pulp pinch also improved from 1.9 ± 0.5 to 2.8 ± 0.9 at final follow-up. On MR neurogram, the proportion of patients with abnormal median nerve morphology decreased from 81.8% to 68.2%, abnormal thenar branch morphology decreased from 63.6% to 36.4% and denervation edema deceased from 59.1% to 13.6%. CONCLUSIONS Patients suffering from severe CTS with thenar atrophy and detectable CMAP-APB showed promising improvement following open carpal tunnel release. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
Collapse
Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vikrant Manhas
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
| | - Anand Vardhan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Chandan J Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Gupta
- Department of Community Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Prakash Kotwal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
16
|
Chhabra A, Bajaj G, Wadhwa V, Quadri RS, White J, Myers LL, Amirlak B, Zuniga JR. MR Neurographic Evaluation of Facial and Neck Pain: Normal and Abnormal Craniospinal Nerves below the Skull Base. Radiographics 2018; 38:1498-1513. [DOI: 10.1148/rg.2018170194] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
17
|
Schwarz D, Pedro MT, Brand C, Bendszus M, Antoniadis G. [Nerve injuries and traumatic lesions of the brachial plexus : Imaging diagnostics and therapeutic options]. Radiologe 2018; 57:184-194. [PMID: 28175932 DOI: 10.1007/s00117-017-0207-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CLINICAL/METHODICAL ISSUE Traumatic lesions of peripheral nerves and the brachial plexus are feared complications because they frequently result in severe functional impairment. The prognosis is greatly dependent on the correct early diagnosis and the right choice of treatment regimen. It is important to distinguish between open and closed injuries. STANDARD RADIOLOGICAL METHODS Initial imaging must critically evaluate or prove nerve continuity and is commonly achieved by high-resolution ultrasonography. During the further course, reactive soft tissue alterations, such as constrictive scarring or neuroma formation can be detected. In the case of deep nerve and plexus injuries this can be excellently achieved by dedicated magnetic resonance neurography (MRN) sequences. METHODICAL INNOVATIONS The signal yield from brachial plexus imaging can be critically enhanced by the use of dedicated surface coil arrays. Furthermore, diffusion tensor imaging (DTI) may enable the regeneration potential of a nerve lesion to be recognized in the future. PERFORMANCE Multiple reports have shown that neurosonography enables a precise evaluation of peripheral nerve structures (up to 90% sensitivity and 95% specificity in nerve transection) and that the method can critically impact on therapeutic decision-making in 60%. Currently, there are only few quantitative data on the exact performance of MRN in traumatic nerve lesions; however, individual reports indicate a high level of agreement with intraoperative findings. PRACTICAL RECOMMENDATIONS In the initial work-up, especially in the case of peripheral, superficial and lesser nerve injuries, neurosonography is the preferred imaging approach to evaluate nerve integrity and the extent of nerve lesions. In the case of extensive nerve injury of proximal nerves and structures of the plexus as well as in the case of suspected root avulsion MRN is the method of choice.
Collapse
Affiliation(s)
- D Schwarz
- AG MR-Neurographie, Abteilung für Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - M T Pedro
- Sektion Periphere Nervenchirurgie, Neurochirurgische Klinik der Universität Ulm, Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Straße 2, 89312, Günzburg, Deutschland
| | - C Brand
- Sektion Periphere Nervenchirurgie, Neurochirurgische Klinik der Universität Ulm, Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Straße 2, 89312, Günzburg, Deutschland
| | - M Bendszus
- AG MR-Neurographie, Abteilung für Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - G Antoniadis
- Sektion Periphere Nervenchirurgie, Neurochirurgische Klinik der Universität Ulm, Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Straße 2, 89312, Günzburg, Deutschland.
| |
Collapse
|
18
|
|
19
|
Ahlawat S, Belzberg AJ, Fayad LM. Utility of Magnetic Resonance Imaging for Predicting Severity of Sciatic Nerve Injury. J Comput Assist Tomogr 2018; 42:580-587. [DOI: 10.1097/rct.0000000000000730] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Ratner S, Khwaja R, Zhang L, Xi Y, Dessouky R, Rubin C, Chhabra A. Sciatic neurosteatosis: Relationship with age, gender, obesity and height. Eur Radiol 2017; 28:1673-1680. [PMID: 29063256 DOI: 10.1007/s00330-017-5087-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/26/2017] [Accepted: 09/22/2017] [Indexed: 12/24/2022]
Abstract
AIM To evaluate inter-reader performance for cross-sectional area and fat quantification of bilateral sciatic nerves on MRI and assess correlations with anthropometrics. METHODS In this IRB-approved, HIPPA-compliant study, three readers performed a cross-sectional analysis of 3T lumbosacral plexus MRIs over an 18-month period. Image slices were evaluated at two levels (A and B). The sciatic nerve was outlined using a free hand region of interest tool on PACS. Proton-density fat fraction (FF) and cross-sectional areas were recorded. Inter-reader agreement was assessed using intra-class correlation coefficient (ICC). Spearman correlation coefficients were used for correlations with age, BMI and height and Wilcoxon rank sum test was used to assess gender differences. RESULTS A total of 67 patients were included in this study with male to female ratio of 1:1. Inter-reader agreement was good to excellent for FF measurements at both levels (ICC=0.71-0.90) and poor for sciatic nerve areas (ICC=0.08-0.27). Positive correlations of sciatic FF and area were seen with age (p value<0.05). Males had significantly higher sciatic intraneural fat than females (p<0.05). CONCLUSION Fat quantification MRI is highly reproducible with significant positive correlations of sciatic FF and area with age, which may have implications for MRI diagnosis of sciatic neuropathy. KEY POINTS • MR proton density fat fraction is highly reproducible at multiple levels. • Sciatic intraneural fat is positively correlated with increasing age (p < 0.05). • Positive correlations exist between bilateral sciatic nerve areas and age (p < 0.05). • Males had significantly higher sciatic intraneural fat than females (p < 0.05).
Collapse
Affiliation(s)
- Shayna Ratner
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Raamis Khwaja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Lihua Zhang
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA.,Radiology, Peking University Third Hospital, Beijing, China
| | - Yin Xi
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Riham Dessouky
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA.,Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Craig Rubin
- Geriatric division, Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA. .,Departments of Radiology and Orthopedic Surgery and Musculoskeletal Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA.
| |
Collapse
|
21
|
MR T2 value of the tibial nerve can be used as a potential non-invasive and quantitative biomarker for the diagnosis of diabetic peripheral neuropathy. Eur Radiol 2017; 28:1234-1241. [DOI: 10.1007/s00330-017-5043-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 12/19/2022]
|
22
|
Martín Noguerol T, Barousse R, Socolovsky M, Luna A. Quantitative magnetic resonance (MR) neurography for evaluation of peripheral nerves and plexus injuries. Quant Imaging Med Surg 2017; 7:398-421. [PMID: 28932698 DOI: 10.21037/qims.2017.08.01] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Traumatic conditions of peripheral nerves and plexus have been classically evaluated by morphological imaging techniques and electrophysiological tests. New magnetic resonance imaging (MRI) studies based on 3D fat-suppressed techniques are providing high accuracy for peripheral nerve injury evaluation from a qualitative point of view. However, these techniques do not provide quantitative information. Diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) are functional MRI techniques that are able to evaluate and quantify the movement of water molecules within different biological structures. These techniques have been successfully applied in other anatomical areas, especially in the assessment of central nervous system, and now are being imported, with promising results for peripheral nerve and plexus evaluation. DWI and DTI allow performing a qualitative and quantitative peripheral nerve analysis, providing valuable pathophysiological information about functional integrity of these structures. In the field of trauma and peripheral nerve or plexus injury, several derived parameters from DWI and DTI studies such as apparent diffusion coefficient (ADC) or fractional anisotropy (FA) among others, can be used as potential biomarkers of neural damage providing information about fiber organization, axonal flow or myelin integrity. A proper knowledge of physical basis of these techniques and their limitations is important for an optimal interpretation of the imaging findings and derived data. In this paper, a comprehensive review of the potential applications of DWI and DTI neurographic studies is performed with a focus on traumatic conditions, including main nerve entrapment syndromes in both peripheral nerves and brachial or lumbar plexus.
Collapse
Affiliation(s)
| | - Rafael Barousse
- Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina
| | - Mariano Socolovsky
- Peripheral Nerve and Plexus Surgery Unit, Department of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Antonio Luna
- MRI Unit, Neuroradiology Section, Clínica Las Nieves, SERCOSA, Health Time, Jaén, Spain.,Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
23
|
Bignotti B, Assini A, Signori A, Martinoli C, Tagliafico A. Ultrasound versus MRI in common fibular neuropathy. Muscle Nerve 2017; 55:849-857. [PMID: 27668978 DOI: 10.1002/mus.25418] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/13/2016] [Accepted: 09/23/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION We prospectively compared ultrasound (US) and MRI in patients with common fibular neuropathy. METHODS Forty adult patients with clinical suspicion of common fibular neuropathy and 40 healthy controls underwent both US and MRI. US and MRI datasets were randomized for prospective reading. RESULTS The overall sensitivity of US and MRI for diagnosing fibular neuropathy was 90% (95% confidence interval [CI], 79.7%-97.3%) and 87.5% (95% CI, 71.55%-93.1%), respectively. The overall specificity of US and MRI was 92% (95% CI, 77.45%-96.1%) and 85% (95% CI, 73.3%-94.4%), respectively. The overall sensitivity and specificity of US combined with MRI were 94% (95% CI, 0.80%-0.99%) and 84% (95% CI, 0.70%-0.91%), respectively. Overall intra- and inter-observer agreements among 3 readers were 0.76% (95% CI, 0.62%-0.85%) and 0.74% (95% CI, 0.65%-0.81%). CONCLUSIONS US diagnostic accuracy for common fibular neuropathy was slightly higher than that of MRI. Muscle Nerve 55: 849-857, 2017.
Collapse
Affiliation(s)
- Bianca Bignotti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Alberto Tagliafico
- Institute of Anatomy, Department of Experimental Medicine (DIMES), University of Genoa, Via L.B. Alberti 2, 16132, Genoa, Italy
| |
Collapse
|
24
|
|
25
|
Weissman E, Boothe E, Wadhwa V, Scott K, Chhabra A. Magnetic Resonance Neurography of the Pelvic Nerves. Semin Ultrasound CT MR 2016; 38:269-278. [PMID: 28705371 DOI: 10.1053/j.sult.2016.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic pelvic pain syndrome is commonly caused by nerve injury, inflammation, or entrapment. Owing to the complex anatomy and branching patterns of pelvic nerves, pelvic neuropathies are often difficult to illustrate and diagnose. High-resolution 3-T magnetic resonance neurography is a promising technique for the evaluation of peripheral neuropathy. In this article, the authors discuss the normal anatomy of major pelvic nerves, technical considerations of high-resolution imaging, and normal and abnormal imaging appearances with relevant case examples.
Collapse
Affiliation(s)
- Eric Weissman
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ethan Boothe
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Kelly Scott
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Avneesh Chhabra
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| |
Collapse
|
26
|
Fisher S, Wadhwa V, Manthuruthil C, Cheng J, Chhabra A. Clinical impact of magnetic resonance neurography in patients with brachial plexus neuropathies. Br J Radiol 2016; 89:20160503. [PMID: 27558928 DOI: 10.1259/bjr.20160503] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To study the impact of brachial plexus MR neurography (MRN) in the diagnostic thinking and therapeutic management of patients with suspected plexopathy. METHODS MRN examinations of adult brachial plexuses over a period of 18 months were reviewed. Relevant data collection included-patient demographics, clinical history, pre-imaging diagnostic impression, pre-imaging treatment plan, post-imaging diagnosis, post-imaging treatment plan, surgical notes and electrodiagnostic (ED) results. Impact of imaging on the pre-imaging clinical diagnosis and therapeutic management were classified as no change, mild change or substantial change. RESULTS Final sample included 121 studies. The common aetiologies included inflammatory in 31 (25.6%) of 121 patients, trauma in 29 (23.9%) of 121 patients and neoplastic in 26 (21.5%) of 121 patients. ED tests were performed in 47 (38.8%) of 121 patients and these showed concordance with MRN findings in 31 (66.0%) of 47 patients. Following MRN, there was change in the pre-imaging clinical impression for 91 (75.2%) of 121 subjects, with a mild change in diagnosis in 57 (47.1%) of 121 patients and a substantial change in 34 (28.0%) of 121 patients. 19 (15.7%) of 121 patients proceeded to therapies that would not have been performed in the same manner without the information obtained from MRN. CONCLUSION MRN of the brachial plexus significantly impacts clinical decision-making and should be routinely performed in suspected brachial plexopathy. Advances in knowledge: MRN significantly impacts the diagnostic thinking and therapeutic management of patients with suspected brachial plexopathy. MRN not only provides concordant information to ED tests in majority of cases, but also supplements with additional diagnostic data in patients who are ED negative.
Collapse
Affiliation(s)
- Stephen Fisher
- 1 Musculoskeletal Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Vibhor Wadhwa
- 2 Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Christine Manthuruthil
- 1 Musculoskeletal Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jonathan Cheng
- 3 Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- 1 Musculoskeletal Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
27
|
Markvardsen LH, Vaeggemose M, Ringgaard S, Andersen H. Diffusion tensor imaging can be used to detect lesions in peripheral nerves in patients with chronic inflammatory demyelinating polyneuropathy treated with subcutaneous immunoglobulin. Neuroradiology 2016; 58:745-52. [DOI: 10.1007/s00234-016-1692-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/20/2016] [Indexed: 01/12/2023]
|
28
|
Kumar Y, Wadhwa V, Phillips L, Pezeshk P, Chhabra A. MR imaging of skeletal muscle signal alterations: Systematic approach to evaluation. Eur J Radiol 2016; 85:922-35. [PMID: 27130052 DOI: 10.1016/j.ejrad.2016.02.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 01/24/2023]
Abstract
Muscle edema or edema-like signal alterations are commonly encountered findings in musculoskeletal magnetic resonance (MR) imaging. Although such signal alterations are very sensitive for detection of the underlying muscle pathology, these are often non-specific findings. Encompassing knowledge of their typical clinical presentations, characteristic appearances and patterns of muscle signal alterations and following a systematic approach towards their assessment, a reader can effectively narrow down the differential diagnosis. This article outlines the role of conventional imaging and advanced anatomic and functional musculoskeletal MR imaging techniques in the evaluation of various muscle disorders and presents a systematic approach towards their diagnosis and management.
Collapse
Affiliation(s)
- Yogesh Kumar
- Department of Radiology, Yale New Haven Health System at Bridgeport Hospital, CT, United States
| | - Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Lauren Phillips
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Parham Pezeshk
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States.
| |
Collapse
|
29
|
Cox B, Zuniga JR, Panchal N, Cheng J, Chhabra A. Magnetic resonance neurography in the management of peripheral trigeminal neuropathy: experience in a tertiary care centre. Eur Radiol 2016; 26:3392-400. [PMID: 26795500 DOI: 10.1007/s00330-015-4182-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/14/2015] [Accepted: 12/18/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This tertiary care experience examines the utility of magnetic resonance neurography (MRN) in the management of peripheral trigeminal neuropathies. MATERIALS AND METHODS Seventeen patients with clinically suspected peripheral trigeminal neuropathies (inferior alveolar nerve and lingual nerve) were imaged uniformly with 1.5-T examinations. MRN results were correlated with clinical and surgical findings in operated patients and the impact on clinical management was assessed. RESULTS Clinical findings included pain (14/17), sensory changes (15/17), motor changes (2/17) and palpable masses (3/17). Inciting events included prior dental surgery (12/17), trauma (1/17) and idiopathic incidents (4/17). Non-affected side nerves and trigeminal nerves in the intracranial and skull base course were normal in all cases. Final diagnoses on affected sides were nerve inflammation (4/17), neuroma in continuity (2/17), LN transection (1/17), scar entrapment (3/17), infectious granuloma (1/17), low-grade injuries (3/17) and no abnormality (3/17). Associated submandibular gland and sublingual gland oedema-like changes were seen in 3/17 cases because of parasympathetic effects. Moderate-to-excellent MRN-surgical correlation was seen in operated (8/17) patients, and neuroma and nerve transection were prospectively identified in all cases. CONCLUSION MRN is useful for the diagnostic work-up of suspected peripheral trigeminal neuropathy patients with significant impact on clinical management and moderate-to-excellent correlation with intra-operative findings. KEY POINTS • MRN substantially impacts diagnostic thinking and management in peripheral trigeminal neuropathy. • MRN has moderate-to-excellent correlation with intra-operative findings. • MRN should be considered in pre-surgical planning of peripheral trigeminal neuropathy subjects.
Collapse
Affiliation(s)
- Brian Cox
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA
| | - John R Zuniga
- Department of Oral & Maxillofacial Surgery, Surgery, Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Neeraj Panchal
- Department of Oral Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan Cheng
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA.
| |
Collapse
|
30
|
Bignotti B, Cadoni A, Assini A, Martinoli C, Tagliafico A. Fascicular involvement in common fibular neuropathy: Evaluation with ultrasound. Muscle Nerve 2016; 53:532-7. [DOI: 10.1002/mus.24879] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/29/2015] [Accepted: 08/06/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Bianca Bignotti
- Department of Health Sciences; University of Genoa; Largo Rosanna Benzi 8 16132 Genoa Italy
| | - Angela Cadoni
- Institute of Anatomy, Department of Experimental Medicine; University of Genoa; Genoa Italy
| | - Andrea Assini
- Ente Ospedaliero Ospedali Galliera, Unità Operativa S.C. Neurologia; Genoa Italy
| | - Carlo Martinoli
- Department of Health Sciences; University of Genoa; Largo Rosanna Benzi 8 16132 Genoa Italy
| | - Alberto Tagliafico
- Institute of Anatomy, Department of Experimental Medicine; University of Genoa; Genoa Italy
| |
Collapse
|
31
|
Chhabra A, Belzberg AJ, Rosson GD, Thawait GK, Chalian M, Farahani SJ, Shores JT, Deune G, Hashemi S, Thawait SK, Subhawong TK, Carrino JA. Impact of high resolution 3 tesla MR neurography (MRN) on diagnostic thinking and therapeutic patient management. Eur Radiol 2015; 26:1235-44. [DOI: 10.1007/s00330-015-3958-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 07/26/2015] [Accepted: 07/30/2015] [Indexed: 01/05/2023]
|
32
|
Filli L, Piccirelli M, Kenkel D, Boss A, Manoliu A, Andreisek G, Bhat H, Runge VM, Guggenberger R. Accelerated magnetic resonance diffusion tensor imaging of the median nerve using simultaneous multi-slice echo planar imaging with blipped CAIPIRINHA. Eur Radiol 2015; 26:1921-8. [PMID: 26373759 DOI: 10.1007/s00330-015-3985-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 08/08/2015] [Accepted: 08/31/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate the feasibility of MR diffusion tensor imaging (DTI) of the median nerve using simultaneous multi-slice echo planar imaging (EPI) with blipped CAIPIRINHA. MATERIALS AND METHODS After federal ethics board approval, MR imaging of the median nerves of eight healthy volunteers (mean age, 29.4 years; range, 25-32) was performed at 3 T using a 16-channel hand/wrist coil. An EPI sequence (b-value, 1,000 s/mm(2); 20 gradient directions) was acquired without acceleration as well as with twofold and threefold slice acceleration. Fractional anisotropy (FA), mean diffusivity (MD) and quality of nerve tractography (number of tracks, average track length, track homogeneity, anatomical accuracy) were compared between the acquisitions using multivariate ANOVA and the Kruskal-Wallis test. RESULTS Acquisition time was 6:08 min for standard DTI, 3:38 min for twofold and 2:31 min for threefold acceleration. No differences were found regarding FA (standard DTI: 0.620 ± 0.058; twofold acceleration: 0.642 ± 0.058; threefold acceleration: 0.644 ± 0.061; p ≥ 0.217) and MD (standard DTI: 1.076 ± 0.080 mm(2)/s; twofold acceleration: 1.016 ± 0.123 mm(2)/s; threefold acceleration: 0.979 ± 0.153 mm(2)/s; p ≥ 0.074). Twofold acceleration yielded similar tractography quality compared to standard DTI (p > 0.05). With threefold acceleration, however, average track length and track homogeneity decreased (p = 0.004-0.021). CONCLUSION Accelerated DTI of the median nerve is feasible. Twofold acceleration yields similar results to standard DTI. KEY POINTS • Standard DTI of the median nerve is limited by its long acquisition time. • Simultaneous multi-slice acquisition is a new technique for accelerated DTI. • Accelerated DTI of the median nerve yields similar results to standard DTI.
Collapse
Affiliation(s)
- Lukas Filli
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Marco Piccirelli
- Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - David Kenkel
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Andreas Boss
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Andrei Manoliu
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Gustav Andreisek
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Himanshu Bhat
- Siemens Medical Solutions USA Inc, Charlestown, MA, USA
| | - Val M Runge
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Roman Guggenberger
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| |
Collapse
|