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Lin Y, Tan ET, Campbell G, Colucci PG, Singh S, Lan R, Wen Y, Sneag DB. Improved 3D DESS MR neurography of the lumbosacral plexus with deep learning and geometric image combination reconstruction. Skeletal Radiol 2024; 53:1529-1539. [PMID: 38386108 DOI: 10.1007/s00256-024-04613-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE To evaluate the impact of deep learning (DL) reconstruction in enhancing image quality and nerve conspicuity in LSP MRN using DESS sequences. Additionally, a geometric image combination (GIC) method to improve DESS signals' combination was proposed. MATERIALS AND METHODS Adult patients undergoing 3.0 Tesla LSP MRN with DESS were prospectively enrolled. The 3D DESS echoes were separately reconstructed with and without DL and DL-GIC combined reconstructions. In a subset of patients, 3D T2-weighted short tau inversion recovery (STIR-T2w) sequences were also acquired. Three radiologists rated 4 image stacks ('DESS S2', 'DESS S2 DL', 'DESS GIC DL' and 'STIR-T2w DL') for bulk motion, vascular suppression, nerve fascicular architecture, and overall nerve conspicuity. Relative SNR, nerve-to-muscle, -fat, and -vessel contrast ratios were measured. Statistical analysis included ANOVA and Wilcoxon signed-rank tests. p < 0.05 was considered statistically significant. RESULTS Forty patients (22 females; mean age = 48.6 ± 18.5 years) were enrolled. Quantitatively, 'DESS GIC DL' demonstrated superior relative SNR (p < 0.001), while 'DESS S2 DL' exhibited superior nerve-to-background contrast ratio (p value range: 0.002 to < 0.001). Qualitatively, DESS provided superior vascular suppression and depiction of sciatic nerve fascicular architecture but more bulk motion as compared to 'STIR-T2w DL'. 'DESS GIC DL' demonstrated better nerve visualization for several smaller, distal nerve segments than 'DESS S2 DL' and 'STIR-T2w DL'. CONCLUSION Application of a DL reconstruction with geometric image combination in DESS MRN improves nerve conspicuity of the LSP, especially for its smaller branch nerves.
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Affiliation(s)
- Yenpo Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Gracyn Campbell
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Philip G Colucci
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Sumedha Singh
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Ranqing Lan
- Biostatistics Core, Hospital for Special Surgery, New York, NY, USA
| | - Yan Wen
- GE Healthcare, Waukesha, WI, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
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She D, Huang H, Jiang D, Hong J, You P, Li L, Zhao X, Cao D. Visualization of the Extracranial Branches of the Trigeminal Nerve Using Improved Motion-Sensitized Driven Equilibrium-Prepared 3D Inversion Recovery TSE Sequence. AJNR Am J Neuroradiol 2024:ajnr.A8273. [PMID: 38964862 DOI: 10.3174/ajnr.a8273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/28/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND AND PURPOSE Visualization of the extracranial trigeminal nerve is crucial to detect nerve pathologic alterations. This study aimed to evaluate visualization of the extracranial trigeminal nerve using 3D inversion recovery TSE with an improved motion-sensitized driven equilibrium (iMSDE) pulse. MATERIALS AND METHODS In this prospective study, 35 subjects underwent imaging of the trigeminal nerve using conventional 3D inversion recovery TSE, 3D inversion recovery TSE with an iMSDE pulse, and contrast-enhanced 3D inversion recovery TSE. The visibility of 7 extracranial branches of the trigeminal nerve, venous/muscle suppression, and identification of the relationship between nerves and lesions were scored on a 5-point scale system. In addition, SNR, nerve-muscle contrast ratio, nerve-venous contrast ratio, nerve-muscle contrast-to-noise ratio, and nerve-venous contrast-to-noise ratio were calculated and compared. RESULTS Images acquired with iMSDE 3D inversion recovery TSE had significantly higher nerve-muscle contrast ratio, nerve-venous contrast ratio, and nerve-to-venous contrast-to-noise ratio (all P < .001); improved venous/muscle suppression and clearer visualization of the trigeminal nerve branches except the ophthalmic nerve than with conventional 3D inversion recovery TSE (all P < .05). Compared with contrast-enhanced 3D inversion recovery TSE, images acquired with iMSDE 3D inversion recovery TSE had significantly higher SNR, nerve-muscle contrast ratio, and nerve-to-venous contrast-to-noise ratio (all P < .05), and demonstrated comparable diagnostic quality (scores ≥3) of the maxillary nerve, mandibular nerve, inferior alveolar nerve, lingual nerve, and masseteric nerve (P > .05). As for the identification of the relationship between nerves and lesions, iMSDE 3D inversion recovery TSE showed the highest scores among these 3 sequences (all P < .05). CONCLUSIONS The iMSDE 3D inversion recovery TSE is a promising alternative to conventional 3D inversion recovery TSE and contrast-enhanced 3D inversion recovery TSE for visualization of the extracranial branches of trigeminal nerve in clinical practice.
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Affiliation(s)
- Dejun She
- From the Department of Radiology (D.S., H.H., D.J., J.H., P.Y., D.C.), First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Radiology (D.S., H.H., D.J., J.H., P.Y., D.C), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions (D.S., D.C.), the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Hao Huang
- From the Department of Radiology (D.S., H.H., D.J., J.H., P.Y., D.C.), First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Radiology (D.S., H.H., D.J., J.H., P.Y., D.C), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Dongmei Jiang
- From the Department of Radiology (D.S., H.H., D.J., J.H., P.Y., D.C.), First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Radiology (D.S., H.H., D.J., J.H., P.Y., D.C), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Junhuan Hong
- From the Department of Radiology (D.S., H.H., D.J., J.H., P.Y., D.C.), First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Radiology (D.S., H.H., D.J., J.H., P.Y., D.C), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Peiying You
- From the Department of Radiology (D.S., H.H., D.J., J.H., P.Y., D.C.), First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Radiology (D.S., H.H., D.J., J.H., P.Y., D.C), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Lu Li
- The School of Medical Imaging (L.L.), Fujian Medical University, Fuzhou, Fujian, China
| | - Xiance Zhao
- Philips Healthcare (X.Z.), Shanghai, P.R. China
| | - Dairong Cao
- From the Department of Radiology (D.S., H.H., D.J., J.H., P.Y., D.C.), First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Radiology (D.S., H.H., D.J., J.H., P.Y., D.C), National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions (D.S., D.C.), the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Department of Radiology (D.C.), Fujian Key Laboratory of Precision Medicine for Cancer, First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
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Tokeshi S, Eguchi Y, Sakai T, Yoneyama M, Watanabe A, Aoki Y, Sato M, Orita S, Suzuki M, Inage K, Shiga Y, Inoue M, Toshi N, Okuyama K, Ohyama S, Suzuki N, Maki S, Nakamura J, Hagiwara S, Kawarai Y, Akazawa T, Takahashi H, Ohtori S. A novel simultaneous three-dimensional volumetric morphological imaging and T2-mapping method, multi-interleaved X-prepared turbo-spin echo with intuitive relaxometry provides more accurate quantification of cervical spinal nerves. J Clin Neurosci 2024; 125:97-103. [PMID: 38761535 DOI: 10.1016/j.jocn.2024.05.004] [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: 12/06/2023] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE MIXTURE is a simultaneous morphological and quantitative imaging sequence developed by Philips that provides high-resolution T2 maps from the imaged series. We aimed to compare the T2 maps of MIXTURE and SHINKEI-Quant (S-Q) in the cervical spine and to examine their usefulness in the functional diagnosis of cervical radiculopathy. METHODS Seven healthy male volunteers (mean age: 31 ± 8.0 years) and one patient with cervical disc herniation (44 years old, male) underwent cervical spine magnetic resonance imaging (MRI), and T2-mapping of each was performed simultaneously using MIXTURE and S-Q in consecutive sequences in one imaging session. The standard deviation (SD) of the T2 relaxation times and T2 relaxation times of the bilateral C6 and C7 dorsal root ganglia (DRG) and C5/6 level cervical cord on the same slice in the 3D T2-map of the cervical spine coronal section were measured and compared between MIXTURE and S-Q. RESULTS T2 relaxation times were significantly shorter in MIXTURE than in S-Q for all C6, C7 DRG, and C5/6 spinal cord measurements. The SD values of the T2 relaxation times were significantly lower for MIXTURE in the C5/6 spinal cord and C7 DRG. In cervical disc herniation, MRI showed multiple intervertebral compression lesions with spinal canal stenosis at C5/6 and disc herniation at C6/7. CONCLUSION MIXTURE is useful for preoperative functional diagnosis. T2-mapping using MIXTURE can quantify cervical nerve roots more accurately than the S-Q method and is expected to be clinically applicable to cervical radiculopathy.
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Affiliation(s)
- Soichiro Tokeshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Yawara Eguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan; Department of Orthopaedic Surgery, Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba 284-0003, Japan.
| | - Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan
| | - Masami Yoneyama
- MR Clinical Science, Philips Japan, 2-13-37 Konan, Minato-ku, Tokyo 108-8507, Japan
| | - Atsuya Watanabe
- Tsuga Orthopeadic Rehabilitation Clinic, 3-16-13 Tsuga Wakaba-ku, Chiba 264-0025, Japan.
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan.
| | - Masashi Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Miyako Suzuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Yasuhiro Shiga
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Masahiro Inoue
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Noriyasu Toshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Kohei Okuyama
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Shuhei Ohyama
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Noritaka Suzuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Satoshi Maki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Shigeo Hagiwara
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Yuya Kawarai
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-City, Ibaraki 305-8575, Japan.
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
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Lee JH, Gong HS. Volumetric assessment of ulnar nerves in cubital tunnel syndrome with 3D modeling of the MRI and its relationship with electrodiagnostic findings. J Plast Reconstr Aesthet Surg 2024; 92:244-251. [PMID: 38574571 DOI: 10.1016/j.bjps.2024.03.014] [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: 01/08/2023] [Revised: 09/06/2023] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Thickened nerve cross-sectional areas (CSA) have been investigated in compressive neuropathy, but the longitudinal extent of nerve swelling has yet to be evaluated. We did a volumetric assessment of the ulnar nerve in cubital tunnel syndrome (CuTS) with three-dimensional (3D) magnetic resonance imaging (MRI) modeling and investigated this relationship with clinical and electrodiagnostic parameters. METHODS We compared 40 CuTS patient elbow MRIs to 46 patient elbow MRIs with lateral elbow epicondylitis as controls. The ulnar nerve was modeled with Mimics software and was assessed qualitatively and quantitatively. The CSA and ulnar nerve volumes were recorded, and the area under the receiver operating characteristic (ROC) curve was calculated for diagnostic performance. We analyzed clinical and electrodiagnostic parameters to investigate their relationship with the 3D ulnar nerve parameters. RESULTS For the diagnosis of CuTS, the area under the curve value was 0.915 for the largest CSA and 0.910 for the volume in the ROC curve. The optimal cut-off was 14.53 mm2 and 529 mm3 respectively. When electrodiagnostic parameters were investigated, the 3D ulnar nerve volume was significantly inversely associated with motor conduction velocity, although there was no association between the largest CSA and any of the electrodiagnostic parameters. CONCLUSIONS The 3D ulnar nerve volume, which is an integration or multilevel measurement of CSAs, showed diagnostic usefulness similar to CSA, but it correlated better with conduction velocity, indicating demyelination or early-to-moderate nerve damage in CuTS.
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Affiliation(s)
- Jeong Hyun Lee
- Department of Orthopedic Surgery, Armed Forces Capital Hospital, Seongnam, South Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Zhang Y, Li X, Liu Y, Sun Y, Duan L, Zhang Y, Shi R, Yu X, Peng Z. 3D SHINKEI MR neurography in evaluation of traumatic brachial plexus. Sci Rep 2024; 14:6268. [PMID: 38491150 PMCID: PMC10943192 DOI: 10.1038/s41598-024-57022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/13/2024] [Indexed: 03/18/2024] Open
Abstract
3D SHINKEI neurography is a new sequence for imaging the peripheral nerves. The study aims at assessing traumatic brachial plexus injury using this sequence. Fifty-eight patients with suspected trauma induced brachial plexus injury underwent MR neurography (MRN) imaging in 3D SHINKEI sequence at 3 T. Surgery and intraoperative somatosensory evoked potentials or clinical follow-up results were used as the reference standard. MRN, surgery and electromyography (EMG) findings were recorded at four levels of the brachial plexus-roots, trunks, cords and branches. Fifty-eight patients had pre- or postganglionic injury. The C5-C6 nerve postganglionic segment was the most common (average 42%) among the postganglionic injuries detected by 3D SHINKEI MRN. The diagnostic accuracy (83.75%) and the specificity (90.30%) of MRN higher than that of EMG (p < 0.001). There was no significant difference in the diagnostic sensitivity of MRN compared with EMG (p > 0.05). Eighteen patients with brachial plexus injury underwent surgical exploration after MRN examination and the correlation between MRN and surgery was 66.7%. Due to the high diagnostic accuracy and specificity, 3D SHINKEI MRN can comprehensively display the traumatic brachial plexus injury. This sequence has great potential in the accurate diagnosis of traumatic brachial plexus injury.
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Affiliation(s)
- Yizhe Zhang
- Department of Radiology, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Xiaona Li
- Department of Radiology, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Ying Liu
- Department of Radiology, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yingcai Sun
- Department of Radiology, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Luyao Duan
- Department of Radiology, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yingshuai Zhang
- Department of Radiology, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Ruiqing Shi
- Department of Radiology, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Xiaoman Yu
- Department of Radiology, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Zhigang Peng
- Department of Radiology, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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Pitman J, Lin Y, Tan ET, Sneag D. Magnetic Resonance Neurography of the Lumbosacral Plexus. Radiol Clin North Am 2024; 62:229-245. [PMID: 38272617 DOI: 10.1016/j.rcl.2023.09.008] [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: 01/27/2024]
Abstract
Pain and weakness in the low back, pelvis, and lower extremities are diagnostically challenging, and imaging can be an important step in the workup and management of these patients. Technical advances in magnetic resonance neurography (MRN) have significantly improved its utility for imaging the lumbosacral plexus (LSP). In this article, the authors review LSP anatomy and selected pathology examples. In addition, the authors will discuss technical considerations for MRN with specific points for the branch nerves off the plexus.
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Affiliation(s)
- Jenifer Pitman
- Musculoskeletal Imaging, Department of Radiology, Johns Hopkins Hospital, 601 N Caroline Street, 3rd Floor, Baltimore, MD, USA.
| | - Yenpo Lin
- Radiology Department, Hospital For Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, USA; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ek Tsoon Tan
- Radiology Department, Hospital For Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, USA
| | - Darryl Sneag
- Radiology Department, Hospital For Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, USA
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Felisaz PF, Napolitano A, Terrani S, Parisi C, Toto-Brocchi M, Cè M, Alessandrino F, Oliva G, Cellina M, Gerevini S. An optimized 1.5 Tesla MRI protocol of the brachial plexus. Neuroradiol J 2024; 37:43-53. [PMID: 37621183 PMCID: PMC10863567 DOI: 10.1177/19714009231196475] [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: 08/26/2023] Open
Abstract
PURPOSE Creating an effective MRI protocol for examining the brachial plexus poses significant challenges, and despite the abundance of protocols in the literature, there is a lack of reference standards for basic sequences and essential parameters needed for replication. The aim of this study is to establish a reproducible 1.5 T brachial plexus imaging protocol, including patient positioning, coil selection, imaging planes, and essential sequence parameters. METHODS We systematically investigated MRI sequences, testing each parameter through in vivo experiments, examining their effects on signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), visual quality scores, and acquisition time. Sequences were refined based on optimal quality and timing scores. The final protocol was tested on scanners from two other vendors for reliability. RESULTS The final protocol included a combination of 2D turbo-spin-echo and 3D SPACE T1, SPACE STIR, and VIBE DIXON sequences. Recommendations for imaging planes, phase encoding, field of view, TR, TE, resolution, number of slices, slice thickness, fat and blood suppression, and acceleration strategies are provided. The protocol was successfully translated to other vendor's scanners with comparable quality. CONCLUSION We present an optimized protocol detailing the essential parameters for reproducibility. Our comprehensive list of experiments describes the impact of each parameter on image quality and scan time, addressing common artifacts and potential solutions. This protocol can benefit both young radiologists new to the field and experienced professionals seeking to refine their existing protocols.
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Affiliation(s)
| | | | | | | | - Marco Toto-Brocchi
- Postgraduate School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Maurizio Cè
- Postgraduate School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Francesco Alessandrino
- Division of Abdominal Imaging, Department of Radiology, University of Miami Health System, Miami, FL, USA
| | - Giancarlo Oliva
- Radiology Department, Ospedale Fatebenefratelli e Oftalmico, Milano, Italy
| | - Michaela Cellina
- Radiology Department, Ospedale Fatebenefratelli e Oftalmico, Milano, Italy
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Zhang N, Zeng J, Lv P, Miao X, Chen C, Lin J. Comparison Between a Modified Fast 3-Dimensional Turbo Spin-Echo and Diffusion-Weighted Imaging With Background Suppression in Evaluation of Lumbosacral Plexus and Its Branches. J Comput Assist Tomogr 2024; 48:156-160. [PMID: 37551131 DOI: 10.1097/rct.0000000000001523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVES To compare the fast 3-dimensional NerveVIEW (3D NerveVIEW) with diffusion-weighted imaging with background suppression (DWIBS) in imaging of lumbosacral plexus and its branches. METHODS A prospective study was performed on 30 healthy volunteers and patients who had undergone compressed sensing 3D NerveVIEW and DWIBS scans. There were 11 healthy subjects, 15 patients with lumbar disc herniation, and 4 patients with chronic inflammatory demyelinating polyradiculoneuropathy. Image quality was rated using a 4-point subjective scale. Quantitative evaluation of the nerves was done by measuring signal-to-noise ratio, contrast-to-noise ratio, and signal-to-background ratio, and the consistency in the measurements of nerve root cross-sectional areas was also assessed. The differences of signal-to-noise ratio, contrast-to-noise ratio, signal-to-background ratio, and the scores of image quality between 2 sequences were compared. RESULTS The overall average image quality score of 3D NerveVIEW was significantly higher than that of DWIBS (2.72 ± 0.45 and 2.45 ± 0.81, respectively; P < 0.01). In terms of individual nerves, there was no significant difference between the 2 sequences in the display of the nerves from L2 to S1; however, 3D NerveVIEW was significantly better than DWIBS in demonstration of the S2-S3 nerves, as well as the nerve details. Regarding quantitative measurements, these sequences achieved comparable results with excellent interobserver agreements. CONCLUSION Fast 3D NerveVIEW was superior to DWIBS with improved conspicuity of small distal nerves of S2-S3 and nerve details.
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Affiliation(s)
- Nan Zhang
- From the Department of Radiology, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
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Jung JY, Lin Y, Carrino JA. An Updated Review of Magnetic Resonance Neurography for Plexus Imaging. Korean J Radiol 2023; 24:1114-1130. [PMID: 37899521 PMCID: PMC10613850 DOI: 10.3348/kjr.2023.0150] [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: 02/15/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 10/31/2023] Open
Abstract
Magnetic resonance neurography (MRN) is increasingly used to visualize peripheral nerves in vivo. However, the implementation and interpretation of MRN in the brachial and lumbosacral plexi are challenging because of the anatomical complexity and technical limitations. The purpose of this article was to review the clinical context of MRN, describe advanced magnetic resonance (MR) techniques for plexus imaging, and list the general categories of utility of MRN with pertinent imaging examples. The selection and optimization of MR sequences are centered on the homogeneous suppression of fat and blood vessels while enhancing the visibility of the plexus and its branches. Standard 2D fast spin-echo sequences are essential to assess morphology and signal intensity of nerves. Moreover, nerve-selective 3D isotropic images allow improved visualization of nerves and multiplanar reconstruction along their course. Diffusion-weighted and diffusion-tensor images offer microscopic and functional insights into peripheral nerves. The interpretation of MRN in the brachial and lumbosacral plexi should be based on a thorough understanding of their anatomy and pathophysiology. Anatomical landmarks assist in identifying brachial and lumbosacral plexus components of interest. Thus, understanding the varying patterns of nerve abnormalities facilitates the interpretation of aberrant findings.
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Affiliation(s)
- Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yenpo Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA.
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Tsurumi Y, Hagiwara S, Horikoshi T, Yokota H, Kurosawa R, Matsumoto K, Masuda Y, Kawarai Y, Nakamura J, Eguchi Y, Orita S, Ohtori S. Leg position effects on the femoral neurovascular bundle location during a direct anterior approach total hip arthroplasty: a radiographic study. BMC Musculoskelet Disord 2023; 24:824. [PMID: 37858083 PMCID: PMC10585724 DOI: 10.1186/s12891-023-06947-0] [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] [Received: 03/28/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Femoral neurovascular injury is a serious complication in a direct anterior approach (DAA) total hip arthroplasty. However, dynamic neurovascular bundle location changes during the approach were not examined. Thus, this study aimed to analyze the effects of leg position on the femoral neurovascular bundle location using magnetic resonance imaging (MRI). METHODS This study scanned 30 healthy volunteers (15 males and 15 females) with 3.0T MRI in a supine and 30-degree hip extension position with the left leg in a neutral rotation position and the right leg in a 45-degree external extension position. The minimum distance from the edge of the anterior acetabulum to the femoral nerve (dFN), artery, and vein were measured on axial T1-weighted images at the hip center level, as well as the angle to the horizontal line of the femoral nerve (aFN), artery (aFA), and vein from the anterior acetabulum. RESULTS The dFN in the supine position with external rotation was significantly larger than supine with neutral and extension with external rotation position (20.7, 19.5, and 19.0; p = 0.031 and 0.012, respectively). The aFA in supine with external rotation was significantly larger than in other postures (52.4°, 34.2°, and 36.2°, p < 0.001, respectively). The aFV in supine with external rotation was significantly larger than in supine with a neutral position (52.3° versus 47.7°, p = 0.037). The aFN in supine and external rotation was significantly larger than other postures (54.6, 38.2, and 33.0, p < 0.001, respectively). CONCLUSIONS This radiographic study revealed that the leg position affected the neurovascular bundle location. These movements can be the risk of direct neurovascular injury or traction.
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Affiliation(s)
- Yousuke Tsurumi
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Takuro Horikoshi
- Department of Radiology, Chiba University Hospital, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Ryuna Kurosawa
- Department of Radiology, Chiba University Hospital, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yuya Kawarai
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Junichi Nakamura
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yawara Eguchi
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Sumihisa Orita
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Seiji Ohtori
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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11
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Zhao L, Zhao J, Ma C, Lu Y, Dong C. Diagnostic Performance of 3D-NERVE as an Adjunct to Electromyography for the Assessment of Brachial Plexus Injury in Infants. J Child Neurol 2023; 38:617-621. [PMID: 37700631 DOI: 10.1177/08830738231200301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Objective: This study aimed to explore diagnostic performance of 3D-NERVE as an adjunct to electromyography for the assessment of brachial plexus injury in infants. Methods: Imaging of infants with brachial plexus injury using 3D-NERVE and/or 3D-STIR from 2019 to 2022 were reviewed. Images were evaluated between the 2 sequences for nerve-to-fat ratio, nerve-to-muscle ratio, muscle-to-fat ratio, fat suppression homogeneity, and display rate of brachial plexus branches. Results: This study included 37 infants who were referred for a clinical diagnosis of brachial plexus injury. A total of 21 infants accepted 3D-NERVE sequence scanning, and 16 infants accepted 3D-NERVE and 3D-STIR sequences scanning. The results of examination were generally consistent with electromyography. The 2 sequences were compared, yielding the following results. There were no pulsation artifacts (0/16), and 1 case with heterogeneous fat saturation (1/16) was seen on 3D-NERVE. There were no pulsation artifacts (0/16), and 5 cases with heterogeneous fat saturation (5/16) were seen on 3D-STIR. 3D-NERVE performed better (P < .05) for nerve-to-fat and nerve-to-muscle ratios compared with 3D-STIR, and no significant difference in the muscle-to-fat ratio (P > .05). The 3D-NERVE and STIR helped depict 100% (16/16) of the brachial roots and brachial plexus trunk. Brachial plexus bundles and brachial plexus branches were observed in 93.75% (15/16) and 68.75% (11/16) of the 3D-NERVE and 93.75% (15/16) and 62.5% (10/16) of the 3D-STIR, respectively. The differences were not statistically significant (P > .05). Conclusion: Nerve trauma was better visualized with the 3D-NERVE, which is an effective adjunct to electromyography for doctors to assess brachial plexus injury and consequently helps in better treatment planning.
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Affiliation(s)
- Leilei Zhao
- Department of Radiology, Jinan Children's Hospital, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Jianshe Zhao
- Department of Radiology, Jinan Children's Hospital, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Changyou Ma
- Department of Radiology, Jinan Children's Hospital, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Yi Lu
- Department of Radiology, Jinan Children's Hospital, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Chunhua Dong
- Department of Radiology, Jinan Children's Hospital, Qilu Children's Hospital of Shandong University, Jinan, China
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12
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Serhal A, Lee SK, Michalek J, Serhal M, Omar IM. Role of high-resolution ultrasound and magnetic resonance neurography in the evaluation of peripheral nerves in the upper extremity. J Ultrason 2023; 23:e313-e327. [PMID: 38020515 PMCID: PMC10668945 DOI: 10.15557/jou.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/30/2023] [Indexed: 12/01/2023] Open
Abstract
Upper extremity entrapment neuropathies are common conditions in which peripheral nerves are prone to injury at specific anatomical locations, particularly superficial regions or within fibro-osseous tunnels, resulting in pain and potential disability. Although neuropathy is primarily diagnosed clinically by physical examination and electrophysiology, imaging evaluation with ultrasound and magnetic resonance neurography are valuable complementary non-invasive and accurate tools for evaluation and can help define the site and cause of nerve dysfunction which ultimately leads to precise and timely treatment. Ultrasound, which has higher spatial resolution, can quickly and comfortably characterize the peripheral nerves in real time and can evaluate for denervation related muscle atrophy. Magnetic resonance imaging on the other hand provides excellent contrast resolution between the nerves and adjacent tissues, also between pathologic and normal segments of peripheral nerves. It can also assess the degree of muscle denervation and atrophy. As a prerequisite for nerve imaging, radiologists and sonographers should have a thorough knowledge of anatomy of the peripheral nerves and their superficial and deep branches, including variant anatomy, and the motor and sensory territories innervated by each nerve. The purpose of this illustrative article is to review the common neuropathy and nerve entrapment syndromes in the upper extremities focusing on ultrasound and magnetic resonance neurography imaging.
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Affiliation(s)
- Ali Serhal
- Department of Radiology, Northwestern University, Chicago, USA
| | | | - Julia Michalek
- Department of Radiology, Northwestern Memorial Hospital, Chicago, USA
| | - Muhamad Serhal
- Department of Radiology, Northwestern University, Chicago, USA
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13
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Sneag DB, Abel F, Potter HG, Fritz J, Koff MF, Chung CB, Pedoia V, Tan ET. MRI Advancements in Musculoskeletal Clinical and Research Practice. Radiology 2023; 308:e230531. [PMID: 37581501 PMCID: PMC10477516 DOI: 10.1148/radiol.230531] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 08/16/2023]
Abstract
Over the past decades, MRI has become increasingly important for diagnosing and longitudinally monitoring musculoskeletal disorders, with ongoing hardware and software improvements aiming to optimize image quality and speed. However, surging demand for musculoskeletal MRI and increased interest to provide more personalized care will necessitate a stronger emphasis on efficiency and specificity. Ongoing hardware developments include more powerful gradients, improvements in wide-bore magnet designs to maintain field homogeneity, and high-channel phased-array coils. There is also interest in low-field-strength magnets with inherently lower magnetic footprints and operational costs to accommodate global demand in middle- and low-income countries. Previous approaches to decrease acquisition times by means of conventional acceleration techniques (eg, parallel imaging or compressed sensing) are now largely overshadowed by deep learning reconstruction algorithms. It is expected that greater emphasis will be placed on improving synthetic MRI and MR fingerprinting approaches to shorten overall acquisition times while also addressing the demand of personalized care by simultaneously capturing microstructural information to provide greater detail of disease severity. Authors also anticipate increased research emphasis on metal artifact reduction techniques, bone imaging, and MR neurography to meet clinical needs.
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Affiliation(s)
- Darryl B. Sneag
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Frederik Abel
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Hollis G. Potter
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Jan Fritz
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Matthew F. Koff
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Christine B. Chung
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Valentina Pedoia
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Ek T. Tan
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
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Boonsuth R, Battiston M, Grussu F, Samlidou CM, Calvi A, Samson RS, Gandini Wheeler-Kingshott CAM, Yiannakas MC. Feasibility of in vivo multi-parametric quantitative magnetic resonance imaging of the healthy sciatic nerve with a unified signal readout protocol. Sci Rep 2023; 13:6565. [PMID: 37085693 PMCID: PMC10121559 DOI: 10.1038/s41598-023-33618-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/15/2023] [Indexed: 04/23/2023] Open
Abstract
Magnetic resonance neurography (MRN) has been used successfully over the years to investigate the peripheral nervous system (PNS) because it allows early detection and precise localisation of neural tissue damage. However, studies demonstrating the feasibility of combining MRN with multi-parametric quantitative magnetic resonance imaging (qMRI) methods, which provide more specific information related to nerve tissue composition and microstructural organisation, can be invaluable. The translation of emerging qMRI methods previously validated in the central nervous system to the PNS offers real potential to characterise in patients in vivo the underlying pathophysiological mechanisms involved in a plethora of conditions of the PNS. The aim of this study was to assess the feasibility of combining MRN with qMRI to measure diffusion, magnetisation transfer and relaxation properties of the healthy sciatic nerve in vivo using a unified signal readout protocol. The reproducibility of the multi-parametric qMRI protocol as well as normative qMRI measures in the healthy sciatic nerve are reported. The findings presented herein pave the way to the practical implementation of joint MRN-qMRI in future studies of pathological conditions affecting the PNS.
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Affiliation(s)
- Ratthaporn Boonsuth
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK.
- Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.
| | - Marco Battiston
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Francesco Grussu
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Christina Maria Samlidou
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Alberto Calvi
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Hospital Clinic Barcelona, Fundació Clinic Per a La Recerca Biomedica, Barcelona, Spain
| | - Rebecca S Samson
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- Brain Connectivity Research Centre, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Marios C Yiannakas
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
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Multi-echo in steady-state acquisition improves MRI image quality and lumbosacral radiculopathy diagnosis efficacy compared with T2 fast spin-echo sequence. Neuroradiology 2023; 65:969-977. [PMID: 36862186 DOI: 10.1007/s00234-023-03130-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/05/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE This study compares the performance of a 4-min multi-echo in steady-state acquisition (MENSA) with a 6-min fast spin echo with variable flip angle (CUBE) protocol for the assessment of lumbosacral plexus nerve root lesions. METHODS Seventy-two subjects underwent MENSA and CUBE sequences on a 3.0-T MRI scanner. Two musculoskeletal radiologists independently assessed the images for quality and diagnostic capability. A qualitative assessment scoring system for image quality and quantitative nerve signal-to-noise ratio (SNR) and iliac vein and muscle contrast-to-noise ratios (CNR) was applied. Using surgical reports as the reference, sensitivity, specificity, accuracy, and area under the receiver operating characteristic curves (AUC) were evaluated. Intraclass correlation coefficients (ICC) and weighted kappa were used to calculate reliability. RESULTS MENSA image quality rating (3.679 ± 0.47) was higher than for CUBE images (3.038 ± 0.68), and MENSA showed higher mean nerve root SNR (36.935 ± 8.33 vs. 27.777 ± 7.41), iliac vein CNR (24.678 ± 6.63 vs. 5.210 ± 3.93), and muscle CNR (19.414 ± 6.07 vs. 13.531 ± 0.65) than CUBE (P < 0.05). Weighted kappa and ICC values indicated good reliability. Sensitivity, specificity, and accuracy of diagnosis based on MENSA images were 96.23%, 89.47%, and 94.44%, respectively, and AUC was 0.929, compared with 92.45%, 84.21%, 90.28%, and 0.883 for CUBE images. The two correlated ROC curves were not significantly different. Weighted kappa values for intraobserver (0.758) and interobserver (0.768-0.818) reliability were substantial to perfect. CONCLUSION A time-efficient 4-min MENSA protocol exhibits superior image quality and high vascular contrast with the potential to produce high-resolution lumbosacral nerve root images.
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Abstract
ABSTRACT Magnetic resonance neurography of the brachial plexus (BP) is challenging owing to its complex anatomy and technical obstacles around this anatomic region. Magnetic resonance techniques to improve image quality center around increasing nerve-to-background contrast ratio and mitigating imaging artifacts. General considerations include unilateral imaging of the BP at 3.0 T, appropriate selection and placement of surface coils, and optimization of pulse sequences. Technical considerations to improve nerve conspicuity include fat, vascular, and respiratory artifact suppression techniques; metal artifact reduction techniques; and 3-dimensional sequences. Specific optimization of these techniques for BP magnetic resonance neurography greatly improves image quality and diagnostic confidence to help guide nonoperative and operative management.
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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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Thejeel B, Endo Y. Imaging of total hip arthroplasty: part II – imaging of component dislocation, loosening, infection, and soft tissue injury. Clin Imaging 2022; 92:72-82. [DOI: 10.1016/j.clinimag.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
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Kim SG, Jung JY. Role of MR Neurography for Evaluation of the Lumbosacral Plexus: A Scoping Review. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:1273-1285. [PMID: 36545407 PMCID: PMC9748467 DOI: 10.3348/jksr.2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 06/06/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022]
Abstract
Purpose MR neurography (MRN) is an imaging technique optimized to visualize the peripheral nerves. This review aimed to discover an optimized protocol for MRN of the lumbosacral plexus (LSP) and identify evidence for the clinical benefit of lumbosacral plexopathies. Materials and Methods We performed a systematic search of the two medical databases until September 2021. 'Magnetic resonance imaging', 'lumbosacral plexus', 'neurologic disease', or equivalent terms were used to search the literature. We extracted information on indications, MRN protocols for LSP, and clinical efficacy from 55 studies among those searched. Results MRN of the LSP is useful for displaying the distribution of peripheral nerve disease, guiding perineural injections, and assessing extraspinal causes of sciatica. Three-dimensional short-tau inversion recovery turbo spin-echo combined with vascular suppression is the mainstay of MRN. Conclusion Future work on the MRN of LSP should be directed to technical maturation and clinical validation of efficacy.
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Yoon D, Antil N, Biswal S, Lutz AM. A robust 3D fast spin-echo technique for fast examination of the brachial plexus. Skeletal Radiol 2022; 51:1865-1872. [PMID: 35347408 DOI: 10.1007/s00256-022-04021-9] [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] [Received: 10/05/2021] [Revised: 02/17/2022] [Accepted: 02/17/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To introduce a 3D fast spin-echo (FSE) sequence technique that may replace conventional clinical 2D FSE sequences for examining the brachial plexus. MATERIALS AND METHODS A 3D FSE sequence with motion-sensitized driven equilibrium magnitude preparation, triple-echo Dixon, and outer-volume suppression techniques, dubbed as MSDE-CUBE-fTED, was compared with clinical 2D T2-weighted and T1-weighted FSE sequences on the conventional brachial plexus exam of 14 volunteers. The resulting images were evaluated by two radiologists for fat suppression, blood flow suppression, nerve visualization, scalene muscle shape, surrounding fat planes, and diagnostic confidence. The inter-rater agreement of the reviewers was also measured. In addition, the signal magnitude ratios and contrast-to-noise ratios between nerve-to-vessel, nerve-to-muscle, and fat-to-muscle were compared. RESULTS The MSDE-CUBE-fTED sequence scored significantly higher than the T2-weighed FSE sequence in all visualization categories (P < 0.05). Its score was not significantly different from that of the T1-weighted FSE in muscle and fat visualization (P ≥ 0.5). The inter-rater agreements were substantial (Gwet's agreement coefficient ≥ 0.7). The signal magnitude and contrast ratios were significantly higher in the MSDE-CUBE-fTED sequence (P < 0.05). CONCLUSION Our results suggest that the MSDE-CUBE-fTED sequence can make a potential alternative to standard T2- and T1-weighted FSE sequences for examining the brachial plexus.
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Affiliation(s)
- Daehyun Yoon
- Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Neha Antil
- Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Sandip Biswal
- Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Amelie M Lutz
- Radiology, Stanford University, Stanford, CA, 94305, USA.
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21
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Martín-Noguerol T, Montesinos P, Hassankhani A, Bencardino DA, Barousse R, Luna A. Technical Update on MR Neurography. Semin Musculoskelet Radiol 2022; 26:93-104. [PMID: 35609571 DOI: 10.1055/s-0042-1742753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Imaging evaluation of peripheral nerves (PNs) is challenging. Magnetic resonance imaging (MRI) and ultrasonography are the modalities of choice in the imaging assessment of PNs. Both conventional MRI pulse sequences and advanced techniques have important roles. Routine MR sequences are the workhorse, with the main goal to provide superb anatomical definition and identify focal or diffuse nerve T2 signal abnormalities. Selective techniques, such as three-dimensional (3D) cranial nerve imaging (CRANI) or 3D NerveVIEW, allow for a more detailed evaluation of normal and pathologic states. These conventional pulse sequences have a limited role in the comprehensive assessment of pathophysiologic and ultrastructural abnormalities of PNs. Advanced functional MR neurography sequences, such as diffusion tensor imaging tractography or T2 mapping, provide useful and robust quantitative parameters that can be useful in the assessment of PNs on a microscopic level. This article offers an overview of various technical parameters, pulse sequences, and protocols available in the imaging of PNs and provides tips on avoiding potential pitfalls.
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Affiliation(s)
| | | | - Alvand Hassankhani
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | - Rafael Barousse
- Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina
| | - Antonio Luna
- MRI Unit, Radiology Department, HT Médica, Jaén, Spain
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22
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Aoike T, Fujima N, Yoneyama M, Fujiwara T, Takamori S, Aoike S, Ishizaka K, Kudo K. Development of three-dimensional MR neurography using an optimized combination of compressed sensing and parallel imaging. Magn Reson Imaging 2021; 87:32-37. [PMID: 34968698 DOI: 10.1016/j.mri.2021.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/18/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the cervical magnetic resonance neurography (MRN) imaging quality obtained with compressed sensing and sensitivity-encoding (compressed SENSE; CS-SENSE) technique in comparison to that obtained with the conventional parallel imaging (i.e., SENSE) technique. MATERIALS AND METHODS Five healthy volunteers underwent a three-dimensional (3D) turbo spin-echo (TSE)-based cervical MRN examination using a 3.0 Tesla MR-unit. All MRN acquisitions were performed with CS-SENSE and conventional SENSE. We used four acceleration factors (4, 8, 16 and 32) in CS-SENSE. The image quality in MRN was evaluated by assessing the degree of cervical nerve depiction using the contrast ratio (CR) and contrast-noise ratio (CNR) between the cervical nerve and the background signal intensity and a visual scoring system (1: poor, 2: moderate, 3: good). In all of the CR, CNR and visual score, we calculated the ratio of the CS-SENSE-based MRN to that from SENSE-based MRN plus the 95% confidence intervals (CIs) of these ratios. RESULTS In the multiple comparison of MRN images with the control of conventional SENSE-based MRN, both the quantitative CR values and the visual score for the CS-SENSE factors of 16 and 32 were significantly lower, whereas the CS-SENSE factors of 4 and 8 showed a non-significant difference. In addition, the quantitative CNR values obtained with the CS-SENSE factors of 4 and 8 were significantly higher than that obtained with the conventional SENSE-based MRN while the CS-SENSE factor of 32 was significantly lower, in contrast, the CS-SENSE factors of 16 showed a non-significant difference. For CS-SENSE factors of 4 and 8, all ratios of the CS-SENSE-based MRN values for CR, CNR and visual scores to those from SENSE-based MRN were above 0.95. CONCLUSION CS-SENSE-based MRN can accomplish fast scanning with sufficient image quality when using a high acceleration factor.
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Affiliation(s)
- Takuya Aoike
- Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.
| | | | - Taro Fujiwara
- Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Sayaka Takamori
- Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Suzuko Aoike
- Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Kinya Ishizaka
- Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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23
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Boonsuth R, Samson RS, Tur C, Battiston M, Grussu F, Schneider T, Yoneyama M, Prados F, Ttofalla A, Collorone S, Cortese R, Ciccarelli O, Gandini Wheeler-Kingshott CAM, Yiannakas MC. Assessing Lumbar Plexus and Sciatic Nerve Damage in Relapsing-Remitting Multiple Sclerosis Using Magnetisation Transfer Ratio. Front Neurol 2021; 12:763143. [PMID: 34899579 PMCID: PMC8654928 DOI: 10.3389/fneur.2021.763143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/21/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Multiple sclerosis (MS) has traditionally been regarded as a disease confined to the central nervous system (CNS). However, neuropathological, electrophysiological, and imaging studies have demonstrated that the peripheral nervous system (PNS) is also involved, with demyelination and, to a lesser extent, axonal degeneration representing the main pathophysiological mechanisms. Aim: The purpose of this study was to assess PNS damage at the lumbar plexus and sciatic nerve anatomical locations in people with relapsing-remitting MS (RRMS) and healthy controls (HCs) in vivo using magnetisation transfer ratio (MTR), which is a known imaging biomarker sensitive to alterations in myelin content in neural tissue, and not previously explored in the context of PNS damage in MS. Method: Eleven HCs (7 female, mean age 33.6 years, range 24-50) and 15 people with RRMS (12 female, mean age 38.5 years, range 30-56) were recruited for this study and underwent magnetic resonance imaging (MRI) investigations together with clinical assessments using the expanded disability status scale (EDSS). Magnetic resonance neurography (MRN) was first used for visualisation and identification of the lumbar plexus and the sciatic nerve and MTR imaging was subsequently performed using identical scan geometry to MRN, enabling straightforward co-registration of all data to obtain global and regional mean MTR measurements. Linear regression models were used to identify differences in MTR values between HCs and people with RRMS and to identify an association between MTR measures and EDSS. Results: MTR values in the sciatic nerve of people with RRMS were found to be significantly lower compared to HCs, but no significant MTR changes were identified in the lumbar plexus of people with RRMS. The median EDSS in people with RRMS was 2.0 (range, 0-3). No relationship between the MTR measures in the PNS and EDSS were identified at any of the anatomical locations studied in this cohort of people with RRMS. Conclusion: The results from this study demonstrate the presence of PNS damage in people with RRMS and support the notion that these changes, suggestive of demyelination, maybe occurring independently at different anatomical locations within the PNS. Further investigations to confirm these findings and to clarify the pathophysiological basis of these alterations are warranted.
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Affiliation(s)
- Ratthaporn Boonsuth
- Nuclear Magnetic Resonance Research Unit, Queen Square MS Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rebecca S. Samson
- Nuclear Magnetic Resonance Research Unit, Queen Square MS Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Carmen Tur
- Nuclear Magnetic Resonance Research Unit, Queen Square MS Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Institute of Research, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marco Battiston
- Nuclear Magnetic Resonance Research Unit, Queen Square MS Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Francesco Grussu
- Nuclear Magnetic Resonance Research Unit, Queen Square MS Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
- Radiomics Group, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | | | | | - Ferran Prados
- Nuclear Magnetic Resonance Research Unit, Queen Square MS Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, United Kingdom
- E-Health Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Antrea Ttofalla
- Nuclear Magnetic Resonance Research Unit, Queen Square MS Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sara Collorone
- Nuclear Magnetic Resonance Research Unit, Queen Square MS Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rosa Cortese
- Nuclear Magnetic Resonance Research Unit, Queen Square MS Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Olga Ciccarelli
- Nuclear Magnetic Resonance Research Unit, Queen Square MS Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Claudia A. M. Gandini Wheeler-Kingshott
- Nuclear Magnetic Resonance Research Unit, Queen Square MS Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Brain Connectivity Research Centre, Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia, Italy
| | - Marios C. Yiannakas
- Nuclear Magnetic Resonance Research Unit, Queen Square MS Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, University College London, London, United Kingdom
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24
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Nair PP, Mariappan YK, Paruthikunnan SM, Kamath A, Rolla NK, Saha I, Kadavigere R. Magnetic Resonance Neurography of the Brachial Plexus Using 3D SHINKEI: Comparative Evaluation with Conventional Magnetic Resonance Sequences for the Visualization of Anatomy and Detection of Nerve Injury at 1.5T. J Med Phys 2021; 46:140-147. [PMID: 34703097 PMCID: PMC8491319 DOI: 10.4103/jmp.jmp_13_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Purpose This work aims at optimizing and studying the feasibility of imaging the brachial plexus at 1.5T using 3D nerve-SHeath signal increased with INKed rest-tissue RARE imaging (3D SHINKEI) neurography sequence by comparing with routine sequences. Materials and Methods The study was performed on a 1.5T Achieva scanner. It was designed in two parts: (a) Optimization of SHINKEI sequence at 1.5T; and (b) Feasibility study of the optimized SHINKEI sequence for generating clinical quality magnetic resonance neurography images at 1.5T. Simulations and volunteer experiments were conducted to optimize the T2 preparation duration for optimum nerve-muscle contrast at 1.5T. Images from the sequence under study and other routine sequences from 24 patients clinically referred for brachial plexus imaging were scored by a panel of radiologists for diagnostic quality. Injury detection efficacy of these sequences were evaluated against the surgical information available from seven patients. Results T2 preparation duration of 50 ms gives the best contrast to noise between nerve and muscle. The images of 3D SHINKEI and short-term inversion recovery turbo spin-echo sequences are of similar diagnostic quality but significantly better than diffusion weighted imaging with background signal suppression. In comparison with the surgical findings, 3D SHINKEI has the lowest specificity; however, it had the highest sensitivity and predictive efficacy compared to other routine sequences. Conclusion 3D SHINKEI sequence provides a good nerve-muscle contrast and has high predictive efficacy of nerve injury, indicating that it is a potential screening sequence candidate for brachial plexus scans at 1.5T also.
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Affiliation(s)
- Prashant Prabhakaran Nair
- Department of Radiodiagnosis and Imaging, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
| | | | - Samir M Paruthikunnan
- Department of Radiodiagnosis and Imaging, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
| | - Asha Kamath
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Gurgaon, Haryana, India
| | | | | | - Rajagopal Kadavigere
- Department of Radiodiagnosis and Imaging, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
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25
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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.
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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
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26
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Enomoto K, Eguchi Y, Sato T, Norimoto M, Inoue M, Watanabe A, Sakai T, Yoneyama M, Aoki Y, Orita S, Narita M, Inage K, Shiga Y, Umimura T, Sato M, Suzuki M, Takaoka H, Mizuki N, Kim G, Hozumi T, Hirosawa N, Furuya T, Maki S, Nakamura J, Hagiwara S, Koda M, Akazawa T, Takahashi H, Takahashi K, Ohtori S. Usefulness of Simultaneous Magnetic Resonance Neurography and Apparent T2 Mapping for the Diagnosis of Cervical Radiculopathy. Asian Spine J 2021; 16:47-55. [PMID: 34000796 PMCID: PMC8873997 DOI: 10.31616/asj.2020.0668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective observational study. Purpose We investigated the correlation between T2 relaxation times and clinical symptoms in patients with cervical radiculopathy caused by cervical disk herniation. Overview of Literature There are currently no imaging modalities that can assess the affected cervical nerve roots quantitatively. Methods A total of 14 patients with unilateral radicular symptoms and five healthy subjects were subjected to simultaneous apparent T2 mapping and neurography with nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement signaling (SHINKEI-Quant) using a 3-Tesla magnetic resonance imaging. The Visual Analog Scale (VAS) score for neck pain and upper arm pain was used to evaluate clinical symptoms. T2 relaxation times of the cervical dorsal root ganglia of the brachial plexus were measured bilaterally from C4 to C8 in patients with radicular symptoms and from C5 to C8 in healthy controls. The T2 ratio was calculated as the affected side to unaffected side. Results When comparing nerve roots bilaterally at each spinal level, no significant differences in T2 relaxation times were found between patients and healthy subjects. However, T2 relaxation times of nerve roots in the patients with unilateral radicular symptoms were significantly prolonged on the involved side compared with the uninvolved side (p<0.05). The VAS score for upper arm pain was not significantly correlated with the T2 relaxation times, but was positively correlated with the T2 ratio. Conclusions In patients with cervical radiculopathy, the SHINKEI-Quant technique can be used to quantitatively evaluate the compressed cervical nerve roots. The VAS score for upper arm pain was positively correlated with the T2 ratio. This suggests that the SHINKEI-Quant is a potential tool for the diagnosis of cervical nerve entrapment.
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Affiliation(s)
- Keigo Enomoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Orthopaedic Surgery, Shimoshizu National Hospital, Yotsukaido, Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaki Norimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center, Togane, Japan.,Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | | | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Miyako Narita
- 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
| | - Yasuhiro Shiga
- 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
| | - 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
| | - Hiromitsu Takaoka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Norichika Mizuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Geundong Kim
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Hozumi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Hirosawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeo Furuya
- 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
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Kazuhisa Takahashi
- 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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27
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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.
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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
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28
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Yoshino K, Hagiwara S, Nakamura J, Horikoshi T, Yokota H, Shimokawa K, Matsumoto K, Shiko Y, Kawasaki Y, Ohtori S. The distance between the femoral nerve and anterior acetabulum is significantly shorter in hip osteoarthritis than in non-osteoarthritis hip. BMC Musculoskelet Disord 2021; 22:416. [PMID: 33952226 PMCID: PMC8101116 DOI: 10.1186/s12891-021-04295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/21/2021] [Indexed: 11/27/2022] Open
Abstract
Background The appropriate position of retractors to minimize the risk of femoral nerve palsy remains uncertain. The purpose of this imaging study was to evaluate the distance between the femoral nerve (FN) and anterior acetabulum (AA) in hip osteoarthritis (OA). Methods Forty-one patients with unilateral hip OA underwent magnetic resonance imaging. Three measurement levels were defined and the minimum distance between the femoral nerve (FN) margin and anterior acetabulum (AA) rim was measured on axial T1-weighted images on the OA and normal sides at each level, with reference to an advanced neurography view. The cross-sectional area (CSA) of the iliopsoas muscle was also measured at each level bilaterally by three observers. Distances and CSAs were compared between the OA and normal side. Multiple regression analysis was performed to identify variables associated with the distance in OA. Results The mean minimum FN to AA distances in OA were 19.4 mm at the top of the anterior inferior iliac spine (AIIS), 24.3 mm at the bottom of the AIIS, and 21.0 mm at the tip of the greater trochanter. These distances were significantly shorter than in normal hips at the top and bottom of the AIIS, with mean differences of 1.6 and 5.8 mm, respectively (p = 0.012, p < 0.001). CSAs of the iliopsoas in OA were significantly smaller at all levels (all p < 0.001), with reductions of 10.5 to 17.9%. The CSA of the iliopsoas at the bottom of the AIIS was associated with the FN to AA distance at the same level (p = 0.026). Interobserver reliabilities for measurements were very good to perfect (intraclass correlation coefficients 0.897 to 0.966). Conclusions To minimize the risk of femoral nerve palsy, surgeons should consider the change of the femoral nerve to anterior acetabulum distance in osteoarthritic hip surgery.
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Affiliation(s)
- Kensuke Yoshino
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Takuro Horikoshi
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Yokota
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kenji Shimokawa
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koji Matsumoto
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
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De Paepe KN, Higgins DM, Ball I, Morgan VA, Barton DP, deSouza NM. Visualizing the autonomic and somatic innervation of the female pelvis with 3D MR neurography: a feasibility study. Acta Radiol 2020; 61:1668-1676. [PMID: 32212832 PMCID: PMC7720358 DOI: 10.1177/0284185120909337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Treatment of female pelvic malignancies often causes pelvic nerve damage. Magnetic resonance (MR) neurography mapping the female pelvic innervation could aid in treatment planning. PURPOSE To depict female autonomic and somatic pelvic innervation using a modified 3D NerveVIEW sequence. MATERIAL AND METHODS Prospective study in 20 female volunteers (n = 6 normal, n = 14 cervical pathology) who underwent a modified 3D short TI inversion recovery (STIR) turbo spin-echo (TSE) scan with a motion-sensitive driven equilibrium (MSDE) preparation radiofrequency pulse and flow compensation. Modifications included offset independent trapezoid (OIT) pulses for inversion and MSDE refocusing. Maximum intensity projections (MIP) were evaluated by two observers (Observer 1, Observer 2); image quality was scored as 2 = high, 1 = medium, or 0 = low with the sciatic nerve serving as a reference. Conspicuity of autonomic superior (SHP) and bilateral inferior hypogastric plexuses (IHP), hypogastric nerves, and somatic pelvic nerves (sciatic, pudendal) was scored as 2 = well-defined, 1 = poorly defined, or 0 = not seen, and inter-observer agreement was determined. RESULTS Images were of medium to high quality according to both observers agreeing in 15/20 (75%) of individuals. SHP and bilateral hypogastric nerves were seen in 30/60 (50%) of cases by both observers. Bilateral IHP was seen in 85% (34/40) by Observer 1 and in 75% (30/40) by Observer 2. Sciatic nerves were well identified in all cases, while pudendal nerves were seen bilaterally by Observer 1 in 65% (26/40) and by Observer 2 in 72.5% (29/40). Agreement between observers for scoring nerve conspicuity was in the range of 60%-100%. CONCLUSION Modified 3D NerveVIEW renders high-quality images of the female autonomic and pudendal nerves.
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Affiliation(s)
- Katja N De Paepe
- The Institute of Cancer Research, Division of Radiotherapy and Imaging, Sutton, UK
- The Royal Marsden NHS Foundation Trust, Department of Radiology, London, UK
| | | | | | - Veronica A Morgan
- The Royal Marsden NHS Foundation Trust, Department of Radiology, London, UK
| | - Desmond P Barton
- The Royal Marsden NHS Foundation Trust, Department of Gynecological Oncology, London, UK
| | - Nandita M deSouza
- The Institute of Cancer Research, Division of Radiotherapy and Imaging, Sutton, UK
- The Royal Marsden NHS Foundation Trust, Department of Radiology, London, UK
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Post-Contrast 3D Inversion Recovery Magnetic Resonance Neurography for Evaluation of Branch Nerves of the Brachial Plexus. Eur J Radiol 2020; 132:109304. [PMID: 33035919 DOI: 10.1016/j.ejrad.2020.109304] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/07/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare 3.0 Tesla brachial plexus three-dimensional (3D) T2-weighted short tau inversion recovery fast spin echo (STIR-FSE) MRI sequences before (pre-contrast STIR) and after (post-contrast STIR) administration of gadolinium intravenous contrast. METHOD Eighteen patients were included. Each patient was imaged before and after intravenous contrast administration during the same session. 3D STIR-FSE sequences were obtained at 3.0 Tesla using two 16-channel flexible coils positioned over the lower neck and chest wall region. Three musculoskeletal radiologists qualitatively assessed degree of vascular signal suppression, visualization of the axillary, musculocutaneous, and suprascapular nerves, diagnostic confidence in nerve evaluation, and lesion conspicuity. Marginal ordinal logistic regression models were used to compare subjective ratings between sequences. Pre- and post-STIR lesion conspicuity was compared using Wilcoxon signed-rank test. Inter- and intra-observer agreements were assessed using Gwet's agreement coefficient. RESULTS Vascular signal suppression significantly improved following contrast administration (odds ratio, OR = 209.9, 95% confidence interval, CI: 21.0-2094.6, p < .001). The post-contrast STIR technique significantly improved nerve visualization (OR = 8.4, 95% CI: 3.6-19.9, p < .001) and diagnostic confidence in evaluation (OR = 13.2, 95% CI: 4.8-36.0, p < .001) across all nerve segments. Post-contrast STIR improved lesion conspicuity by 1 point, but statistical significance was not reached (Reader 1: p = 0.5, Reader 2: p = 0.063). Post-contrast STIR imaging demonstrated substantial to near-perfect inter- and intra-rater agreement coefficients for both nerve visualization (inter-rater: 0.74-1.0, intra-rater: 0.94-1.0) and diagnostic confidence (inter-rater: 0.79-1.0, intra-rater: 0.94-1.0). Quantitatively, post-contrast STIR demonstrated a 24% increase in mean C6 nerve-to-muscle signal intensity ratio (p = 0.017). CONCLUSIONS Post-contrast STIR improved nerve-to-muscle contrast ratio, allowing for enhanced visualization and diagnostic confidence in evaluation of branch nerves of the brachial plexus.
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Yiannakas MC, Schneider T, Yoneyama M, Aforlabi-Logoh I, Prados F, Ciccarelli O, Wheeler-Kingshott CAM. Magnetisation transfer ratio combined with magnetic resonance neurography is feasible in the proximal lumbar plexus using healthy volunteers at 3T. Sci Rep 2020; 10:14568. [PMID: 32884016 PMCID: PMC7471697 DOI: 10.1038/s41598-020-71570-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/14/2020] [Indexed: 12/30/2022] Open
Abstract
Magnetic resonance neurography (MRN) has been used extensively to study pathological conditions affecting the peripheral nervous system (PNS). However, tissue damage is assessed qualitatively with little information regarding the underlying pathophysiological processes involved. Magnetisation transfer ratio (MTR) is a quantitative magnetic resonance imaging method which is sensitive to tissue macromolecular content and may therefore have an important role in the study of pathologies affecting the PNS. This study explored the feasibility of obtaining reliable MTR measurements in the proximal lumbar plexus of healthy volunteers using MRN to identify and segment each lumbar segment (L2-L5) and regions (preganglionic, ganglionic and postganglionic). Reproducibility of the MTR measurements and of the segmentation method were assessed from repeated measurements (scan-rescan), and from the reanalysis of images (intra- and inter-rater assessment), by calculating the coefficient of variation (COV). In all segments combined (L2-L5), mean (± SD) MTR was 30.5 (± 2.4). Scan-rescan, intra- and inter-rater COV values were 3.2%, 4.4% and 5.3%, respectively. One-way analysis of variance revealed a statistically significant difference in MTR between the preganglionic and postganglionic regions in all lumbar segments. This pilot study in healthy volunteers demonstrates the feasibility of obtaining reliable MTR measurements in the proximal lumbar plexus, opening up the possibility of studying a broad spectrum of neurological conditions in vivo.
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Affiliation(s)
- Marios C Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, Queen Square House, Queen Square, London, WC1N 3BG, UK.
| | | | | | - Innocent Aforlabi-Logoh
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, Queen Square House, Queen Square, London, WC1N 3BG, UK
| | - Ferran Prados
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, Queen Square House, Queen Square, London, WC1N 3BG, UK
- Centre for Medical Image Computing, Medical Physics and Biomedical Engineering Department, University College London, London, UK
- e-Health Centre, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, Queen Square House, Queen Square, London, WC1N 3BG, UK
| | - Claudia A M Wheeler-Kingshott
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, Queen Square House, Queen Square, London, WC1N 3BG, UK
- Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
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Combine contrast-enhanced 3D T2-weighted short inversion time inversion recovery MR neurography with MR angiography at 1.5 T in the assessment of brachial plexopathy. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 34:229-239. [DOI: 10.1007/s10334-020-00867-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/20/2020] [Accepted: 07/08/2020] [Indexed: 12/21/2022]
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Sollmann N, Cervantes B, Klupp E, Weidlich D, Makowski MR, Kirschke JS, Hu HH, Karampinos DC. Magnetic resonance neurography of the lumbosacral plexus at 3 Tesla - CSF-suppressed imaging with submillimeter resolution by a three-dimensional turbo spin echo sequence. Magn Reson Imaging 2020; 71:132-139. [PMID: 32553857 DOI: 10.1016/j.mri.2020.06.009] [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] [Received: 04/12/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate magnetic resonance neurography (MRN) of the lumbosacral plexus (LSP) with cerebrospinal fluid (CSF) suppression by using submillimeter resolution for three-dimensional (3D) turbo spin echo (TSE) imaging. MATERIALS AND METHODS Using extended phase graph (EPG) analysis, the signal response of CSF was simulated considering dephasing from coherent motion for frequency-encoding voxel sizes ranging from 0.3 to 1.3 mm and for CSF velocities ranging from 0 to 4 cm/s. In-vivo MRN included 3D TSE data with frequency encoding parallel to the feet/head axis from 15 healthy adults (mean age: 28.5 ± 3.8 years, 5 females; acquisition voxel size: 2 × 2 × 2 mm3) and 16 pediatric patients (mean age: 6.7 ± 4.1 years, 7 females; acquisition voxel size: 0.7 × 0.7 × 1.4 mm3) acquired at 3 Tesla. Five of the adults were scanned repetitively with changing acquisition voxel sizes (1 × 2 × 2 mm3, 0.7 × 2× 2 mm3, and 0.5 × 2 × 2 mm3). Measurements of the bilateral ganglion of the L5 nerve root, averaged between sides, as well as the CSF in the thecal sac were obtained for all included subjects and compared between adults and pediatric patients and between voxel sizes, using a CSF-to-nerve signal ratio (CSFNR). RESULTS According to simulations, the CSF signal is reduced along the echo train for moving spins. Specifically, it can be reduced by over 90% compared to the maximum simulated signal for flow velocities above 2 cm/s, and could be most effectively suppressed by considering a frequency-encoding voxel size of 0.8 mm or less. For in-vivo measurements, mean CSFNR was 1.52 ± 0.22 for adults and 0.10 ± 0.03 for pediatric patients (p < .0001). Differences in CSFNR were significant between measurements using a voxel size of 2 × 2 × 2 mm3 and measurements in data with reduced voxel sizes (p ≤ .0012), with submillimeter resolution (particularly 0.5 × 2 × 2 mm3) providing highest CSF suppression. CONCLUSIONS Applying frequency-encoding voxel sizes in submillimeter range for 3D TSE imaging with frequency encoding parallel to the feet/head axis may considerably improve MRN of LSP pathology in adults in the future because of favorable CSF suppression.
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Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Barbara Cervantes
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Elisabeth Klupp
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Dominik Weidlich
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Houchun H Hu
- Department of Medical Imaging and Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA; Hyperfine Research, Guilford, CT, USA
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Zhang Y, Kong X, Zhao Q, Liu X, Gu Y, Xu L. Enhanced MR neurography of the lumbosacral plexus with robust vascular suppression and improved delineation of its small branches. Eur J Radiol 2020; 129:109128. [PMID: 32554296 DOI: 10.1016/j.ejrad.2020.109128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/20/2020] [Accepted: 06/07/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate whether gadolinium enhanced 3D SPACE STIR sequence technique increases the visualization of the lumbosacral plexus (LSP) and its small branches. METHODS A retrospective study was performed on 24 patients who had underwent 3D SPACE STIR sequences scan with and without the administration of gadolinium contrast. In this study, we focused on the healthy sides of the LSP and its branches in each patient. The contrast ratio (CR), contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were objectively calculated by two experienced radiologists. The subjective visualization scores of the branches that were vitally important to therapeutic decision-making including femoral nerves, obturator nerves, lumbosacral trunks, superior gluteal and extra-pelvic sciatic nerves, were assessed using post-processing images. RESULTS Of the 24 subjects, all LSP nerve roots, femoral nerves, lumbosacral trunks and sciatic nerves were illustrated on both contrast-enhanced and non-contrast images. The enhanced images were found to have higher nerve to vein CNRs compared to non-contrast images. Compared to non-contrast images, the CRs of nerves versus surrounding fat tissues, bones, veins and muscles were improved in contrast-enhanced images, while the SNRs were better but not significantly so. Targeted maximum intensity projection (MIP) nerves including femoral, obturator, superior gluteal and extra-pelvic sciatic nerves obtained significantly higher subjective scores when gadolinium was administered. CONCLUSIONS The gadolinium enhanced 3D SPACE STIR sequence provided superior vascular suppression, resulting in increased conspicuity of LSP and its small branches. Altogether, this shows great potential for therapeutic decision-making in traumatic LSP lesions cases.
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Affiliation(s)
- Youlai Zhang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, 200030, People's Republic of China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, 200030, People's Republic of China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Qian Zhao
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, 200030, People's Republic of China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, 200030, People's Republic of China
| | - Xi Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yudong Gu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, 200030, People's Republic of China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, 200030, People's Republic of China
| | - Lei Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, 200030, People's Republic of China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, 200030, People's Republic of China.
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Chronic Pelvic Pain and the Chronic Overlapping Pain Conditions in Women. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00267-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Sato T, Eguchi Y, Norimoto M, Inoue M, Enomoto K, Watanabe A, Sakai T, Yoneyama M, Aoki Y, Orita S, Narita M, Inage K, Shiga Y, Umimura T, Sato M, Suzuki M, Takaoka H, Mizuki N, Kim G, Hozumi T, Hirosawa N, Furuya T, Maki S, Nakamura J, Hagiwara S, Koda M, Akazawa T, Takahashi H, Takahashi K, Ohtori S. Diagnosis of lumbar radiculopathy using simultaneous MR neurography and apparent T2 mapping. J Clin Neurosci 2020; 78:339-346. [PMID: 32336629 DOI: 10.1016/j.jocn.2020.04.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
Abstract
We sought to assess the utility of simultaneous apparent T2 mapping and neurography with the nerve-sheath signal increased by inked rest-tissue rapid acquisition of relaxation-enhancement imaging (SHINKEI-Quant) for the quantitative evaluation of compressed nerves in patients with lumbar radiculopathy. Thirty-two patients with lumbar radiculopathy and 5 healthy subjects underwent simultaneous apparent T2 mapping and neurography with SHINKEI-Quant. Regions of interest (ROIs) were placed in the lumbar dorsal root ganglia (DRG) and the spinal nerves distal to the lumbar nerves bilaterally at L4-S1. The T2 relaxation times were measured on the affected and unaffected sides. The T2 ratio was calculated as the affected side/unaffected side. Pearson correlation coefficients were calculated to determine the correlation between the T2 relaxation times or T2 ratio and clinical symptoms. An ROC curve was used to examine the diagnostic accuracy and threshold of the T2 relaxation times and T2 ratio. We observed no significant differences in the T2 relaxation times between the nerve roots on the left and right at each spinal level in healthy subjects. In patients, lumbar neurography revealed swelling of the involved nerve, and prolonged T2 relaxation times compared with that of the contralateral nerve. The T2 ratio correlated with leg pain. The ROC analysis revealed that the T2 relaxation time threshold was 127 ms and the T2 ratio threshold was 1.07. To our knowledge, this is the first study to show the utility of SHINKEI-Quant for the quantitative evaluation of lumbar radiculopathy.
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Affiliation(s)
- Takashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan; Department of Orthopaedic Surgery, Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba 284-0003, Japan.
| | - Masaki Norimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan.
| | - Keigo Enomoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan.
| | - Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan; Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan.
| | - Masami Yoneyama
- MR Clinical Science, Philips Japan, 2-13-37 Konan, Minato-ku, Tokyo 108-8507, Japan.
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan.
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Miyako Narita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Tomotaka Umimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Masashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Masahiro Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Hiromitsu Takaoka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Norichika Mizuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Geundong Kim
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Takashi Hozumi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Naoya Hirosawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Masao Koda
- Department of Orthopedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-City, Ibaraki 305-8575, Japan.
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba 285-8741, Japan.
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku 260-0856, Japan.
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Kim DH, Sung DH, Chang MC. Diagnosis of Hourglass-Like Constriction Neuropathy of the Radial Nerve Using High-Resolution Magnetic Resonance Neurography: A Report of Two Cases. Diagnostics (Basel) 2020; 10:diagnostics10040232. [PMID: 32316634 PMCID: PMC7235890 DOI: 10.3390/diagnostics10040232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 11/17/2022] Open
Abstract
Hourglass-like constriction neuropathy is a neurological condition caused by fascicular constriction of one or more peripheral nerves, unrelated to intrinsic or extrinsic compression. It is often neglected in clinical practice, and its diagnosis is challenging. Here, we report two cases of hourglass-like constriction neuropathy in the radial nerve diagnosed using high-resolution magnetic resonance neurography (MRN). Two men, aged 47 and 19 years, developed sudden weakness in the left wrist and finger extensors. They were diagnosed with radial neuropathy between the left mid-humerus level and the elbow joint, using the electrodiagnostic test. To evaluate the cause of the nerve lesion and the lesion location, high-resolution MRN was performed. Patient 1 showed an hourglass-like constriction of the left posterior interosseous nerve within the epineurium of the left radial nerve, 8.9 cm proximal to the lateral epicondyle. Patient 2 showed two focal constrictions of the left radial nerve, 8.0 and 6.9 cm proximal to the lateral epicondyle, respectively, and distal to the radial groove. Additionally, bull’s eye signs were observed juxta-proximal to constrictions of the left radial nerve. The findings were indicative of hourglass-like constriction neuropathy. Both of the patients underwent surgery. However, at the 6-month follow-up, their motor weakness showed no improvement. MRN can be beneficial for diagnosing hourglass-like constriction neuropathy and locating the lesion.
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Affiliation(s)
- Du Hwan Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea;
| | - Duk Hyun Sung
- Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Taegu 705-717, Korea
- Correspondence: ; Tel.: +82-53-620-4682
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Lee SK, Jung JY. Degenerative lumbar scoliosis: added value of coronal images to routine lumbar MRI for nerve root compromise. Eur Radiol 2020; 30:2270-2279. [PMID: 31900693 DOI: 10.1007/s00330-019-06584-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Radiating pain in degenerative scoliosis is primary indication for surgery. However, axial and sagittal MR images are limited for identifying nerve root compromise. Therefore, we aimed to assess the value of coronal images for evaluating nerve root compromise in degenerative scoliosis. METHODS Forty-six patients (mean 70 years; range 41-91 years; 8 men) with degenerative scoliosis were enrolled. Coronal images were added to routine MRI. Two radiologists independently reviewed 350 nerve roots in two MRI sets: sagittal images alone (set 1) and coronal and sagittal images combined (set 2). The following features were evaluated: interpedicular height, lateral osteophyte, asymmetric bulging disc, lateral listhesis, anterolisthesis, axial rotation angle, facet arthrosis, ligamentum flavum thickening, and pseudoarticulation. Symptomatic levels were determined by transforaminal selective nerve root block. RESULTS There were 80 symptomatic and 270 asymptomatic nerve roots. The sensitivity (86%) and accuracy (93%) of set 2 were significantly higher than set 1 (53% and 87%) for radiculopathy, while specificity was similar between two sets (set 1, 97%; set 2, 95%). The AUC was significantly different between two sets (set 1, 0.853; set 2, 0.942). The negative interpedicular height difference, longer lateral osteophyte, asymmetric bulging disc, lateral listhesis, negative axial rotation angle difference, and pseudoarticulation were associated with change of grades between set 1 and set 2. CONCLUSION Coronal images are helpful for diagnosing nerve root compromise in patients with degenerative scoliosis. KEY POINTS • Sagittal and axial images have low sensitivity for detection of extraforaminal nerve root compromise in degenerative scoliosis. • Addition of coronal images may improve the sensitivity in nerve root compromise. • The structural changes that may contribute to nerve root compromise can also be easily assessed with coronal images.
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Affiliation(s)
- Seul Ki Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Ha DH. MR Neurography: Current Several Issues for Novice Radiologists. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:81-100. [PMID: 36238129 PMCID: PMC9432089 DOI: 10.3348/jksr.2020.81.1.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/24/2019] [Accepted: 01/08/2020] [Indexed: 11/15/2022]
Abstract
말초신경병증의 진단을 위해 MR neurography의 사용이 점차 증가하고 있다. 고대조도와 고해상도로 말초신경을 직접 영상화한 MR 영상을 MR neurography라고 하고, 지방억제 T2 강조영상과 확산강조영상이 흔히 사용되는 시퀀스이다. 작은 직경, 복잡한 해부학적 구조를 가진 말초신경을 합리적 시간 안에 영상화하기 위해서 최신의 isotropic 3차원 기법, 다양한 고속영상기법, post-processing 영상 기법 등이 사용된다. 이런 발전들로 인해 MR neurography가 유용하게 사용되지만 항상 적절한 MR neurography 영상을 얻을 수 있는 것은 아니다. 적절한 MR neurography 영상을 얻기 위해 영상의학과 의사가 고려해야 할 다음의 몇가지 쟁점들이 있다. 이에는 적절한 표준 프로토콜의 선책, 지방억제 기법의 선택, 해상도와 field of view와 slice thickness 간의 상호 관계의 이해, 적절한 post-processing 영상 기법의 적용, 2차원 영상획득 기법과 3차원 영상획득 기법의 장단점, 근위부 말초신경과 말단부 말초신경의 T2 대조도의 차이, 말초신경에 인접한 정맥이 MR neurography에 미치는 영향, 확산강조영상에서 기하학적 왜곡의 발생과 적절한 b value의 선택 등이다. 이런 쟁점들을 잘 이해하는 것이 경험이 적은 영상의학과 의사가 적절한 MR neurography 영상을 얻고, 말초신경병증을 정확히 평가하는 데 많은 도움이 될 것이다.
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Affiliation(s)
- Dong-ho Ha
- Department of Radiology, Dong-A University, Busan, Korea
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Eguchi Y, Enomoto K, Sato T, Watanabe A, Sakai T, Norimoto M, Yoneyama M, Aoki Y, Suzuki M, Yamanaka H, Tamai H, Kobayashi T, Orita S, Suzuki M, Inage K, Shiga Y, Hirosawa N, Inoue M, Koda M, Furuya T, Nakamura J, Hagiwara S, Akazawa T, Takahashi H, Takahashi K, Ohtori S. Simultaneous MR neurography and apparent T2 mapping of cervical nerve roots before microendoscopic surgery to treat patient with radiculopathy due to cervical disc herniation: Preliminary results. J Clin Neurosci 2019; 74:213-219. [PMID: 31526679 DOI: 10.1016/j.jocn.2019.08.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/26/2019] [Indexed: 11/17/2022]
Abstract
There is no imaging modality to quantitatively evaluate compressed cervical nerve roots in cervical radiculopathy. Here we sought to evaluate the usefulness of simultaneous apparent T2 mapping and neurography with nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation-enhancement imaging (SHINKEI-Quant) to evaluate compressed nerves quantitatively in patients with cervical radiculopathy due to cervical disc hernia before microendoscopic surgery. One patient with cervical radiculopathy due to cervical disc hernia before microendoscopic surgery and 5 healthy subjects underwent simultaneous apparent T2 mapping and neurography with SHINKEI-Quant. The patient was a 49-year-old man with severe right upper arm pain and numbness. Based on MRI images, we suspected right C7 radiculopathy due to C6-7 cervical disc hernia. The T2 relaxation times of the cervical dorsal root ganglia of the brachial plexus bilaterally at C5-C8 were measured. We observed no significant differences in T2 relaxation times between the nerve roots on the left and right at each spinal level with values in healthy subjects. In our patient, neurography revealed swelling of the right C7 nerve, and a prolonged T2 relaxation time compared with that of the contralateral, unaffected C7 nerve. We performed microendoscopic surgery and the symptoms improved. We were able to evaluate the injured nerve root quantitatively in a patient with cervical radiculopathy using the SHINKEI-Quant technique, being the first study to our knowledge to show the usefulness of this technique to evaluate cervical radiculopathy quantitatively before microendoscopic surgery.
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Affiliation(s)
- Yawara Eguchi
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba 284-0003, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, 260-0856, Japan.
| | - Keigo Enomoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, 260-0856, Japan.
| | - Takashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, 260-0856, Japan.
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan.
| | - Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan; Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan.
| | - Masaki Norimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, 260-0856, Japan
| | - Masami Yoneyama
- MR Clinical Science, Philips Japan, 2-13-37 Konan, Minato-ku, Tokyo 108-8507, Japan.
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan.
| | - Munetaka Suzuki
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba 284-0003, Japan.
| | - Hajime Yamanaka
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba 284-0003, Japan.
| | - Hiroshi Tamai
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba 284-0003, Japan.
| | - Tatsuya Kobayashi
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba 284-0003, Japan.
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, 260-0856, Japan.
| | - Miyako Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, 260-0856, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, 260-0856, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, 260-0856, Japan
| | - Naoya Hirosawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, 260-0856, Japan
| | - Masahiro Inoue
- Department of Radiology, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-City, Ibaraki 305-8575, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, 260-0856, Japan.
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, 260-0856, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, 260-0856, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba 285-8741, Japan.
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, 260-0856, Japan.
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, 260-0856, Japan.
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Hourglass-like constriction neuropathy of the suprascapular nerve detected by high-resolution magnetic resonance neurography: report of three patients. Skeletal Radiol 2019; 48:1451-1456. [PMID: 30747238 DOI: 10.1007/s00256-019-03174-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/26/2019] [Accepted: 01/28/2019] [Indexed: 02/02/2023]
Abstract
Hourglass-like constriction neuropathy is a neurological condition caused by non-traumatic, non-compressive fascicular constrictions of one or more individual peripheral nerves. Based on clinical manifestations, it is very difficult to differentiate hourglass-like constriction neuropathy from idiopathic neuralgic amyotrophy. Focal hourglass-like constriction neuropathy may be erroneously diagnosed as idiopathic neuralgic amyotrophy. Previous studies demonstrated hourglass-like constrictions of peripheral nerves in the surgical exploration of patients diagnosed with idiopathic neuralgic amyotrophy. Recently, high-resolution ultrasound or magnetic resonance neurography (MRN) have been introduced to detect focal hourglass-like constrictions of peripheral nerves in spontaneous nerve palsy. We present a series of three cases in which the suprascapular nerve was affected by hourglass-like constrictions, which were visualized by high-solution MRN, including a nerve-selective morphological MR pulse sequence with strong fat- and water-signal suppression.
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Krishnamurthy R, Wang DJJ, Cervantes B, McAllister A, Nelson E, Karampinos DC, Hu HH. Recent Advances in Pediatric Brain, Spine, and Neuromuscular Magnetic Resonance Imaging Techniques. Pediatr Neurol 2019; 96:7-23. [PMID: 31023603 DOI: 10.1016/j.pediatrneurol.2019.03.001] [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: 07/01/2018] [Revised: 02/25/2019] [Accepted: 03/03/2019] [Indexed: 12/21/2022]
Abstract
Magnetic resonance imaging (MRI) is a powerful radiologic tool with the ability to generate a variety of proton-based signal contrast from tissues. Owing to this immense flexibility in signal generation, new MRI techniques are constantly being developed, tested, and optimized for clinical utility. In addition, the safe and nonionizing nature of MRI makes it a suitable modality for imaging in children. In this review article, we summarize a few of the most popular advances in MRI techniques in recent years. In particular, we highlight how these new developments have affected brain, spine, and neuromuscular imaging and focus on their applications in pediatric patients. In the first part of the review, we discuss new approaches such as multiphase and multidelay arterial spin labeling for quantitative perfusion and angiography of the brain, amide proton transfer MRI of the brain, MRI of brachial plexus and lumbar plexus nerves (i.e., neurography), and T2 mapping and fat characterization in neuromuscular diseases. In the second part of the review, we focus on describing new data acquisition strategies in accelerated MRI aimed collectively at reducing the scan time, including simultaneous multislice imaging, compressed sensing, synthetic MRI, and magnetic resonance fingerprinting. In discussing the aforementioned, the review also summarizes the advantages and disadvantages of each method and their current state of commercial availability from MRI vendors.
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Affiliation(s)
| | - Danny J J Wang
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Barbara Cervantes
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | | | - Eric Nelson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
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Sollmann N, Weidlich D, Cervantes B, Klupp E, Ganter C, Kooijman H, Zimmer C, Rummeny EJ, Meyer B, Baum T, Kirschke JS, Karampinos DC. T2 mapping of lumbosacral nerves in patients suffering from unilateral radicular pain due to degenerative disc disease. J Neurosurg Spine 2019; 30:750-758. [PMID: 30797199 DOI: 10.3171/2018.10.spine181172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/30/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Lumbosacral radicular syndrome (LRS) is a very common condition, often requiring diagnostic imaging with the aim of elucidating a structural cause when symptoms are longer lasting. However, findings on conventional anatomical MRI do not necessarily correlate with clinical symptoms, and it is primarily performed for the qualitative evaluation of surrounding compressive structures, such as herniated discs, instead of to evaluate the nerves directly. The present study investigated the performance of quantitative imaging by using magnetic resonance neurography (MRN) in patients with LRS. METHODS Eighteen patients (55.6% males, mean age 64.4 ± 10.2 years), with strict unilateral LRS matching at least one dermatome and suspected disc herniation, underwent high-resolution 3-T MRN using T2 mapping. On T2 maps, the presumably affected and contralateral unaffected nerves were identified; subsequent regions of interest (ROIs) were placed at preganglionic, ganglionic, and postganglionic sites; and T2 values were extracted. Patients then underwent an epidural steroid injection (ESI) with local anesthetic agents at the site of suspected nerve affection. T2 values of the affected nerves were compared against the contralateral nerves. Furthermore, receiver operating characteristics were calculated based on the measured T2 values and the responsiveness to ESI. RESULTS The mean T2 value was 77.3 ± 1.9 msec for affected nerves and 74.8 ± 1.4 msec for contralateral nerves (p < 0.0001). In relation to ESI performed at the site of suspected nerve affection, MRN with T2 mapping had a sensitivity/specificity of 76.9%/60.0% and a positive/negative predictive value of 83.3%/50.0%. Signal alterations in affected nerves according to qualitative visual inspection were present in only 22.2% of patients. CONCLUSIONS As one of the first of its kind, this study revealed elevated T2 values in patients suffering from LRS. T2 values of lumbosacral nerves might be used as more objective parameters to directly detect nerve affection in such patients.
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Affiliation(s)
- Nico Sollmann
- 1Department of Diagnostic and Interventional Neuroradiology
- 2TUM-Neuroimaging Center
- 3Department of Neurosurgery, and
| | - Dominik Weidlich
- 4Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich; and
| | - Barbara Cervantes
- 4Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich; and
| | | | - Carl Ganter
- 4Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich; and
| | | | - Claus Zimmer
- 1Department of Diagnostic and Interventional Neuroradiology
- 2TUM-Neuroimaging Center
| | - Ernst J Rummeny
- 4Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich; and
| | | | - Thomas Baum
- 1Department of Diagnostic and Interventional Neuroradiology
| | - Jan S Kirschke
- 1Department of Diagnostic and Interventional Neuroradiology
| | - Dimitrios C Karampinos
- 4Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich; and
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Role of MR Neurography in Groin and Genital Pain: Ilioinguinal, Iliohypogastric, and Genitofemoral Neuralgia. AJR Am J Roentgenol 2019; 212:632-643. [PMID: 30620677 DOI: 10.2214/ajr.18.20316] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Chronic neuralgia of the border nerves (ilioinguinal, iliohypogastric, and genitofemoral) is difficult to diagnose and treat clinically. We examined the role of MR neurography (MRN) in the evaluation of border nerve abnormalities and the results of treatments directed at the MRN-detected nerve abnormalities. MATERIALS AND METHODS This retrospective cross-sectional study included 106 subjects with groin or genital pain (mean [± SD] age, 50.7 ± 15.4 years) who showed mono- or multifocal neuropathy of the border nerves at 3-T MRN. Subjects who underwent CT-guided perineural injection were assessed for pain response. Injection responses were categorized as positive, possible positive, and negative. Subjects who received hyaluronidase, continuous radiofrequency ablation, or surgery were also evaluated for treatment outcomes. RESULTS One hundred forty abnormal nerves were positive for neuropathy in 106 studies. Eighty of 106 subjects had single neuropathy, and 26 had multifocal neuropathy. Fifty-eight subjects underwent CT-guided perineural injections, with five receiving bilateral injections (63 injections). Improvement in subjective pain was seen in 53 of 63 cases (84.2%). A statistically significant improvement in pain response was noted in the isolated ilioinguinal nerve block group as compared with the isolated genitofemoral nerve block group (p = 0.0085). Thirteen of 58 subjects received multiple nerve injections at the same sitting. Both groups receiving single or multiple nerve injections had similar improvement in pain scores of 84% and 85%, respectively, although this difference was not statistically significant. CONCLUSION Our retrospective analysis showed improved pain relief in subjects who underwent CT-guided nerve blocks on the basis of a positive MRN.
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Hiwatashi A, Togao O, Yamashita K, Kikuchi K, Momosaka D, Nakatake H, Yamasaki R, Ogata H, Yoneyama M, Kira JI, Honda H. Simultaneous MR neurography and apparent T2 mapping in brachial plexus: Evaluation of patients with chronic inflammatory demyelinating polyradiculoneuropathy. Magn Reson Imaging 2018; 55:112-117. [PMID: 30266626 DOI: 10.1016/j.mri.2018.09.025] [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] [Received: 05/07/2018] [Revised: 09/03/2018] [Accepted: 09/24/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE MR neurography is known to be useful to evaluate nerve pathology. The purpose of this study was to evaluate the usefulness of simultaneous apparent T2 mapping and neurography with nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement imaging (SHINKEI) to distinguish patients with chronic inflammatory demyelinating polyneuropathy (CIDP) from healthy subjects. MATERIALS AND METHODS This retrospective study included 13 patients with CIDP and five healthy subjects from 2015 to 2017. The T2 relaxation time and the size of the cervical ganglia and roots of the brachial plexus were measured. Statistical analyses were performed with the Mann-Whitney U test and receiver operating characteristics (ROC) analysis. RESULTS The T2 relaxation times of the ganglia and roots were longer in patients with CIDP (119.31 ± 35.53 msec and 111.15 ± 33.82 msec) than in healthy subjects (101.42 ± 26.42 msec and 85.29 ± 13.22 msec, P = 0.0007 and P < 0.0001, respectively). The sizes of the ganglia and the roots were larger in patients with CIDP (6.25 ± 1.56 mm and 4.37 ± 1.71 mm) than in healthy subjects (5.59 ± 1.08 mm and 3.50 ± 0.62 mm, P = 0.0114 and P = 0.0014, respectively). ROC analysis revealed that T2 relaxation time of the roots was best at distinguishing CIDP patients from healthy subjects (the area under the curve = 0.748). CONCLUSION Patients with CIDP could be distinguished from healthy subjects using simultaneous apparent T2 mapping and neurography with SHINKEI.
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Affiliation(s)
- Akio Hiwatashi
- Departments of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Japan.
| | - Osamu Togao
- Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Koji Yamashita
- Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kazufumi Kikuchi
- Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Daichi Momosaka
- Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Hiroshi Nakatake
- Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Ryo Yamasaki
- Neurology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Hidenori Ogata
- Neurology, Graduate School of Medical Sciences, Kyushu University, Japan
| | | | - Jun-Ichi Kira
- Neurology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Hiroshi Honda
- Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
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Hiwatashi A, Togao O, Yamashita K, Kikuchi K, Momosaka D, Nakatake H, Yamasaki R, Ogata H, Yoneyama M, Kira JI, Honda H. Lumbar plexus in patients with chronic inflammatory demyelinating polyradiculoneuropathy: evaluation with simultaneous T 2 mapping and neurography method with SHINKEI. Br J Radiol 2018; 91:20180501. [PMID: 30160180 DOI: 10.1259/bjr.20180501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE: To evaluate the usefulness of simultaneous T2 mapping and neurography with nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement imaging (SHINKEI) in the lumbar plexus to distinguish patients with chronic inflammatory demyelinating polyneuropathy (CIDP) from healthy controls. METHODS: Our institutional review boards approved this retrospective study, and written informed consent was waived. 10 patients with CIDP from 2015 to 2017 were studied along with 5 healthy controls on a 3 T scanner. The T2 relaxation time and the size of the dorsal root ganglia and nerves of the lumbar plexus at L3-S1 were measured. Statistical analyses were performed with the Mann-Whitney U test and a receiver operating characteristics analysis. RESULTS: The T2 relaxation times of the dorsal root ganglia and the nerves of the lumbar plexus were longer in the CIDP patients (133.34 ± 41.36 and 130.40 ± 47.78 ms) compared to the healthy controls (114.69 ± 24.90 and 83.72 ± 17.51 ms, p = 0.0265 and p < 0.0001, respectively). The sizes of the nerves were larger in the CIDP patients (6.19 ± 2.28 mm) compared to the controls (4.54 ± 0.86 mm, p < 0.0001). However, there was no significant difference between the sizes of the ganglia in the CIDP patients and the controls. The receiver operating characteristics analysis revealed that the T2 relaxation time of the nerves was best at distinguishing the CIDP patients from the controls (Az = 0.848). CONCLUSION: Patients with CIDP could be distinguished from healthy controls using simultaneous T2 mapping and neurography with SHINKEI in the lumbar plexus. ADVANCES IN KNOWLEDGE: Patients with CIDP could be distinguished from healthy controls using simultaneous T2 mapping and neurography with SHINKEI in the lumbar plexus.
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Affiliation(s)
- Akio Hiwatashi
- 1 Departments of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Osamu Togao
- 2 Clinical Radiology, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Koji Yamashita
- 2 Clinical Radiology, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Kazufumi Kikuchi
- 2 Clinical Radiology, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Daichi Momosaka
- 2 Clinical Radiology, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Hiroshi Nakatake
- 2 Clinical Radiology, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Ryo Yamasaki
- 3 Neurology, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Hidenori Ogata
- 3 Neurology, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | | | - Jun-Ichi Kira
- 3 Neurology, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - Hiroshi Honda
- 2 Clinical Radiology, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
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Cervantes B, Van AT, Weidlich D, Kooijman H, Hock A, Rummeny EJ, Gersing A, Kirschke JS, Karampinos DC. Isotropic resolution diffusion tensor imaging of lumbosacral and sciatic nerves using a phase-corrected diffusion-prepared 3D turbo spin echo. Magn Reson Med 2018; 80:609-618. [PMID: 29380414 PMCID: PMC5947302 DOI: 10.1002/mrm.27072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/07/2017] [Accepted: 12/14/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE To perform in vivo isotropic-resolution diffusion tensor imaging (DTI) of lumbosacral and sciatic nerves with a phase-navigated diffusion-prepared (DP) 3D turbo spin echo (TSE) acquisition and modified reconstruction incorporating intershot phase-error correction and to investigate the improvement on image quality and diffusion quantification with the proposed phase correction. METHODS Phase-navigated DP 3D TSE included magnitude stabilizers to minimize motion and eddy-current effects on the signal magnitude. Phase navigation of motion-induced phase errors was introduced before readout in 3D TSE. DTI of lower back nerves was performed in vivo using 3D TSE and single-shot echo planar imaging (ss-EPI) in 13 subjects. Diffusion data were phase-corrected per kz plane with respect to T2 -weighted data. The effects of motion-induced phase errors on DTI quantification was assessed for 3D TSE and compared with ss-EPI. RESULTS Non-phase-corrected 3D TSE resulted in artifacts in diffusion-weighted images and overestimated DTI parameters in the sciatic nerve (mean diffusivity [MD] = 2.06 ± 0.45). Phase correction of 3D TSE DTI data resulted in reductions in all DTI parameters (MD = 1.73 ± 0.26) of statistical significance (P ≤ 0.001) and in closer agreement with ss-EPI DTI parameters (MD = 1.62 ± 0.21). CONCLUSION DP 3D TSE with phase correction allows distortion-free isotropic diffusion imaging of lower back nerves with robustness to motion-induced artifacts and DTI quantification errors. Magn Reson Med 80:609-618, 2018. © 2018 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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Affiliation(s)
- Barbara Cervantes
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | - Anh T. Van
- Institute of Medical Engineering (IMETUM)Technical University of MunichGarchingGermany
| | - Dominik Weidlich
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | | | | | - Ernst J. Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | - Alexandra Gersing
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | - Dimitrios C. Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
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Klupp E, Cervantes B, Sollmann N, Treibel F, Weidlich D, Baum T, Rummeny EJ, Zimmer C, Kirschke JS, Karampinos DC. Improved Brachial Plexus Visualization Using an Adiabatic iMSDE-Prepared STIR 3D TSE. Clin Neuroradiol 2018; 29:631-638. [DOI: 10.1007/s00062-018-0706-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/03/2018] [Indexed: 12/12/2022]
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High Isotropic Resolution T2 Mapping of the Lumbosacral Plexus with T2-Prepared 3D Turbo Spin Echo. Clin Neuroradiol 2018; 29:223-230. [PMID: 29322233 PMCID: PMC6579865 DOI: 10.1007/s00062-017-0658-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/18/2017] [Indexed: 10/31/2022]
Abstract
PURPOSE Isotropic high-resolution three-dimensional (3D) magnetic resonance neurography (MRN) is increasingly used to depict even small and highly oblique nerves of the lumbosacral plexus (LSP). The present study introduces a T2 mapping sequence (T2-prepared 3D turbo spin echo) that is B1-insensitive and enables quantitative assessment of LSP nerves. METHODS In this study 15 healthy subjects (mean age 28.5 ± 3.8 years) underwent 3 T MRN of the LSP area three times. The T2 values were calculated offline on a voxel-by-voxel basis and measured at three segments (preganglionic, ganglionic, postganglionic) of three LSP nerves (S1, L5, L4) by two independent investigators (experienced and novice). Normative data for the different nerves were extracted and intraclass correlation coefficients (ICCs) were calculated to assess reproducibility and interobserver reliability of T2 measurements. RESULTS The T2 mapping showed excellent reproducibility with ICCs ranging between 0.99 (S1 preganglionic) and 0.89 (L5 postganglionic). Interobserver reliability was less robust with ICCs ranging between 0.78 (S1 preganglionic) and 0.44 (L5 postganglionic) for S1 and L5. A mean T2 value of 74.6 ± 4.7 ms was registered for preganglionic segments, 84.7 ± 4.1 ms for ganglionic and 65.4 ± 2.5 ms for postganglionic segments, respectively. There was a statistically significant variation of T2 values across the nerve (preganglionic vs ganglionic vs postganglionic) for S1, L5, and L4. CONCLUSION Our approach enables isotropic high-resolution and B1-insensitive T2 mapping of LSP nerves with excellent reproducibility. It might reflect a robust and clinically useful method for future diagnostics of LSP pathologies.
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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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