1
|
Remy K, Raasveld FV, Saqr H, Khouri KS, Hwang CD, Austen WG, Valerio IL, Eberlin KR, Gfrerer L. The neuroma map: A systematic review of the anatomic distribution, etiologies, and surgical treatment of painful traumatic neuromas. Surgery 2024:S0039-6060(24)00368-4. [PMID: 39025690 DOI: 10.1016/j.surg.2024.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/01/2024] [Accepted: 05/24/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND This study analyzed all reported cases of painful traumatic neuromas to better understand their anatomic distribution, etiologies, and surgical treatment. METHODS PubMed, Embase, Cochrane, and Web of Science were searched in October 2023 for articles describing painful traumatic neuromas. RESULTS In total, 414 articles reporting 5,562 neuromas were included and categorized into head/neck, trunk, upper extremity, lower extremity, and autonomic nerves. Distribution was as follows: Head/neck: 82 articles reported on 393 neuromas (93.2% iatrogenic) most frequently involving the lingual (44.3%), cervical plexus (14.9%), great auricular (8.5%), inferior/superior alveolar (8.3%), and occipital (7.2%) nerves. Trunk: 47 articles reported on 554 neuromas (92.9% iatrogenic) most commonly involving the intercostal (35.4%), genitofemoral (14.3%), and pudendal (12.9%) nerves. Upper extremity: 159 articles reported on 2079 neuromas (53.3% after amputation) most frequently involving the digital (46.9%), superficial radial (18.3%), and median (7.0%) nerves. Lower extremity: 128 articles reported on 2,531 neuromas (53.0% after amputation) most commonly involving the sural (17.9%), superficial peroneal (17.3%), and saphenous (16.0%) nerves. Autonomic nerves: 15 articles reported on 53 neuromas (100% iatrogenic) most frequently involving the biliary tract (73.9%) and vagus nerve (14.9%). Compared with the extremities, neuromas in the head/neck and trunk had significantly longer symptom duration before surgical treatment and the nerve end was significantly less frequently reconstructed after neuroma excision. CONCLUSION Painful neuromas are predominantly reported in the extremities yet may occur throughout the body primarily after iatrogenic injury. Knowledge of their anatomic distribution from head to toe will encourage awareness to avoid injury and expedite diagnosis to prevent treatment delay.
Collapse
Affiliation(s)
- Katya Remy
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Floris V Raasveld
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Hazem Saqr
- Division of Plastic and Reconstructive Surgery, University of Pittsburgh, PA
| | - Kimberly S Khouri
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Charles D Hwang
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - William G Austen
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ian L Valerio
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kyle R Eberlin
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lisa Gfrerer
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| |
Collapse
|
2
|
Bangia M, Ahmadzai I, Casselman J, Politis C, Jacobs R, Van der Cruyssen F. Accuracy of MR neurography as a diagnostic tool in detecting injuries to the lingual and inferior alveolar nerve in patients with iatrogenic post-traumatic trigeminal neuropathy. Eur Radiol 2024; 34:4619-4627. [PMID: 38047973 PMCID: PMC11213806 DOI: 10.1007/s00330-023-10363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES MR neurography has the ability to detect and depict peripheral nerve injuries. This study evaluated the potential of MR neurography in the diagnosis of post-traumatic trigeminal neuropathy. METHODS Forty-one participants prospectively underwent MR neurography of the lingual and inferior alveolar nerves using a 3D TSE STIR black-blood sequence. Two blinded and independent observers recorded the following information for each nerve of interest: presence of injury, nerve thickness, nerve signal intensity, MR neurography Sunderland class, and signal gap. Afterwards, the apparent nerve-muscle contrast-to-noise ratio and apparent signal-to-noise ratio were calculated. Clinical data (neurosensory testing score and clinical Sunderland class) was extracted retrospectively from the medical records of patients diagnosed with post-traumatic trigeminal neuropathy. RESULTS Compared to neurosensory testing, MR neurography had a sensitivity of 38.2% and specificity of 93.5% detecting nerve injuries. When differentiated according to clinical Sunderland class, sensitivity was 19.1% in the presence of a low class injury (I to III) and improved to 83.3% in the presence of a high class (IV to V). Specificity remained unchanged. The area under the curve using the apparent nerve-muscle contrast-to-noise ratio, apparent signal-to-noise ratio, and nerve thickness to predict the presence of an injury was 0.78 (p < .05). Signal intensities and nerve diameter increased in injured nerves (p < .05). Clinical and MR neurography Sunderland scores positively correlated (correlation coefficient = 0.53; p = .005). CONCLUSIONS This study shows that MR neurography can accurately differentiate between injured and healthy nerves, especially in the presence of a more severe nerve injury. CLINICAL RELEVANCE STATEMENT MR neurography is not only able to detect trigeminal nerve injuries, but it can also provide information about the anatomical specifications of the injury, which is not possible with clinical neurosensory testing. This makes MR neurography an added value in the management of post-traumatic trigeminal neuropathy. KEY POINTS • The current diagnosis of post-traumatic trigeminal neuropathy is mainly based on clinical examination. • MR neurography is able to visualize and stratify peripheral trigeminal nerve injuries. • MR neurography contributes to the diagnostic process as well as to further decision-making.
Collapse
Affiliation(s)
- Mado Bangia
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium
| | - Iraj Ahmadzai
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium
| | - Jan Casselman
- Department of Radiology, AZ St-Jan Brugge-Oostende, Brugge, Belgium
- Department of Radiology, AZ St-Augustinus, Antwerp, Belgium
- University Ghent, Ghent, Belgium
| | - Constantinus Politis
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium
| | - Reinhilde Jacobs
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium
- Dentomaxillofacial Imaging Center, University Hospitals Leuven, Louvain, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fréderic Van der Cruyssen
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Louvain, Belgium.
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Louvain, Belgium.
| |
Collapse
|
3
|
Xia S, Thornton T, Ravi V, Hammad Y, Zuniga JR, Chhabra A. Efficacy of MR Neurography of Peripheral Trigeminal Nerves: Correlation of Sunderland Grade versus Neurosensory Testing. AJNR Am J Neuroradiol 2024; 45:335-341. [PMID: 38331961 DOI: 10.3174/ajnr.a8120] [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: 06/30/2023] [Accepted: 12/02/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND AND PURPOSE The current reference standard of diagnosis for peripheral trigeminal neuropathies (PTN) is clinical neurosensory testing (NST). MR neurography (MRN) is useful for PTN injury diagnosis, but it has only been studied in small case series. The aim of this study was to evaluate the agreement of Sunderland grades of nerve injury on MRN and NST by using surgical findings and final diagnoses as reference standards. MATERIALS AND METHODS A total of 297 patient records with a chief complaint of PTN neuralgia were identified from the university database, and 70 patients with confirmed NST and MRN findings who underwent surgical nerve repair were included in the analysis. Cohen weighted kappa was used to calculate the strength of the agreement between the 3 modalities. RESULTS There were 19 men and 51 women, with a mean age of 39.6 years and a standard deviation of 16.9 years. Most (51/70, 73%) injuries resulted from tooth extractions and implants. MRN injury grades agreed with surgical findings in 84.09% (37/44) of cases, and NST injury grades agreed with surgical findings in 74.19% (23/31) of cases. MRN and NST both showed similar agreement with surgery for grades I to III (70% and 71.43%). However, MRN showed a higher rate of agreement with surgery (88.24%) for injury grades IV and V than did NST (75%). CONCLUSIONS MRN can objectively improve preoperative planning in patients with higher-grade nerve injuries.
Collapse
Affiliation(s)
- Shuda Xia
- From The University of Texas Southwestern Medical Center (S.X., V.R., Y.H., J.R.Z., A.C.), Dallas, Texas
| | - Tyler Thornton
- The University of North Texas (T.T.) Health Science Center
| | - Varun Ravi
- From The University of Texas Southwestern Medical Center (S.X., V.R., Y.H., J.R.Z., A.C.), Dallas, Texas
| | - Yousef Hammad
- From The University of Texas Southwestern Medical Center (S.X., V.R., Y.H., J.R.Z., A.C.), Dallas, Texas
| | - John R Zuniga
- From The University of Texas Southwestern Medical Center (S.X., V.R., Y.H., J.R.Z., A.C.), Dallas, Texas
| | - Avneesh Chhabra
- From The University of Texas Southwestern Medical Center (S.X., V.R., Y.H., J.R.Z., A.C.), Dallas, Texas
| |
Collapse
|
4
|
Van der Cruyssen F, Palla B, Jacobs R, Politis C, Zuniga J, Renton T. Consensus guidelines on training, diagnosis, treatment and follow-up care of trigeminal nerve injuries. Int J Oral Maxillofac Surg 2024; 53:68-77. [PMID: 37365073 DOI: 10.1016/j.ijom.2023.06.003] [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: 03/19/2023] [Revised: 05/15/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
The aim was to present expert-based guidelines on the management of trigeminal nerve injuries. A two-round multidisciplinary Delphi study was conducted amongst international trigeminal nerve injury experts with a set of statements and three summary flowcharts using a nine-point Likert scale (1 = strongly disagree; 9 = strongly agree). An item was deemed appropriate if the median panel score was within the range of 7-9, undecided if the score was 4-6, and inappropriate if the score was 1-3. Consensus was achieved if at least 75% of panelists scored within one range. Eighteen specialists from dental, medical, and surgical specialties participated in both rounds. Consensus was reached on most statements related to training/services (78%) and diagnosis (80%). Statements related to treatment were mainly undecided due to a lack of sufficient evidence for some of the proposed treatments. Nevertheless, the summary treatment flowchart reached consensus with a median score of eight. Recommendations on follow-up and opportunities for future research were discussed. None of the statements were deemed inappropriate. A set of recommendations and accepted flowcharts are presented; these will aid professionals involved in managing patients with trigeminal nerve injuries.
Collapse
Affiliation(s)
- F Van der Cruyssen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University of Leuven, Leuven, Belgium.
| | - B Palla
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - R Jacobs
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University of Leuven, Leuven, Belgium; Dentomaxillofacial Imaging Center, Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - J Zuniga
- Departments of Surgery and Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - T Renton
- Department of Oral Surgery, King's College London Dental Institute, King's College London, London, United Kingdom
| |
Collapse
|
5
|
Taneja AK, Chhabra A. Neuropathy Score Reporting and Data System (NS-RADS): A Practical Review of MRI-Based Peripheral Neuropathy Assessment. Semin Ultrasound CT MR 2023; 44:386-397. [PMID: 37437974 DOI: 10.1053/j.sult.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
The Neuropathy Score Reporting and Data System (NS-RADS) is a newly developed MR imaging-based classification that standardizes reporting and multidisciplinary communication for MR imaging diagnosis and follow-up of peripheral neuropathies. NS-RADS classification has shown to be accurate and reliable across different centers, readers' experience levels, and degrees of peripheral neuropathies, which include nerve injury, entrapment, neoplasm, diffuse neuropathy, post-interventional status, and temporal changes in muscle denervation. This article brings a practical review of NS-RADS classification, representative MR cases, and a step-by-step tutorial on how to approach this staging system. Readers can gain knowledge and apply it in their practice, aiming to standardize the communications between specialties and improve patient management.
Collapse
Affiliation(s)
- Atul K Taneja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Avneesh Chhabra
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX; Johns Hopkins University, Baltimore, MD; Walton Center of Neuroscience, Liverpool, UK; University of Dallas, Richardson, TX; Johns Hopkins University, Maryland, MD; Walton Centre for Neuroscience, Liverpool, UK.
| |
Collapse
|
6
|
Casselman J, Van der Cruyssen F, Vanhove F, Peeters R, Hermans R, Politis C, Jacobs R. 3D CRANI, a novel MR neurography sequence, can reliable visualise the extraforaminal cranial and occipital nerves. Eur Radiol 2023; 33:2861-2870. [PMID: 36435876 PMCID: PMC10017653 DOI: 10.1007/s00330-022-09269-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/04/2022] [Accepted: 10/23/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We aim to validate 3D CRANI, a novel high-field STIR TSE, MR neurography sequence in the visualisation of the extraforaminal cranial and occipital nerve branches on a 3-T system. Furthermore, we wish to evaluate the role of gadolinium administration and calculate nerve benchmark values for future reference. METHODS Eleven consecutive patients underwent MR imaging including the 3D CRANI sequence before and immediately after intravenous gadolinium administration. Two observers rated suppression quality and nerve visualisation using Likert scales before and after contrast administration. Extraforaminal cranial and occipital nerves were assessed. Nerve calibers and signal intensities were measured at predefined anatomical landmarks, and apparent signal intensity ratios were calculated. RESULTS The assessed segments of the cranial and occipital nerves could be identified in most cases. The overall intrarater agreement was 79.2% and interrater agreement was 82.7% (intrarater κ = .561, p < .0001; interrater κ = .642, p < .0001). After contrast administration, this significantly improved to an intrarater agreement of 92.7% and interrater agreement of 93.6% (intrarater κ = .688, p < .0001; interrater κ = .727, p < .0001). Contrast administration improved suppression quality and significant changes in nerve caliber and signal intensity measurements. Nerve diameter and signal intensity benchmarking values were obtained. CONCLUSION 3D CRANI is reliable for the visualization of the extraforaminal cranial and occipital nerves. Intravenous gadolinium significantly improves MR neurography when applying this sequence. Benchmarking data are published to allow future assessment of the 3D CRANI sequence in patients with pathology of the extraforaminal cranial and occipital nerves. KEY POINTS • MR neurography using the 3D CRANI sequence is a reliable method to evaluate the extraforaminal cranial and occipital nerves. • Gadolinium contrast administration significantly improves suppression quality and nerve visualisation. • Benchmarking values including apparent signal intensity ratios and nerve calibers depend on contrast administration and might play an important role in future studies evaluating extraforaminal cranial and occipital neuropathies.
Collapse
Affiliation(s)
- Jan Casselman
- Department of Radiology, AZ St-Jan Brugge-Oostende, Ruddershove 10, 8000, Bruges, Belgium. .,Department of Radiology, AZ St-Augustinus, Antwerp, Belgium. .,University Ghent, Ghent, Belgium.
| | - Fréderic Van der Cruyssen
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium. .,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium.
| | - Frédéric Vanhove
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,Department of Radiology, AZ Groeninge, Kortrijk, Belgium
| | - Ronald Peeters
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Robert Hermans
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium.,Department of Oral Health Sciences, KU Leuven and Department of Dentistry, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
7
|
Neuropathy Score Reporting and Data System (NS-RADS): MRI Reporting Guideline of Peripheral Neuropathy Explained and Reviewed. Skeletal Radiol 2022; 51:1909-1922. [PMID: 35478047 DOI: 10.1007/s00256-022-04061-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 02/02/2023]
Abstract
A standardized guideline and scoring system should be used for the MR imaging diagnosis of peripheral neuropathy. The MR imaging-based Neuropathy Score Reporting and Data System (NS-RADS) is a newly devised classification system (in press in AJR) that can be used to communicate both type and severity of peripheral neuropathy in the light of clinical history and examination findings. The spectrum of neuropathic conditions and peripheral nerve disorders covered in this system includes nerve injury, entrapment, neoplasm, diffuse neuropathy, and post-interventional states. This classification system also describes the temporal MR imaging appearances of regional muscle denervation changes. This review article is based on the multicenter validation study pre-published in American journal of Roentgenology and discusses technical considerations of optimal MR imaging for peripheral nerve evaluation and discusses the NS-RADS classification and its severity scales with illustration of conditions that fall under each classification. The readers can gain knowledge of the NS-RADS classification system and learn to apply it in their practices for improved inter-disciplinary communications and timely patient management.
Collapse
|
8
|
The accuracy of routine knee MR imaging in detection of acute neurovascular injury following multiligamentous knee injury. Skeletal Radiol 2022; 51:981-990. [PMID: 34557951 DOI: 10.1007/s00256-021-03907-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the accuracy of routine knee MRI in detecting acute popliteal artery and/or common peroneal nerve (CPN) dysfunction following multiligamentous knee injury (MLKI), with correlation of MRI findings to clinical outcome. MATERIALS AND METHODS Routine MRI knee examinations in 115 MLKI patients (54/115 with acute neurovascular injury, 61/115 without neurovascular injury) were retrospectively reviewed. Cases were classified by injury mechanism and ligamentous injuries sustained. MRI examinations were reviewed by two readers for vascular (arterial flow void, arterial calibre, intimal flap, perivascular hematoma) and CPN (intraneural T2-hyperintensity, calibre, discontinuity, perineural hematoma) injuries. Accuracy of routine knee MRI in the diagnosis of acute neurovascular injury and correlation of MRI findings to clinical outcome were evaluated. RESULTS Patients included 86/115 males, mean age 33 years. The accuracy of MRI in diagnosis of acute CPN injury was 80.6%, 83.6% (readers 1 and 2): sensitivity (78%, 79.7%), specificity (80%, 86.7%), PPV (78%, 82.5%), and NPV (82.7%, 84.4%). Increased intraneural T2 signal showed a significant correlation to acute CPN dysfunction (p < 0.05). MRI was 75%, 69.8% (readers 1 and 2) accurate in detecting acute vascular injury: sensitivity (73.3%, 86.7%), specificity (75.2%, 67.3%), PPV (30.5%, 36.1%), and NPV (95%, 97.1%). No MRI features of vascular injury showed a statistical correlation with clinical outcome. Neurovascular complications were more common in ultra-low-energy injuries and KD-V3L pattern of ligament disruption. CONCLUSION Routine MRI is of limited accuracy in assessing vascular complication, but higher accuracy in assessing CPN injury following MLKI. Increased intraneural T2 signal on conventional knee MR imaging shows statistically significant association with clinically documented acute CPN dysfunction following MLKI.
Collapse
|
9
|
Neuropathy Score Reporting and Data System: A Reporting Guideline for MRI of Peripheral Neuropathy With a Multicenter Validation Study. AJR Am J Roentgenol 2022; 219:279-291. [PMID: 35234483 DOI: 10.2214/ajr.22.27422] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: A standardized guideline and scoring system would improve evaluation and reporting of peripheral neuropathies on MRI. Objective: The objective of this study was to create and validate a neuropathy classification and grading system, which we named the Neuropathy Score Reporting and Data System (NS-RADS). Methods: This retrospective study included 100 patients with nerve imaging studies and known clinical diagnoses. Experts crafted NS-RADS using mutually agreed-upon qualitative criteria for the classification and grading of peripheral neuropathies. Different classes were created to account for the spectrum of underlying pathologies: unremarkable (U), injury (I), neoplasia (N), entrapment (E), diffuse neuropathy (D), not otherwise specified (NOS), and postintervention state (PI). Subclasses were established to describe the severity or extent of the lesions. Validation testing was performed by 11 readers from multiple institutions with experience levels ranging from 3 to 18 years after residency. After initial reader training, cases were presented to readers, who were blinded to final clinical diagnoses. Interobserver agreement was assessed using correlation coefficients and the Conger kappa, and accuracy testing was performed. Results: Final clinical diagnoses included normal (n = 5), nerve injury (n = 25), entrapment (n = 15), neoplasia (n = 33), diffuse neuropathy (n = 18), and persistent neuropathy after intervention (n = 4). The miscategorization rate for NS-RADS classes was 1.8%. Final diagnoses were correctly identified by readers in 71-88% of cases. Excellent interreader agreement was found on the NS-RADS pathology categorization (κ = 0.96; 95% CI, 0.93-0.98) as well as muscle pathology categorization (κ = 0.76; 95% CI, 0.68-0.82]. The accuracy for determining milder versus more severe categories per radiologist ranged from 88% to 97% for nerve lesions and from 86% to 94% for muscle abnormalities. Conclusion: The proposed NS-RADS classification is accurate and reliable across different reader experience levels and a spectrum of peripheral neuropathy conditions. Clinical Impact: NS-RADS can be used as a standardized guideline for reporting peripheral neuropathies and improved multidisciplinary communications.
Collapse
|
10
|
Orchard A, Adatia A, Moore R, Prabhu S. Management of inferior alveolar nerve and lingual nerve injuries in the UK – A cross-sectional study. Br J Oral Maxillofac Surg 2022; 60:927-932. [DOI: 10.1016/j.bjoms.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 11/27/2022]
|
11
|
Sachdeva S, Chhabra A, Reisch J, Rozen SM. Use of Groin Neurectomies for Noniatrogenic Testicular and Groin Pain. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2021. [DOI: 10.1055/s-0041-1736421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Background Chronic groin neuralgia is a life-debilitating condition that plagues patients worldwide. While groin neuralgia is usually traced to iatrogenic causes (inguinal hernia repairs, vasectomy, and hysterectomy), there is a unique subset of patients that present with noniatrogenic groin neuralgia. The diagnosis and treatment of these patients present a particular challenge.
Methods A total of 30 patients (current mean age, 46.5 [range: 19–72] years) who presented with noniatrogenic groin neuralgia and received neurectomies on the iliohypogastric, ilioinguinal, and genitofemoral nerves between 2008 and 2017 were identified. A retrospective review of preoperative and immediate postoperative pain scores was compared with prospectively collected current pain on a Likert's scale (0–10). Additionally, patients were asked to complete a Short Form (SF)-20 and identify current pain medications. A two-sided Wilcoxon–Mann–Whitney test was used to analyze the data.
Results Of the 30 patients identified, 16 could participate (mean follow-up = 61 months). The average pain reduction for the entire group was 62.7%. When using an established 30% reduction pain as a marker for clinical significance, 12 successful and 4 unsuccessful patients had an average reduction of 81.1 and 7.68%, respectively (success rate of 75%). Patients with successful group showed a statistically significant increased social functioning (p = 0.012) and near-significant increase in mental health (p = 0.063). Improvements, albeit nonsignificant, in mean scaled scores for every other SF-20 quality of life (QoL) category were observed when comparing both groups.
Conclusion Neurectomy is a potentially beneficial surgery that can assuage pain and improve quality of life for patients with noniatrogenic groin neuralgia.
Collapse
Affiliation(s)
- Sanchit Sachdeva
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Avneesh Chhabra
- Musculoskeletal Radiology Division, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joan Reisch
- Division of Biostatistics, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shai M. Rozen
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
12
|
Zuniga JR, AbdelBaky O, Alian A, Thakur U, Pezeshk P, Xi Y, Chhabra A. Does Presurgical Magnetic Resonance Neurography Predict Surgical Gap Size in Trigeminal Class IV and V Injuries? J Oral Maxillofac Surg 2021; 79:2574-2581. [PMID: 34453910 DOI: 10.1016/j.joms.2021.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The accuracy of magnetic resonance neurography (MRN) for quantitative assessment of nerve injury gap is unknown. We tested the hypothesis that presurgical MRN predicts the final surgical gap size after neuroma resection at the time of surgery. MATERIALS AND METHODS This was a retrospective, single-blinded, nonrandomized cohort study on 43 patients with Sunderland Class IV and V injuries of the inferior alveolar (IAN) or the lingual nerve (LN). The MRN maxillofacial protocol was performed on a 3T scanner and was read by 2 musculoskeletal radiologists to determine the maximum size of neuroma and the abnormal nerve segment. Two independent variables were recorded during surgery: 1) the length of neuroma from histologic specimens since only 9 of the 43 neuroma size measurements were accurately measureable at the time of surgery; and 2) the length of nerve gap size after the neuroma was removed and normal fascicles were identified. RESULTS There were 7 IAN and 36 LN cases analyzed. The mean time in months from injury to MRN was 6.97 ± 9.18 and MRN to surgery was 1.21 ± 1.4. The mean length of the neuroma at surgery was 7.22 ± 2.78 mm and mean nerve gap size was 12.02 ± 4.41 mm. Intraclass coefficient (ICC) agreement was fair for abnormal nerve thickness and neuroma length (ICC = 0.28, 0.39) while it was moderate for neuroma thickness and abnormal nerve length (0.50, 0.59). There was no significant correlation between MRN based measurements and surgical gap size for both readers (P > .05). CONCLUSIONS Abnormal nerve and neuromas of the peripheral trigeminal nerve as identified on MRN imaging demonstrates no correlation of the assessed MRN findings with the final surgical gap after neuroma removal.
Collapse
Affiliation(s)
- John R Zuniga
- Professor, Robert V. Walker Chair in Oral and Maxillofacial Surgery, Division of Oral and Maxillofacial Surgery, Departments of Surgery and Neurology, University of Texas Southwestern, Dallas, TX.
| | - Omar AbdelBaky
- Resident, Oral and Maxillofacial Surgery, Parkland Hospital, Dallas, TX
| | - Ali Alian
- Fellow, Department of Radiology, University of Texas Southwestern, Dallas, TX
| | - Uma Thakur
- Assistant Professor, Department of Radiology, University of Texas Southwestern, Dallas, TX
| | - Parham Pezeshk
- Assistant Professor, Department of Radiology, University of Texas Southwestern, Dallas, TX
| | - Yin Xi
- Assistant Professor, Departments of Radiology and Population & Data Sciences, University of Texas Southwestern, Dallas, TX
| | - Avneesh Chhabra
- Associate Professor, Radiology & Orthopedic Surgery, Chief Musculoskeletal Radiology, Department of Radiology, University of Texas Southwestern, Dallas, TX
| |
Collapse
|
13
|
Van der Cruyssen F, Croonenborghs TM, Renton T, Hermans R, Politis C, Jacobs R, Casselman J. Magnetic resonance neurography of the head and neck: state of the art, anatomy, pathology and future perspectives. Br J Radiol 2021; 94:20200798. [PMID: 33513024 PMCID: PMC8011265 DOI: 10.1259/bjr.20200798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Magnetic resonance neurography allows for the selective visualization of peripheral nerves and is increasingly being investigated. Whereas in the past, the imaging of the extracranial cranial and occipital nerve branches was inadequate, more and more techniques are now available that do allow nerve imaging. This basic review provides an overview of the literature with current state of the art, anatomical landmarks and future perspectives. Furthermore, we illustrate the possibilities of the three-dimensional CRAnial Nerve Imaging (3D CRANI) MR-sequence by means of a few case studies.
Collapse
Affiliation(s)
- Fréderic Van der Cruyssen
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Tomas-Marijn Croonenborghs
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Tara Renton
- Department of Oral Surgery, King's College London Dental Institute, London, UK
| | - Robert Hermans
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium.,Department of Oral Health Sciences, KU Leuven and Department of Dentistry, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jan Casselman
- Department of Radiology, AZ St-Jan Brugge-Oostende, Bruges, Belgium.,Department of Radiology, AZ St-Augustinus, Antwerp, Belgium.,Department of Radiology, UZ Gent, Gent, Belgium
| |
Collapse
|
14
|
Romsa B, Ruggiero SL. Diagnosis and Management of Lingual Nerve Injuries. Oral Maxillofac Surg Clin North Am 2021; 33:239-248. [PMID: 33526318 DOI: 10.1016/j.coms.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Injury to the lingual nerve is a well-recognized risk associated with certain routine dental and oral surgical procedures. The assessment and management of a patient with a traumatic lingual nerve neuropathy requires a logical and stepwise approach. The proper application and interpretation of the various neurosensory tests and maneuvers is critical to establishing an accurate diagnosis. The implementation of a surgical or nonsurgical treatment strategy is based not only on the established diagnosis, but also a multitude of variables including patient age, timing and nature of the injury, and the emotional or psychological impact.
Collapse
Affiliation(s)
- Bradley Romsa
- New York Center for Orthognathic and Maxillofacial Surgery, 110 East 55th Street, 15th Floor, New York, NY 10022, USA
| | - Salvatore L Ruggiero
- New York Center for Orthognathic and Maxillofacial Surgery, 2001 Marcus Avenue, Suite N10, Lake Success, NY 11042, USA.
| |
Collapse
|
15
|
Van der Cruyssen F, Croonenborghs TM, Hermans R, Jacobs R, Casselman J. 3D Cranial Nerve Imaging, a Novel MR Neurography Technique Using Black-Blood STIR TSE with a Pseudo Steady-State Sweep and Motion-Sensitized Driven Equilibrium Pulse for the Visualization of the Extraforaminal Cranial Nerve Branches. AJNR Am J Neuroradiol 2020; 42:578-580. [PMID: 33334854 DOI: 10.3174/ajnr.a6904] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/18/2020] [Indexed: 02/02/2023]
Abstract
This study investigated the feasibility of a 3D black-blood STIR TSE sequence with a pseudo steady-state sweep and motion-sensitized driven equilibrium pulse for extraforaminal cranial nerve imaging on a 3T system. Assessments of healthy volunteers showed near-perfect agreement in nerve visualization with excellent to good visualization of the extraforaminal trigeminal, greater occipital, and facial nerves. Suppression of surrounding tissues was excellent to good. 3D cranial nerve imaging can produce nerve selective imaging of extraforaminal cranial and spinal nerve branches.
Collapse
Affiliation(s)
- F Van der Cruyssen
- From the Departments of Oral & Maxillofacial Surgery (F.V.d.C., T.-M.C.) .,OMFS-IMPATH Research Group (F.V.d.C., T.-M.C., R.J.), Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - T-M Croonenborghs
- From the Departments of Oral & Maxillofacial Surgery (F.V.d.C., T.-M.C.).,OMFS-IMPATH Research Group (F.V.d.C., T.-M.C., R.J.), Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - R Hermans
- Radiology (R.H.), University Hospitals Leuven, Leuven, Belgium
| | - R Jacobs
- OMFS-IMPATH Research Group (F.V.d.C., T.-M.C., R.J.), Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Department of Dental Medicine (R.J.), Karolinska Institutet, Stockholm, Sweden
| | - J Casselman
- Department of Radiology (J.C.), AZ St-Jan Brugge-Oostende, Bruges, Belgium.,Department of Radiology (J.C.), AZ St-Augustinus, Antwerp, Belgium
| |
Collapse
|
16
|
Kim BR, Ha DH, Kim JK, Kim YH. Comparison of MR findings of acute traumatic peripheral nerve injury and acute compressive neuropathy in a rat model. PLoS One 2020; 15:e0240911. [PMID: 33211695 PMCID: PMC7676645 DOI: 10.1371/journal.pone.0240911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose The treatment strategy is different for acute traumatic peripheral nerve injury and acute compressive neuropathy. This study aimed to compare magnetic resonance imaging (MRI) features of acute traumatic peripheral nerve injury and acute compressive neuropathy in a rat model. Materials and methods Twenty female Sprague-Dawley rats were divided into two groups. In the crush injury group (n = 10), the unilateral sciatic nerve was crushed using forceps to represent acute traumatic peripheral nerve injury. In the compression injury group (n = 10), the unilateral sciatic nerve was ligated using silk to represent acute compressive neuropathy. The MRI of eight rats from each group were acquired on postoperative days 3 and 10. Fat-suppressed T2-weighted images were acquired. Changes in the injured nerve were divided into three grades. A Fisher’s exact test was used to compare the changes in the nerves of the two groups. Histological staining and a western blot analysis were performed on one rat in each group on day 3. Neurofilament, myelin basic protein (MBP), and p75NTR staining were performed. Expression of neurofilament, MBP, p75NTR, and c-jun was evaluated by western blot analysis. Results MR neurography revealed substantial nerve changes in the compression injury group compared with the crush injury group at two-time points (p = 0.001 on day 3, p = 0.026 on day 10). The histopathological analysis indicated the destruction of the axon and myelin, mainly at the injury site and the distal portion of the injury in the crush injury group. It was prominent in the proximal portion, the injury site, and the distal portion of the injury in the compression injury group. The degree of axonal and myelin destruction was more pronounced in the compression injury group than in the crush injury group. Conclusion MR neurography showed prominent and long-segmental changes associated with the injured nerve in acute compressive neuropathy compared with acute traumatic peripheral nerve injury.
Collapse
Affiliation(s)
- Bo Ra Kim
- Department of Radiology, Dong-A University Medical Center, Busan, Republic of Korea
| | - Dong-Ho Ha
- Department of Radiology, Dong-A University Medical Center, Busan, Republic of Korea
- * E-mail:
| | - Jong Kuk Kim
- Department of Neurology, Dong-A University Medical Center, Busan, Republic of Korea
- Peripheral Neuropathy Research Center (PNRC), Dong-A University College of Medicine, Busan, Republic of Korea
| | - Young Hee Kim
- Peripheral Neuropathy Research Center (PNRC), Dong-A University College of Medicine, Busan, Republic of Korea
| |
Collapse
|
17
|
Probst FA, Schweiger J, Stumbaum MJ, Karampinos D, Burian E, Probst M. Magnetic resonance imaging based
computer‐guided
dental implant surgery—A clinical pilot study. Clin Implant Dent Relat Res 2020; 22:612-621. [DOI: 10.1111/cid.12939] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/23/2020] [Accepted: 07/15/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Florian Andreas Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Josef Schweiger
- Department of Prosthetic Dentistry University Hospital, LMU Munich Munich Germany
| | | | - Dimitrios Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar Technical University Munich Munich Germany
| | - Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar Technical University Munich Munich Germany
| | - Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar Technical University Munich Munich Germany
| |
Collapse
|
18
|
Kaleem A, Amailuk P, Hatoum H, Tursun R. The Trigeminal Nerve Injury. Oral Maxillofac Surg Clin North Am 2020; 32:675-687. [PMID: 32912777 DOI: 10.1016/j.coms.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Trigeminal nerve branches are never far from the operating field of the oral and maxillofacial surgeon. Increasingly the surgeon is required to provide accurate diagnosis and grading of trigeminal nerve injury, and surgical management by oral and maxillofacial surgeons will become common. Although trauma and ablative procedures for head and neck pathology can cause injuries, dentoalveolar surgical procedures remain an important cause of injury to the fifth cranial nerve, with the third division being the main branch affected. Oral and maxillofacial surgeons should be aware of strategies of avoiding iatrogenic injury, and know when referral and surgical management are appropriate.
Collapse
Affiliation(s)
- Arshad Kaleem
- Division of Oral & Maxillofacial Surgery, Department of Surgery, University of Miami, Deering Medical Plaza, 9380 Southwest 150th Street, Suite 170, Miami, FL 33176, USA
| | - Paul Amailuk
- Department of oral and maxillofacial surgery, Gold Coast University Hospital, 1 hospital Boulevard, Queensland 4215, Australia
| | - Hisham Hatoum
- Division of Oral & Maxillofacial Surgery, Department of Surgery, University of Miami, Deering Medical Plaza, 9380 Southwest 150th Street, Suite 170, Miami, FL 33176, USA
| | - Ramzey Tursun
- Division of Oral & Maxillofacial Surgery, Department of Surgery, University of Miami, Deering Medical Plaza, 9380 Southwest 150th Street, Suite 170, Miami, FL 33176, USA.
| |
Collapse
|
19
|
High resolution MRI for quantitative assessment of inferior alveolar nerve impairment in course of mandible fractures: an imaging feasibility study. Sci Rep 2020; 10:11566. [PMID: 32665667 PMCID: PMC7360624 DOI: 10.1038/s41598-020-68501-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to evaluate a magnetic resonance imaging (MRI) protocol for direct visualization of the inferior alveolar nerve in the setting of mandibular fractures. Fifteen patients suffering from unilateral mandible fractures involving the inferior alveolar nerve (15 affected IAN and 15 unaffected IAN from contralateral side) were examined on a 3 T scanner (Elition, Philips Healthcare, Best, the Netherlands) and compared with 15 healthy volunteers (30 IAN in total). The sequence protocol consisted of a 3D STIR, 3D DESS and 3D T1 FFE sequence. Apparent nerve-muscle contrast-to-noise ratio (aNMCNR), apparent signal-to-noise ratio (aSNR), nerve diameter and fracture dislocation were evaluated by two radiologists and correlated with nerve impairment. Furthermore, dislocation as depicted by MRI was compared to computed tomography (CT) images. Patients with clinically evident nerve impairment showed a significant increase of aNMCNR, aSNR and nerve diameter compared to healthy controls and to the contralateral side (p < 0.05). Furthermore, the T1 FFE sequence allowed dislocation depiction comparable to CT. This prospective study provides a rapid imaging protocol using the 3D STIR and 3D T1 FFE sequence that can directly assess both mandible fractures and IAN damage. In patients with hypoesthesia following mandibular fractures, increased aNMCNR, aSNR and nerve diameter on MRI imaging may help identify patients with a risk of prolonged or permanent hypoesthesia at an early time.
Collapse
|
20
|
Wu W, Wu F, Liu D, Zheng C, Kong X, Shu S, Li D, Kong X, Wang L. Visualization of the morphology and pathology of the peripheral branches of the cranial nerves using three-dimensional high-resolution high-contrast magnetic resonance neurography. Eur J Radiol 2020; 132:109137. [PMID: 33022550 DOI: 10.1016/j.ejrad.2020.109137] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 03/25/2020] [Accepted: 06/13/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the feasibility and advantages of high-resolution high-contrast magnetic resonance neurography (HRHC-MRN) for visualizing the morphology and pathology of the peripheral branches of cranial nerves. MATERIALS cMRN (3D SPACE STIR sequence) and HRHC-MRN (contrast enhanced 3D SPACE STIR sequence) were performed at 3 T MR unit on 16 volunteers and 12 patients with head and neck tumors. Quantitative measurements such as SNR, CNR and CR were calculated. Three readers evaluated the continuity of the 10 major peripheral branches of cranial nerves using a 5-score scale (scores 0-4). Interobserver variability was tested. Quantitative measurements and scores were compared between cMRN and HRHC-MRN. The imaging features of the nerve pathology were analyzed. RESULTS The CRs of nerve to bone marrow, nerve to muscle, and nerve to gland were significantly higher with HRHC-MRN than with cMRN (P = 0.014, P = 0.02, P <0.001, respectively). The scores of all nerve trunks were significantly higher with HRHC-MRN than with cMRN (all, P < 0.001). For all nerves on HRHC-MRN, the interobserver consistency was excellent across the three readers (all κ > 0.8). The scores of the inferior alveolar nerve, hypoglossal nerve, lingual nerve, facial nerve, infraorbital nerve, masseteric nerve, glossopharyngeal/vagus nerve, supraorbital nerve, auriculotemporal nerve and buccal nerve were 3.95, 3.77, 3.63, 3.25, 3.15, 3.04, 3.04, 2.87, 2.79, 1.88, respectively. CONCLUSION HRHC-MRN provides improved visualization of the peripheral branches of cranial nerves and is a promising nerve-selective imaging method for evaluating cranial nerve morphology and pathology.
Collapse
Affiliation(s)
- Wenjun Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Feihong Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Dingxi Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiangquan Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Shenglei Shu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Dan Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Lixia Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| |
Collapse
|
21
|
Van der Cruyssen F, Peeters F, Croonenborghs TM, Fransen J, Renton T, Politis C, Casselman J, Jacobs R. A systematic review on diagnostic test accuracy of magnetic resonance neurography versus clinical neurosensory assessment for post-traumatic trigeminal neuropathy in patients reporting neurosensory disturbance. Dentomaxillofac Radiol 2020; 50:20200103. [PMID: 32401614 PMCID: PMC7780836 DOI: 10.1259/dmfr.20200103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To perform a systematic review of published studies on diagnostic accuracy of magnetic resonance neurography (MRN) vs clinical neurosensory testing (NST) for post-traumatic trigeminal neuropathy (PTTN) in patients reporting neurosensory disturbances (NSD). METHODS Human studies except case reports, reviews, systematic reviews and meta-analyses were included. PubMed, Embase, Web of Science and Cochrane Library were consulted. Risk of bias assessment was conducted using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Predetermined data extraction parameters were noted and summarized. RESULTS 8 studies met eligibility criteria of which 7 were retrospective, representing 444 subjects. Most studies were at high risk of bias with low applicability concerns. Populations and objectives were divergent with a large variation in timing (3 days-17 years post injury) and parameters (multiple coil designs, fat suppression techniques, additional contrast agent) of MRI acquisition. T2 weighted 3 T imaging with short echo times (2.2-100 ms) and fat suppression was applied in seven studies, techniques varied. Determination of sensitivity and specificity could not be performed due to the methodological variation between studies and lacking comparative data between index and reference tests. Based on limited data, PTTN correlated reasonably well between clinical assessment, intraoperative findings and MRN abnormalities (k = 0.57). Increased signal intensity correlated with persistency of neurosensory disturbances in one study. Intra- (ICC 0.914-0.927) and interobserver (k = 0.70-0.891) MRN variability was considered good to excellent. One retrospective study showed substantial impact of MRN on clinical decision making in one-third of patients. CONCLUSION Currently, there is insufficient scientific knowledge to support or refute the use of MRN. Based on limited data, MRN seems promising and reliable in detection and grading of PTTN. Methodological issues underline the importance for prospective blinded studies with standardization of signal intensity calculation and rigorous reporting of MRI acquisition parameters.
Collapse
Affiliation(s)
- Frederic Van der Cruyssen
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Frederik Peeters
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Tomas-Marijn Croonenborghs
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Jasper Fransen
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Tara Renton
- Department of Oral Surgery, King's College London Dental Institute, London, United Kingdom
| | - Constantinus Politis
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Jan Casselman
- Department of Radiology, AZ St-Jan Brugge-Oostende, Bruges, Belgium.,Department of Radiology, AZ St-Augustinus, Antwerp, Belgium
| | - Reinhilde Jacobs
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium.,Department of Oral Health Sciences and Department of Dentistry, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
22
|
Burian E, Probst FA, Weidlich D, Cornelius CP, Maier L, Robl T, Zimmer C, Karampinos DC, Ritschl LM, Probst M. MRI of the inferior alveolar nerve and lingual nerve-anatomical variation and morphometric benchmark values of nerve diameters in healthy subjects. Clin Oral Investig 2019; 24:2625-2634. [PMID: 31705309 DOI: 10.1007/s00784-019-03120-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/01/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Since MRI using dedicated imaging sequences has recently shown promising results in direct visualization of the inferior alveolar nerve (IAN) and the lingual nerve (LN) with high spatial resolution, the aim of this study was to generate suitable standard specifications to reliably depict the IAN and LN in MRI and to delineate the anatomy and its variants of these nerves in healthy subjects. METHODS Thirty healthy volunteers were examined on a 3-T scanner (Elition, Philips Healthcare, Best, the Netherlands). The sequence protocol consisted of 3D STIR, 3D DESS, and 3D T1 FFE "black bone" sequences. RESULTS The study reconfirmed a good feasibility of direct visualization of proximal and peripheral portions of the IAN and of the proximal course of the LN. The STIR sequence showed the highest apparent signal to noise ratio (aSNR) and best apparent nerve-muscle contrast to noise ratio (aNMCNR) for IAN and for the LN. The applied MRI sequences allowed to differentiate the tissue composition of the neurovascular bundle inside the mandibular canal. CONCLUSION Dedicated MRI sequence protocols proved effectively to detect the IAN and LN and their course in healthy volunteers. The tissue composition of the mandibular neurovascular bundle was conclusively distinguishable as was the varying topography inside multiple bony channels. CLINICAL RELEVANCE The presented data on the precise and valid visualization of the IAN and LN have clinical implications in respect to local anesthesia prior to dental treatments in the mandible but also regarding surgical procedures and implant insertion in the molar region.
Collapse
Affiliation(s)
- Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81765, Munich, Germany.
| | - Florian A Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Dominik Weidlich
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Carl-Peter Cornelius
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Lisa Maier
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81765, Munich, Germany
| | - Teresa Robl
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81765, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81765, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81765, Munich, Germany
| |
Collapse
|
23
|
Mupparapu M, Ko E, Omolehinwa TT, Chhabra A. Neurologic Disorders of the Maxillofacial Region. Dent Clin North Am 2019; 64:255-278. [PMID: 31735232 DOI: 10.1016/j.cden.2019.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The maxillofacial region is complex in its anatomy and in its variation in the presentation of neurologic disorders. The diagnosis and management of neurologic disorders in clinical practice remains a challenge. A good understanding of the neurologic disorder in its entirety helps dentists in the diagnosis and appropriate referral to a specialist for further investigations and management of the condition. Neurologic disorders described in this article are under broad categories of sensory and motor disturbances as well as movement disorders and infections. This article summarizes the most common maxillofacial neurologic disorders that dentists might encounter in clinical practice.
Collapse
Affiliation(s)
- Mel Mupparapu
- University of Pennsylvania School of Dental Medicine, 240 S 40th Street, Philadelphia, PA 19104, USA.
| | - Eugene Ko
- University of Pennsylvania School of Dental Medicine, 240 S 40th Street, Philadelphia, PA 19104, USA
| | - Temitope T Omolehinwa
- University of Pennsylvania School of Dental Medicine, 240 S 40th Street, Philadelphia, PA 19104, USA
| | - Avneesh Chhabra
- UT Southwestern Medical Center, Harry Hines Boulevard, Dallas, TX 75390, USA
| |
Collapse
|
24
|
Agarwal M, Wangaryattawanich P, Rath TJ. Perineural Tumor Spread in Head and Neck Malignancies. Semin Roentgenol 2019; 54:258-275. [PMID: 31376866 DOI: 10.1053/j.ro.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Mohit Agarwal
- Radiology Department, Medical College of Wisconsin, Wauwatosa, WI.
| | | | - Tanya J Rath
- University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA.
| |
Collapse
|
25
|
Bunch PM. Invited Commentary on “MR Neurographic Evaluation of Facial and Neck Pain”. Radiographics 2018; 38:1513-1515. [DOI: 10.1148/rg.2018180144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Paul M. Bunch
- Department of Radiology, Massachusetts General Hospital Boston, Massachusetts
| |
Collapse
|
26
|
Peacock ZS, Krishnan DG. Advances in Imaging Over 100 Years: The Impact on Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2018; 76:1387-1399. [DOI: 10.1016/j.joms.2018.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 01/08/2023]
|
27
|
Markiewicz MR, Miloro M. The Evolution of Microvascular and Microneurosurgical Maxillofacial Reconstruction. J Oral Maxillofac Surg 2018; 76:687-699. [DOI: 10.1016/j.joms.2018.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/02/2018] [Indexed: 10/17/2022]
|