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Poh F, Hlis R, Chhabra A. Upper limb peripheral neuropathy in sickle cell anemia: MR neurography appearances. Indian J Radiol Imaging 2021; 29:67-71. [PMID: 31000944 PMCID: PMC6467032 DOI: 10.4103/ijri.ijri_364_18] [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] [Indexed: 01/07/2023] Open
Abstract
Sickle cell anemia is an inherited disorder with many systemic complications. Peripheral neuropathy related to this disorder has been sparsely reported. We report an interesting case of upper limb peripheral neuropathy from sickle cell disease with emphasis on MR neurography appearances and electrophysiology correlation.
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Affiliation(s)
- Feng Poh
- Radiologic Clinic, Medi-Rad Associates Ltd, Mt Elizabeth Hospital, Singapore 228510.,Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Rocco Hlis
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390.,Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX
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2
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Sneag DB, Zochowski KC, Tan ET. MR Neurography of Peripheral Nerve Injury in the Presence of Orthopedic Hardware: Technical Considerations. Radiology 2021; 300:246-259. [PMID: 34184933 DOI: 10.1148/radiol.2021204039] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
As the frequency of orthopedic procedures performed each year in the United States continues to increase, evaluation of peripheral nerve injury (PNI) in the presence of pre-existing metallic hardware is in higher demand. Advances in metal artifact reduction techniques have substantially improved the capability to reduce the susceptibility effect at MRI, but few reports have documented the use of MR neurography in the evaluation of peripheral nerves in the presence of orthopedic hardware. This report delineates the challenges of MR neurography around metal given the high spatial resolution often required to adequately depict small peripheral nerves. It offers practical tips, including strategies for prescan assessment and protocol optimization, including use of more conventional two-dimensional proton density and T2-weighted fat-suppressed sequences and specialized three-dimensional techniques, such as reversed free-induction steady-state precession and multispectral imaging, which enable vascular suppression and metal artifact reduction, respectively. Finally, this article emphasizes the importance of real-time monitoring by radiologists to optimize the diagnostic yield of MR neurography in the presence of orthopedic hardware. © RSNA, 2021.
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Affiliation(s)
- Darryl B Sneag
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, Room 2P-040, New York, NY 10021
| | - Kelly C Zochowski
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, Room 2P-040, New York, NY 10021
| | - Ek T Tan
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, Room 2P-040, New York, NY 10021
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3
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Silsby M, Robertson A, Yiannikas C. Proximal Median Neuropathy Following Anterior Shoulder Dislocation: The Use of Magnetic Resonance Neurography. Neurohospitalist 2021; 11:75-79. [PMID: 33868563 DOI: 10.1177/1941874420946528] [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: 11/15/2022] Open
Abstract
Proximal median nerve injury is an uncommon consequence of anterior shoulder dislocation, especially occurring in isolation of other upper limb peripheral nerve injury. We report the case of an 82-year-old woman with a median nerve injury as detected by clinical and neurophysiological examination following a fall and anterior shoulder dislocation. Magnetic resonance neurography confirmed the diagnosis, but also detected asymptomatic brachial plexus and ulnar nerve involvement. Management was non-operative and there has been some improvement over several months. Our case expands the differential diagnosis for proximal median neuropathy and discusses the utility of neurography in cases of neural injury.
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Affiliation(s)
- Matthew Silsby
- Neurology Department, Concord Hospital, Concord, New South Wales, Australia
| | | | - Con Yiannikas
- Neurology Department, Concord Hospital, Concord, New South Wales, Australia
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Zhang C, Xiao RH, Li B, Das SK, Zeng C, Li T, Yang HF. Magnetic resonance neurography in the management of trigeminal neuralgia: a cohort study of 55 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:727-734. [PMID: 33934956 DOI: 10.1016/j.oooo.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/01/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To explore the usefulness of magnetic resonance neurography (MRN) in the diagnosis and management of trigeminal neuralgia (TN). STUDY DESIGN In total, 55 patients clinically diagnosed with TN were imaged with 3.0-T magnetic resonance imaging. Images were reconstructed to show the full course of the trigeminal nerve. Clinical findings included mean duration of symptoms (41.99 months) and mean visual analog scale pain intensity (5.98). Final diagnoses were microvascular compression (19), inflammation (21), microvascular compression with inflammation (5), normal (5), tumor (1), peripheral nerve injury (2), and multiple sclerosis (2). RESULTS MRN had substantial impact on diagnosis and treatment in 56.4% of cases. A total of 33 patients underwent intervention for pain. MRN had substantial impact on 54.5% of the treated patients. The correlation between MRN results and intervention response was excellent in 19 patients (57.6%) and moderate in 14 (42.4%). Pain was reduced after surgery or interventional procedure in most cases (75.8%). CONCLUSIONS MRN is suitable for the diagnosis of clinical TN with beneficial impact on diagnosis and clinical management and moderate-to-excellent correlation with intervention response. Diagnosis of TN should focus not only on microvascular compression but also on the conditions of the peripheral branches of the trigeminal nerve.
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Affiliation(s)
- Chuan Zhang
- Radiology Attending Physician, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China; Graduate School of Jinan University, Guangzhou, Guangdong Province, China
| | - Ru-Hui Xiao
- Radiographer, Department of Radiology, Affiliated Hospital of North Sichuan Medical College
| | - Bing Li
- Radiology Attending Physician, Department of Radiology, Affiliated Hospital of North Sichuan Medical College
| | - Sushant K Das
- Radiology Attending Physician, Department of Radiology, Affiliated Hospital of North Sichuan Medical College
| | - Chen Zeng
- Radiology Resident, Department of Radiology, Affiliated Hospital of North Sichuan Medical College
| | - Tao Li
- Radiology Resident, Department of Radiology, Affiliated Hospital of North Sichuan Medical College
| | - Han-Feng Yang
- Radiology Professor, Department of Radiology, Affiliated Hospital of North Sichuan Medical College.
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Amini B, Beckmann NM, Beaman FD, Wessell DE, Bernard SA, Cassidy RC, Czuczman GJ, Demertzis JL, Greenspan BS, Khurana B, Lee KS, Lenchik L, Motamedi K, Sharma A, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria ® Shoulder Pain-Traumatic. J Am Coll Radiol 2019; 15:S171-S188. [PMID: 29724420 DOI: 10.1016/j.jacr.2018.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 02/08/2023]
Abstract
Traumatic shoulder pain is pain directly attributed to a traumatic event, either acute or chronic. This pain may be the result of either fracture (the clavicle, scapula, or proximal humerus) or soft-tissue injury (most commonly of the rotator cuff, acromioclavicular ligaments, or labroligamentous complex). Imaging assessment of traumatic shoulder pain begins with conventional radiography and, depending on physical examination findings, will require MRI or MR arthrography for assessment of soft-tissue injuries and CT for delineation of fracture planes. Ultrasound excels in assessment of rotator cuff injuries but has limited usefulness for assessment of the deep soft-tissues. CT angiography and conventional arteriography are helpful for assessment of vascular injury, and bone scintigraphy can be used in assessment of complex regional pain syndrome after traumatic shoulder injury. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Behrang Amini
- Principal Author, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | | | | | | | | | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | | | | | | | | | - Kenneth S Lee
- University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Leon Lenchik
- Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Kambiz Motamedi
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; and Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Garwood ER, Duarte A, Bencardino JT. MR Imaging of Entrapment Neuropathies of the Lower Extremity. Radiol Clin North Am 2018; 56:997-1012. [DOI: 10.1016/j.rcl.2018.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Eastlack J, Tenorio L, Wadhwa V, Scott K, Starr A, Chhabra A. Sciatic neuromuscular variants on MR neurography: frequency study and interobserver performance. Br J Radiol 2017; 90:20170116. [PMID: 28830192 DOI: 10.1259/bjr.20170116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the frequency of sciatic neuromuscular variants on MR neurography and determine the interobserver variability. METHODS A retrospective evaluation of 137 consecutive lumbosacral plexus magnetic resonance neurography examinations was performed. All examinations were performed using nerve selective 3D imaging and independently reviewed by two readers for the presence of sciatic neuromuscular variants and piriformis muscle asymmetry. Inter- and intraobserver performance were evaluated. RESULTS There were a total of 44/268 (16.4%) extremities with sciatic neuromuscular variants. The interobserver performance in the identification of sciatic nerve variants was excellent (kappa values from 0.8-0.9). There was a total of 45/134 (33.6%) patients with piriformis muscle asymmetry. Of these, 7/134 (5.2%) had piriformis muscle atrophy and 38/134 (28.4%) had piriformis muscle hypertrophy. The interobserver performance in the identification of piriformis muscle atrophy and hypertrophy was moderate to good (kappa values from 0.39-0.61). The intraobserver performance revealed kappa values of 0.735 and 0.821 on right and left, respectively. CONCLUSION Sciatic neuromuscular variants and piriformis muscle asymmetry are frequent on lumbosacral plexus MRN with moderate to excellent interobserver performance. Advances in knowledge: Sciatic neuromuscular variants and piriformis asymmetry on MR neurography are frequent and the prevalence is similar to cumulative prevalence from available scientific series. Interobserver performance for identification of sciatic neuromuscular variants is excellent, and moderate-good for piriformis muscle asymmetry.
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Affiliation(s)
- Jason Eastlack
- 1 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lulu Tenorio
- 1 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vibhor Wadhwa
- 2 Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kelly Scott
- 3 Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Adam Starr
- 4 Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- 1 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,4 Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Nacey NC, Geeslin MG, Miller GW, Pierce JL. Magnetic resonance imaging of the knee: An overview and update of conventional and state of the art imaging. J Magn Reson Imaging 2017; 45:1257-1275. [PMID: 28211591 DOI: 10.1002/jmri.25620] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 11/04/2016] [Indexed: 12/28/2022] Open
Abstract
Magnetic resonance imaging (MRI) has become the preferred modality for imaging the knee to show pathology and guide patient management and treatment. The knee is one of the most frequently injured joints, and knee pain is a pervasive difficulty that can affect all age groups. Due to the diverse pathology, complex anatomy, and a myriad of injury mechanisms of the knee, the MRI knee protocol and sequences should ensure detection of both soft tissue and osseous structures in detail and with accuracy. The knowledge of knee anatomy and the normal or injured MRI appearance of these key structures are critical for precise diagnosis. Advances in MRI technology provide the imaging necessary to obtain high-resolution images to evaluate menisci, ligaments, and tendons. Furthermore, recent advances in MRI techniques allow for improved imaging in the postoperative knee and metal artifact reduction, tumor imaging, cartilage evaluation, and visualization of nerves. As treatment and operative management techniques evolve, understanding the correct application of these advancements in MRI of the knee will prove to be valuable to clinical practice. LEVEL OF EVIDENCE 5 J. MAGN. RESON. IMAGING 2017;45:1257-1275.
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Affiliation(s)
- Nicholas C Nacey
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew G Geeslin
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Grady Wilson Miller
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Jennifer L Pierce
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
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10
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Salvalaggio A, Cacciavillani M, Gasparotti R, Briani C. 3D-MR-Neurography of axillary nerve injury: case report of a professional rugby player. Neurol Sci 2016; 37:1361-2. [DOI: 10.1007/s10072-016-2532-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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11
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Wang L, Niu Y, Kong X, Yu Q, Kong X, Lv Y, Shi H, Li C, Wu W, Wang B, Liu D. The application of paramagnetic contrast-based T2 effect to 3D heavily T2W high-resolution MR imaging of the brachial plexus and its branches. Eur J Radiol 2016; 85:578-84. [DOI: 10.1016/j.ejrad.2015.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 11/30/2015] [Accepted: 12/02/2015] [Indexed: 11/17/2022]
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12
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Abstract
We present a review of the imaging findings of large nerve perineural spread within the skull base. The MRI techniques and reasons for performing different sequences are discussed. A series of imaging examples illustrates the appearance of perineural tumor spread with an emphasis on the zonal staging system.
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Affiliation(s)
- Mitesh Gandhi
- The Department of Radiology, Princess Alexandra Hospital and Queensland Xray, Brisbane, Australia
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Shen L, Masih S, Patel DB, Matcuk GR. MR anatomy and pathology of the ulnar nerve involving the cubital tunnel and Guyon's canal. Clin Imaging 2015; 40:263-74. [PMID: 26995584 DOI: 10.1016/j.clinimag.2015.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/12/2015] [Accepted: 11/18/2015] [Indexed: 02/06/2023]
Abstract
Ulnar neuropathy is a common and frequent reason for referral to hand surgeons. Ulnar neuropathy mostly occurs in the cubital tunnel of the elbow or Guyon's canal of the wrist, and it is important for radiologists to understand the imaging anatomy at these common sites of impingement. We will review the imaging and anatomy of the ulnar nerve at the elbow and wrist, and we will present magnetic resonance imaging examples of different causes of ulnar neuropathy, including trauma, overuse, arthritis, masses and mass-like lesions, and systemic diseases. Treatment options will also be briefly discussed.
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Affiliation(s)
- Luyao Shen
- Department of Radiologic Sciences, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095
| | - Sulabha Masih
- Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033-5313
| | - George R Matcuk
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033-5313.
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