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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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Colak C, Chamie LP, Youngner J, Forney MC, Luna Russo MA, Gubbels A, VanBuren WM, Feldman M. MRI Features of Pelvic Nerve Involvement in Endometriosis. Radiographics 2024; 44:e230106. [PMID: 38170677 DOI: 10.1148/rg.230106] [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: 01/05/2024]
Abstract
Endometriosis is a common condition that mostly affects people assigned as female at birth. The most common clinical symptom of endometriosis is pain. Although the mechanism for this pain is poorly understood, in some cases, the nerves are directly involved in endometriosis. Endometriosis is a multifocal disease, and the pelvis is the most common location involved. Nerves in the pelvis can become entrapped and involved in endometriosis. Pelvic nerves are visible at pelvic MRI, especially when imaging planes and sequences are tailored for neural evaluation. In particular, high-spatial-resolution anatomic imaging including three-dimensional isotropic imaging and contrast-enhanced three-dimensional short inversion time inversion-recovery (STIR) fast spin-echo sequences are useful for nerve imaging. The most commonly involved nerves are the sciatic, obturator, femoral, pudendal, and inferior hypogastric nerves and the inferior hypogastric and lumbosacral plexuses. Although it is thought to be rare, the true incidence of nerve involvement in endometriosis is not known. Symptoms of neural involvement include pain, weakness, numbness, incontinence, and paraplegia and may be constant or cyclic (catamenial). Early diagnosis of neural involvement in endometriosis is important to prevent irreversible nerve damage and chronic sensorimotor neuropathy. Evidence of irreversible damage can also be seen at MRI, and radiologists should evaluate pelvic nerves that are commonly involved in endometriosis in their search pattern and report template to ensure that this information is incorporated into treatment planning.
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Affiliation(s)
- Ceylan Colak
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
| | - Luciana P Chamie
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
| | - Jonathan Youngner
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
| | - Michael C Forney
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
| | - Miguel A Luna Russo
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
| | - Ashley Gubbels
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
| | - Wendaline M VanBuren
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
| | - Myra Feldman
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
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Samet JD, Alizai H, Chalian M, Costelloe C, Deshmukh S, Kalia V, Kamel S, Mhuircheartaigh JN, Saade J, Walker E, Wessell D, Fayad LM. Society of skeletal radiology position paper - recommendations for contrast use in musculoskeletal MRI: when is non-contrast imaging enough? Skeletal Radiol 2024; 53:99-115. [PMID: 37300709 DOI: 10.1007/s00256-023-04367-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
The following White Paper will discuss the appropriateness of gadolinium administration in MRI for musculoskeletal indications. Musculoskeletal radiologists should consider the potential risks involved and practice the judicious use of intravenous contrast, restricting administration to cases where there is demonstrable added value. Specific nuances of when contrast is or is not recommended are discussed in detail and listed in table format. Briefly, contrast is recommended for bone and soft tissue lesions. For infection, contrast is reserved for chronic or complex cases. In rheumatology, contrast is recommended for early detection but not for advanced arthritis. Contrast is not recommended for sports injuries, routine MRI neurography, implants/hardware, or spine imaging, but is helpful in complex and post-operative cases.
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Affiliation(s)
- Jonathan D Samet
- Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, USA.
| | - Hamza Alizai
- CHOP Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Majid Chalian
- Department of Radiology, University of Washington, Seattle, USA
| | | | | | - Vivek Kalia
- Children's Scottish Rite Hospital, Dallas, USA
| | - Sarah Kamel
- Thomas Jefferson University Hospital, Philadelphia, USA
| | | | - Jimmy Saade
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, USA
| | - Eric Walker
- Penn State Health Milton S Hershey Medical Center, Hershey, USA
| | - Daniel Wessell
- Mayo Clinic Jacksonville Campus: Mayo Clinic in Florida, Jacksonville, USA
| | - Laura M Fayad
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, USA.
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Meiling JB, Boon AJ, Niu Z, Howe BM, Hoskote SS, Spinner RJ, Klein CJ. Parsonage-Turner Syndrome and Hereditary Brachial Plexus Neuropathy. Mayo Clin Proc 2024; 99:124-140. [PMID: 38176820 DOI: 10.1016/j.mayocp.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/10/2023] [Accepted: 06/23/2023] [Indexed: 01/06/2024]
Abstract
Parsonage-Turner syndrome and hereditary brachial plexus neuropathy (HBPN) present with indistinguishable attacks of rapid-onset severe shoulder and arm pain, disabling weakness, and early muscle atrophy. Their combined incidence ranges from 3 to 100 in 100,000 persons per year. Dominant mutations of SEPT9 are the only known mutations responsible for HBPN. Parsonage and Turner termed the disorder "brachial neuralgic amyotrophy," highlighting neuropathic pain and muscle atrophy. Modern electrodiagnostic and imaging testing assists the diagnosis in distinction from mimicking disorders. Shoulder and upper limb nerves outside the brachial plexus are commonly affected including the phrenic nerve where diaphragm ultrasound improves diagnosis. Magnetic resonance imaging can show multifocal T2 nerve and muscle hyperintensities with nerve hourglass swellings and constrictions identifiable also by ultrasound. An inflammatory immune component is suggested by nerve biopsies and associated infectious, immunization, trauma, surgery, and childbirth triggers. High-dose pulsed steroids assist initial pain control; however, weakness and subsequent pain are not clearly responsive to steroids and instead benefit from time, physical therapy, and non-narcotic pain medications. Recurrent attacks in HBPN are common and prophylactic steroids or intravenous immunoglobulin may reduce surgical- or childbirth-induced attacks. Rehabilitation focusing on restoring functional scapular mechanics, energy conservation, contracture prevention, and pain management are critical. Lifetime residual pain and weakness are rare with most making dramatic functional recovery. Tendon transfers can be used when recovery does not occur after 18 months. Early neurolysis and nerve grafts are controversial. This review provides an update including new diagnostic tools, new associations, and new interventions crossing multiple medical disciplines.
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Affiliation(s)
- James B Meiling
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Zhiyv Niu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Sumedh S Hoskote
- Department of Pulmonary Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Christopher J Klein
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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Telleman JA, Sneag DB, Visser LH. The role of imaging in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:19-42. [PMID: 38697740 DOI: 10.1016/b978-0-323-90108-6.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Electrodiagnostic testing (EDX) has been the diagnostic tool of choice in peripheral nerve disease for many years, but in recent years, peripheral nerve imaging has been used ever more frequently in daily clinical practice. Nerve ultrasound and magnetic resonance (MR) neurography are able to visualize nerve structures reliably. These techniques can aid in localizing nerve pathology and can reveal significant anatomical abnormalities underlying nerve pathology that may have been otherwise undetected by EDX. As such, nerve ultrasound and MR neurography can significantly improve diagnostic accuracy and can have a significant effect on treatment strategy. In this chapter, the basic principles and recent developments of these techniques will be discussed, as well as their potential application in several types of peripheral nerve disease, such as carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), radial neuropathy, brachial and lumbosacral plexopathy, neuralgic amyotrophy (NA), fibular, tibial, sciatic, femoral neuropathy, meralgia paresthetica, peripheral nerve trauma, tumors, and inflammatory neuropathies.
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Affiliation(s)
- Johan A Telleman
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Leo H Visser
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
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Osawa I, Nagawa K, Hara Y, Shimizu H, Tanaka S, Kozawa E. Utility of contrast-enhanced 3D STIR FLAIR imaging for evaluating pituitary adenomas at 3 Tesla. Eur J Radiol Open 2023; 11:100500. [PMID: 37408663 PMCID: PMC10319169 DOI: 10.1016/j.ejro.2023.100500] [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: 05/27/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose To assess the usefulness of contrast-enhanced 3D STIR FLAIR imaging for evaluation of pituitary adenomas. Methods Patients with pituitary adenomas underwent MR examinations including contrast-enhanced 3D STIR FLAIR and 2D T1-weighted (T1W) imaging. We subjectively compared the two techniques in terms of 10 categories. In addition, images were rated by side-by-side comparisons into three outcomes: 3D STIR FLAIR imaging superior, equal, or 2D T1W imaging superior. Additionally, the added value of 3D STIR FLAIR imaging for adenoma detection over conventional MR imaging was assessed. Results Twenty-one patients were included in this study. 3D STIR FLAIR imaging offered significantly better images than 2D T1W imaging in terms of three categories, including overall visualization of the cranial nerves in the cavernous sinus (mean 4.0 vs. 2.8, p < 0.0001), visualization of the optic nerves and chiasm (mean 4.0 vs. 2.6, p < 0.0001), and severity of susceptibility artifacts (mean 0.0 vs. 0.4, p = 0.004). In the side-by-side comparison, 3D STIR FLAIR imaging was judged to be significantly superior to 2D T1W imaging for overall lesion conspicuity (62% vs. 19%, p = 0.049) and border between the adenoma and the pituitary gland (67% vs. 19%, p = 0.031). The addition of 3D STIR FLAIR imaging significantly improved the adenoma detection of conventional MR imaging. Conclusion 3D STIR FLAIR imaging improved overall lesion conspicuity compared to 2D T1W imaging. We suggest that 3D STIR FLAIR imaging is recommended as a supplemental technique when pituitary adenomas are invisible or equivocal on conventional imaging.
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Affiliation(s)
- Iichiro Osawa
- Correspondence to: 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan.
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Payen M, Didier M, Vialle R, Lehericy S, Fitoussi F, Bachy M. MRI of brachial plexus using diffusion tensor imaging: a pilot study for the use of resolve sequence surgical and radiologic anatomy. Surg Radiol Anat 2023; 45:1567-1577. [PMID: 37884742 DOI: 10.1007/s00276-023-03255-z] [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: 03/13/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Clinical exam is the goldstandard for surgical indication. ENMG and conventional MRI are insufficient to understand the highly variable clinical presentation of brachial plexus (BP) lesions. DTI is based on motion of water molecules and can explore nerve function. PURPOSE This pilot study of healthy subjects aimed to develop RESOLVE sequence for BP exploration using diffusion MRI. The main objective was to provide complete precise information from DTI cartography associated with anatomical data. METHODS Six healthy volunteers were scanned using 3T PRISMA scanner with anatomic 3D STIR SPACE and RESOLVE diffusion sequences. Diffusion parametric maps of fractional anisotropy (FA) were extracted from RESOLVE acquisitions. A reproducible method for roots volumes and angles measurements was created using 3DSlicer. ROI were segmented on Mean B0 sequences. FA measurements were obtained with ROI on Mean B0 sequences. RESULTS RESOLVE sequence was adapted to the BP. Mean FA was 0.30. Angles measurements on 3D STIR SPACE sequences showed increasing values from proximal to distal roots with an 0.6 ICC. Volume measurements on anatomic sequences varied widely from one root to another but did not show any significant difference on laterality. CONCLUSIONS A new and reproducible method for BP exploration was developed, using MRI RESOLVE DTI sequences. Complete mapping was obtained but a low resolution of track density imaging did not allow to exploit distal nerves. Deterministic tractography principal limit was the lack of resolution. Extraction of diffusion, volumetric and angular parameters of the plexus roots, and scripts creation for image processing was adapted to the healthy BP.
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Affiliation(s)
- M Payen
- Clinique Chirurgicale Infantile, Hôpital Charles-Nicolle, CHU Rouen, 37 Boulevard Gambetta, 76038, Rouen, France.
- Department of Pediatric Orthopaedics, Sorbonne Université, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France.
- Clinical Research Group on Robotics and Surgical Innovations, GRC-33, Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France.
- The MAMUTH Hospital-University Federation for Innovative Therapies in Musculoskeletal Diseases-Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France.
| | - M Didier
- Paris Brain Institute-ICM, Center for NeuroImaging Research-CENIR, Paris, France
| | - R Vialle
- Department of Pediatric Orthopaedics, Sorbonne Université, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France
- Clinical Research Group on Robotics and Surgical Innovations, GRC-33, Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
- The MAMUTH Hospital-University Federation for Innovative Therapies in Musculoskeletal Diseases-Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
| | - S Lehericy
- Paris Brain Institute-ICM, Center for NeuroImaging Research-CENIR, Paris, France
- Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS, UMR 7225, Pitié-Salpêtrière Hospital, Paris, France
- Investigations and Therapeutics" (MOV'IT), ICM Team "Movement, Paris, France
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - F Fitoussi
- Department of Pediatric Orthopaedics, Sorbonne Université, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France
- Clinical Research Group on Robotics and Surgical Innovations, GRC-33, Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
- The MAMUTH Hospital-University Federation for Innovative Therapies in Musculoskeletal Diseases-Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
| | - M Bachy
- Department of Pediatric Orthopaedics, Sorbonne Université, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France
- Clinical Research Group on Robotics and Surgical Innovations, GRC-33, Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
- The MAMUTH Hospital-University Federation for Innovative Therapies in Musculoskeletal Diseases-Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
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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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Pribowo MA, Harahap MIR, Fazharyasti V, Dwihapsari Y, Kartikasari Y, Sugiyanto. Non-contrast enhancement of brachial plexus magnetic resonance imaging with compressed sensing. Eur J Radiol 2023; 165:110890. [PMID: 37269572 DOI: 10.1016/j.ejrad.2023.110890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/03/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To observe the quality of brachial plexus (BP) images obtained from magnetic resonance imaging (MRI) with 3D T2 STIR SPACE sequence and compressed sensing (CS) and to compare the results with BP images from the same sequence without CS. METHODS In this study, compressed sensing was applied to acquire non-contrast BP images from ten healthy volunteers with 3D T2 STIR SPACE sequence to shorten acquisition time without sacrificing image quality. The acquisition time of scanning with CS was compared to that without CS. The quantitative signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated and compared using paired t-test to determine the quality of images with and without CS. The qualitative assessment by three experienced radiologists was performed using a scoring scale from 1 (poor) to 5 (excellent) and analyzed for interobserver agreement on image quality. RESULTS The increasing SNR and CNR of images with CS were found in nine regions of BP images (p < 0.001) with faster acquisition time. The result of paired t-test (p < 0.001) illustrates the significant difference between images with CS compared to images without CS. The assessment of observers also shows higher scores for images with CS compared to images without CS. CONCLUSIONS This study demonstrates that CS can effectively increase the visibility of images and image boundaries, SNR, and CNR of BP images obtained with 3D T2 STIR SPACE sequence with the good interobserver agreement and within clinically optimal acquisition time compared to images from similar sequence without CS.
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Affiliation(s)
- Muhammad Agus Pribowo
- Department of Radiology, Gatot Soebroto Army Hospital (RSPAD Gatot Soebroto), Jakarta 10410, Indonesia
| | | | - Vininta Fazharyasti
- Department of Radiology, Gatot Soebroto Army Hospital (RSPAD Gatot Soebroto), Jakarta 10410, Indonesia
| | - Yanurita Dwihapsari
- Department of Physics, Institut Teknologi Sepuluh Nopember (ITS), Surabaya 60111, Indonesia.
| | - Yeti Kartikasari
- Health Polytechnic of Semarang, Ministry of Health, Semarang 50239, Indonesia
| | - Sugiyanto
- Health Polytechnic of Semarang, Ministry of Health, Semarang 50239, Indonesia
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Pedrick EG, Sneag DB, Colucci PG, Duong M, Tan ET. Three-dimensional MR Neurography of the Brachial Plexus: Vascular Suppression with Low-dose Ferumoxytol. Radiology 2022; 307:e221087. [PMID: 36511805 DOI: 10.1148/radiol.221087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The efficacy of ferumoxytol, an ultrasmall superparamagnetic iron oxide particle for three-dimensional (3D) MR neurography, has yet to be evaluated. Purpose To evaluate the effects of low-dose ferumoxytol for vascular suppression and nerve visualization in 3D brachial plexus MR neurography as a pilot study. Materials and Methods Volunteers without anemia were prospectively enrolled in July 2021. Brachial plexus MR neurography was performed 30 minutes following infusion of 25% of the standard (510 mg of iron) therapeutic ferumoxytol dose with use of a 3D short-tau inversion recovery T2-weighted fast spin-echo sequence. The 3D fast spin-echo was acquired with and without the use of additional flow suppression techniques. Two musculoskeletal radiologists qualitatively evaluated examinations for the degree of vascular suppression (0-3, none to complete), nerve visualization (0-2, none to full), and motion artifact (0-4, none to severe). Nerve-to-fat, muscle, or vessel contrast ratios were calculated with use of manually drawn regions of interests. Comparisons of the proportion of scans with adequate image quality (vascular suppression, 3; nerve visualization, 1, 2; motion artifacts, 0, 1) were made with use of the McNemar test. Comparisons of quantitative contrast ratios were performed with use of Wilcoxon signed rank tests. P < .05 was deemed statistically significant. Results There were 12 volunteers (mean age, 25 years ± 3; six women) evaluated. The scans with adequate vascular suppression increased from 0% to 98% with and without ferumoxytol, respectively (P < .001). All individual nerve assessments of adequate nerve visualization increased from 4%-63% to 36%-100% without and with ferumoxytol, respectively (P < .001-.010), while motion artifacts were unchanged (from 33% to 52%, P = .212). Quantitatively, nerve-to-vessel contrast ratios increased from 0.6 without to 7.6 with ferumoxytol (P < .001). The addition of flow suppression did not change nerve-to-vessel contrast ratio quantitatively (from 7.5 to 8.4, P > .99) following ferumoxytol. Conclusion Low-dose ferumoxytol improved vascular suppression and nerve visualization in three-dimensional MR neurography of the brachial plexus compared to imaging without ferumoxytol. © RSNA, 2022.
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Affiliation(s)
- Emily G. Pedrick
- From the Department of Radiology and Imaging (E.G.P., D.B.S., P.G.C., E.T.T.) and Department of Pharmacy (M.D.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Darryl B. Sneag
- From the Department of Radiology and Imaging (E.G.P., D.B.S., P.G.C., E.T.T.) and Department of Pharmacy (M.D.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Philip G. Colucci
- From the Department of Radiology and Imaging (E.G.P., D.B.S., P.G.C., E.T.T.) and Department of Pharmacy (M.D.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Mylinh Duong
- From the Department of Radiology and Imaging (E.G.P., D.B.S., P.G.C., E.T.T.) and Department of Pharmacy (M.D.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Ek T. Tan
- From the Department of Radiology and Imaging (E.G.P., D.B.S., P.G.C., E.T.T.) and Department of Pharmacy (M.D.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
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The Application of Contrast-Enhanced 3D-STIR-VISTA MR Imaging of the Brachial Plexus. J Belg Soc Radiol 2022; 106:75. [PMID: 36134175 PMCID: PMC9461682 DOI: 10.5334/jbsr.2803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/09/2022] [Indexed: 11/20/2022] Open
Abstract
Objective: Methods: Results: Conclusion:
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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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Deshmukh S, Tegtmeyer K, Kovour M, Ahlawat S, Samet J. Diagnostic contribution of contrast-enhanced 3D MR imaging of peripheral nerve pathology. Skeletal Radiol 2021; 50:2509-2518. [PMID: 34052869 DOI: 10.1007/s00256-021-03816-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the diagnostic contribution of contrast-enhanced 3D STIR (ce3D-SS) high-resolution magnetic resonance (MR) imaging of peripheral nerve pathology relative to conventional 2D sequences. MATERIALS AND METHODS In this IRB-approved retrospective study, two radiologists reviewed 60 MR neurography studies with nerve pathology findings. The diagnostic contribution of ce3D-SS imaging was scored on a 4-point Likert scale (1 = no additional information, 2 = supports interpretation, 3 = moderate additional information, and 4 = diagnosis not possible without ce3D-SS). Image quality, nerve visualization, and detection of nerve pathology were also assessed for both standard 2D neurography and ce3D-SS sequences utilizing a 3-point Likert scale. Descriptive statistics are reported. RESULTS The diagnostic contribution score for ce3D-SS imaging was 2.25 for the brachial plexus, 1.50 for extremities, and 1.75 for the lumbosacral plexus. For brachial plexus, the mean consensus scores for image quality, nerve visualization, and detection of nerve pathology were 2.55, 2.5, and 2.55 for 2D and 2.35, 2.45, and 2.45 for 3D. For extremities, the mean consensus scores for image quality, nerve visualization, and detection of nerve pathology were 2.60, 2.80, and 2.70 for 2D and 1.8, 2.20, and 2.10 for 3D. For lumbosacral plexus, the mean consensus scores for image quality, nerve visualization, and detection of nerve pathology were 2.45, 2.75, and 2.65 for 2D and 2.0, 2.45, and 2.25 for 3D. CONCLUSION Overall, our study supports the potential application of ce3D-SS imaging for MRN of the brachial plexus but suggests that 2D MRN protocols are sufficient for MRN of the extremities and lumbosacral plexus.
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Affiliation(s)
- Swati Deshmukh
- Department of Radiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Kyle Tegtmeyer
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Mounisha Kovour
- University of Illinois At Urbana-Champaign, 601 E John St, Champaign, IL, 61820, USA
| | - Shivani Ahlawat
- Department of Radiology, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Jonathan Samet
- Department of Radiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
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Queler SC, Tan ET, Geannette C, Prince M, Sneag DB. Ferumoxytol-enhanced vascular suppression in magnetic resonance neurography. Skeletal Radiol 2021; 50:2255-2266. [PMID: 33961070 DOI: 10.1007/s00256-021-03804-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate ferumoxytol-enhanced vascular suppression for visualizing branch nerves of the brachial plexus in magnetic resonance (MR) neurography. MATERIALS AND METHODS Signal simulations were performed to determine ferumoxytol's effect on nerve-, fat-, and blood-to-muscle contrast and to optimize pulse sequence parameters. Prospective, in vivo assessment included 10 subjects with chronic anemia who underwent a total of 19 (9 bilateral) pre- and post-infusion brachial plexus exams using three-dimensional (3D), T2-weighted short-tau inversion recovery (T2-STIR) sequences at 3.0 T. Two musculoskeletal radiologists qualitatively rated sequences for the degree of vascular suppression and brachial plexus branch nerve conspicuity. Nerve-to-muscle, -fat, and -vessel contrast ratios were measured. RESULTS Quantitative nerve/muscle and nerve/small vessel contrast ratios (CRs) increased with ferumoxytol (p < 0.05). Qualitative vascular suppression and suprascapular nerve visualization improved following ferumoxytol administration for both raters (p < .05). Pre- and post-ferumoxytol exams demonstrated moderate to near-perfect inter-rater agreement for nerve visualization and diagnostic confidence for the suprascapular and axillary nerves but poor to no agreement for the long thoracic nerve. CONCLUSION Ferumoxytol in T2-weighted brachial plexus MR neurography provides robust vascular suppression and aids visualization of the suprascapular nerve in volunteers without neuropathy.
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Affiliation(s)
- Sophie C Queler
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Christian Geannette
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Martin Prince
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, 535 E. 70th St., New York, NY, 10021, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
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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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Zhang X, Wang W, Liu T, Qi Y, Ma L. The effects of three different contrast agents (Gd-BOPTA, Gd-DTPA, and Gd-DOTA) on brachial plexus magnetic resonance imaging. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:344. [PMID: 33708971 PMCID: PMC7944290 DOI: 10.21037/atm-21-348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background MRI is very important for guiding the diagnosis and treatment of brachial plexus diseases. The most used type of MRI brachial plexus imaging is the 3D Short Term Inversion Recovery (STIR) sequence with contrast agent. This study aimed to investigate the effect of three contrast agents; gadobenate dimeglumine (Gd-BOPTA), gadopentetate dimeglumine (Gd-DTPA), and Gadoteric Acid Meglumine (Gd-DOTA) on brachial plexus magnetic resonance imaging (MRI). Methods We recruited 60 patients with suspected brachial plexus injury randomly into three groups. MRI images were obtained from each patient. Prior to scanning, the first group was injected with GD-BOPTA, the second group with Gd-DTPA, and the third with Gd-DOTA. The amount of contrast agent was 0.1 mmol/kg according to the weight of each patient, the injection rate was 1.5 mL/s, and 20 mL saline was injected at the same rate with a high-pressure injector. Immediately after the injection of contrast agent and saline, a 3D Sampling perfection with application optimized contrasts using different flip angle evolutions (SPACE) STIR sequence was used for scanning. The Signal Intensity (SI) and Standard Deviation (SD) of Maximal intensity projection (MIP) images for regions outside the anatomy (ROI background) with area of 17 mm2 on both sides of the C6 peripheral nerves (ROI nerve), and tissue adjacent to the peripheral nerves (ROI tissue) were obtained. Signal to noise ratio (SNR) and contrast to noise ratio (CNR) were then calculated. Results The SNR was 40.66±25.27, 34.65±14.86, and 44.63±30.79 for Gd-BOPTA, Gd-DTPA, and Gd-DOTA, respectively and the CNR was 20.24±15.17, 16.07±7.50, and 20.84±15.53 for Gd-BOPTA, Gd-DTPA, and Gd-DOTA, respectively. In addition, there was no statistical difference in the SNR or CNR of brachial plexus nerves using the three contrast agents to enhance the 3D SPACE sequence χ2=1.877, P=0.391>0.05 and χ2=1.717, P=0.424, respectively. Conclusions There were no significant differences in the efficacy of three contrast agents in imaging the brachial plexus.
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Affiliation(s)
- Xiaojing Zhang
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Radiology, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Wensheng Wang
- Department of Radiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tiefang Liu
- Department of Radiology, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yeqing Qi
- Department of Radiology, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lin Ma
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Radiology, The First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
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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: 23] [Impact Index Per Article: 5.8] [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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Kong C, Li XY, Sun SY, Sun XY, Zhang M, Sun Z, Wang Y, Lu J, Lu SB. The value of contrast-enhanced three-dimensional isotropic T2-weighted turbo spin-echo SPACE sequence in the diagnosis of patients with lumbosacral nerve root compression. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:855-864. [PMID: 32936403 DOI: 10.1007/s00586-020-06600-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/18/2020] [Accepted: 09/05/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the diagnostic value of contrast-enhanced three-dimensional (3D) T2-weighted turbo spin-echo SPACE (T2-SPACE) sequence in LNRC. METHODS A total of 90 surgically confirmed LNRC patients with 165 explored nerve roots were enrolled in this study. Diagnostic values were quantified using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. The consistency between 2D MRI and 3D T2-SPACE MRI was quantified using kappa test. The compression of specific branch in nerve root was evaluated on 2D MRI, 3D T2-SPACE MRI, and surgical findings. The pedicle height, vertebral body height (VH), proximal tilting angle of nerve root (PTA) were measured on MR images. RESULTS The sensitivity, specificity, PPV, NPV, and accuracy by 2D MRI were 78.3%, 72.7%, 94.9%, 34.0%, and 77.6%, respectively. For 3D T2-SPACE MRI imaging, the sensitivity, specificity, PPV, NPV, and accuracy were 91.6%, 86.4%, 97.8%, 61.3%, and 90.9%, respectively. 2D MRI and 3D T2-SPACE MRI for detection of intra-foramen and extra-foramen nerve compression showed poor homogeneity (Kappa = 0.333, Kappa = 0.276, respectively). Smaller VHs and larger PTAs could be indicators for the diagnosis of foraminal nerve root compression. CONCLUSIONS 3D T2-SPACE MRI had a higher sensitivity, specificity, PPV, NPV, and accuracy than 2D MRI for detecting LNRC. The 3D T2-SPACE scan could be a good substitute to routine 2D MRI in LNRC diagnosis, especially for foraminal nerve root compression patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China
- National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China
| | - Xiang-Yu Li
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China
- National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China
| | - Si-Yuan Sun
- Department of Interdisciplinary Life Science, Purdue University, West Lafayette, IN, 47907, USA
| | - Xiang-Yao Sun
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China
- National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China
| | - Miao Zhang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China
| | - Zheng Sun
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China
| | - Yu Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China
- National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China.
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China.
- National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China.
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Lee SC, Geannette CS, Sneag DB. Identification of long thoracic nerve on high-resolution 3T MRI. Clin Imaging 2020; 64:97-102. [DOI: 10.1016/j.clinimag.2020.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/08/2020] [Accepted: 04/20/2020] [Indexed: 01/08/2023]
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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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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.
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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.
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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: 14] [Impact Index Per Article: 3.5] [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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Sneag DB, Queler S. Technological Advancements in Magnetic Resonance Neurography. Curr Neurol Neurosci Rep 2019; 19:75. [DOI: 10.1007/s11910-019-0996-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Bordalo-Rodrigues M. Magnetic Resonance Neurography in Musculoskeletal Disorders. Magn Reson Imaging Clin N Am 2018; 26:615-630. [DOI: 10.1016/j.mric.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Wade RG, Itte V, Rankine JJ, Ridgway JP, Bourke G. The diagnostic accuracy of 1.5T magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries. J Hand Surg Eur Vol 2018; 43:250-258. [PMID: 28886666 DOI: 10.1177/1753193417729587] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Identification of root avulsions is of critical importance in traumatic brachial plexus injuries because it alters the reconstruction and prognosis. Pre-operative magnetic resonance imaging is gaining popularity, but there is limited and conflicting data on its diagnostic accuracy for root avulsion. This cohort study describes consecutive patients requiring brachial plexus exploration following trauma between 2008 and 2016. The index test was magnetic resonance imaging at 1.5 Tesla and the reference test was operative exploration of the supraclavicular plexus. Complete data from 29 males was available. The diagnostic accuracy of magnetic resonance imaging for root avulsion(s) of C5-T1 was 79%. The diagnostic accuracy of a pseudomeningocoele as a surrogate marker of root avulsion(s) of C5-T1 was 68%. We conclude that pseudomeningocoles were not a reliable sign of root avulsion and magnetic resonance imaging has modest diagnostic accuracy for root avulsions in the context of adult traumatic brachial plexus injuries. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ryckie G Wade
- 1 Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
- 2 Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK
| | - Vinay Itte
- 1 Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
- 3 Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - James J Rankine
- 4 Department of Radiology, Leeds Teaching Hospitals Trust, Leeds, UK
- 5 Leeds Musculoskeletal Biomedical Research Centre (LMBRC), Chapel Allerton Hospital, Leeds, UK
| | - John P Ridgway
- 5 Leeds Musculoskeletal Biomedical Research Centre (LMBRC), Chapel Allerton Hospital, Leeds, UK
- 6 Department of Medical Physics and Engineering, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Grainne Bourke
- 1 Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
- 2 Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK
- 3 Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
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Zhang X, Li M, Guan J, Wang H, Li S, Guo Y, Liu M. Evaluation of the sacral nerve plexus in pelvic endometriosis by three-dimensional MR neurography. J Magn Reson Imaging 2016; 45:1225-1231. [PMID: 27666420 DOI: 10.1002/jmri.25435] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 08/08/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To investigate the feasibility of three-dimensional MR neurography (3D MRN) for the sacral plexus using sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) sequences, and to demonstrate structural abnormalities in the pelvic nerve of women with pelvic endometriosis. MATERIALS AND METHODS Twenty patients with pelvic endometriosis and 20 healthy controls were examined by contrast-enhanced 3D short time inversion recovery T2-weighted imaging (CE 3D STIR T2WI) SPACE sequences on 3 Tesla MRI. Image quality and diagnostic confidence of the sequences in identifying abnormalities of the sacral plexus were analyzed and compared with conventional three-plane images of 2D turbo-spin echo T2-weighted images (2D TSE T2WI). The changes in the sacral plexus caused by endometrial lesions were evaluated. RESULTS The sacral plexus was clearly revealed in both healthy controls and patients with endometriosis on 3D STIR SPACE images. A good agreement was reached in the evaluation of both imaging quality (Kappa value [κ] = 0.73-1.00) and diagnostic confidence (κ = 0.66-0.81) when compared between the two independent readers. Abnormalities caused by endometriosis were identified in 17 patients, unilaterally in 10 patients, and bilaterally in 7 patients. Nerve fiber abnormalities of lumbar 5 (L5) were detected in 11 patients, of sacral 1 (S1) in 14 patients and of sacral 2 (S2) in 9 patients. CONCLUSION CE 3D STIR SPACE sequences demonstrate its significant capacity to investigate and map the sacral plexus, and reveal the compression and adhesion of the sacral plexus nerve as a result of ectopic lesions. LEVEL OF EVIDENCE 3 J. Magn. Reson. Imaging 2017;45:1225-1231.
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Affiliation(s)
- Xiaoling Zhang
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Meizhi Li
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Jian Guan
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Huanjun Wang
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Shurong Li
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Yan Guo
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Mingjuan Liu
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
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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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