1
|
Preisner F, Pitarokoili K, Lueling B, Motte J, Fisse AL, Grüter T, Godel T, Schwarz D, Heiland S, Gold R, Bendszus M, Kronlage M. Quantitative magnetic resonance neurography in chronic inflammatory demyelinating polyradiculoneuropathy: A longitudinal study over 6 years. Ann Clin Transl Neurol 2024; 11:593-606. [PMID: 38111964 DOI: 10.1002/acn3.51978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To evaluate magnetic resonance neurography (MRN) for the longitudinal assessment of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS Prospective examination of twelve CIDP patients by neurological assessment, MRN, and nerve conduction studies in 2016 and 6 years later in 2022. Imaging parameters were compared with matched healthy controls and correlated with clinical and electrophysiological markers. The MRN protocol included T2-weighted imaging, diffusion tensor imaging (DTI), T2 relaxometry, and magnetization transfer imaging (MTI). RESULTS Nerve cross-sectional area (CSA) was increased in CIDP patients compared to controls (plexus: p = 0.003; sciatic nerve: p < 0.001). Over 6 years, nerve CSA decreased in CIDP patients, most pronounced at the lumbosacral plexus (p = 0.015). Longitudinally, changes in CSA correlated with changes in the inflammatory neuropathy cause and treatment validated overall disability sum score (INCAT/ODSS) (p = 0.006). High initial nerve CSA was inversely correlated with changes in the INCAT/ODSS over 6 years (p < 0.05). The DTI parameter fractional anisotropy (FA) showed robust correlations with electrodiagnostic testing both cross-sectionally and longitudinally (p < 0.05). MTI as a newly added imaging technique revealed a significantly reduced magnetization transfer ratio (MTR) in CIDP patients (p < 0.01), suggesting underlying changes in macromolecular tissue composition, and correlated significantly with electrophysiological parameters of demyelination (p < 0.05). INTERPRETATION This study provides evidence that changes in nerve CSA and FA reflect the clinical and electrophysiological course of CIDP patients. Initial nerve hypertrophy might predict a rather benign course or better therapy response.
Collapse
Affiliation(s)
- Fabian Preisner
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Benjamin Lueling
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Tim Godel
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Moritz Kronlage
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| |
Collapse
|
2
|
Foesleitner O, Sturm V, Hayes J, Weiler M, Sam G, Wildemann B, Wick W, Bendszus M, Heiland S, Jäger LB. Microstructural changes of peripheral nerves in early multiple sclerosis: A prospective magnetic resonance neurography study. Eur J Neurol 2024; 31:e16126. [PMID: 37932921 PMCID: PMC11236022 DOI: 10.1111/ene.16126] [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: 06/03/2023] [Revised: 10/07/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis (MS) is a demyelinating disorder of the central nervous system (CNS). However, there is increasing evidence of peripheral nerve involvement. This study aims to characterize the pattern of peripheral nerve changes in patients with newly diagnosed MS using quantitative magnetic resonance (MR) neurography. METHODS In this prospective study, 25 patients first diagnosed with MS according to the revised McDonald criteria (16 female, mean age = 32.8 ± 10.6 years) and 14 healthy controls were examined with high-resolution 3-T MR neurography of the sciatic nerve using diffusion kurtosis imaging (DKI; 20 diffusional directions, b = 0, 700, 1200 s/mm2 ) and magnetization transfer imaging (MTI). In total, 15 quantitative MR biomarkers were analyzed and correlated with clinical symptoms, intrathecal immunoglobulin synthesis, electrophysiology, and lesion load on brain and spine MR imaging. RESULTS Patients showed decreased fractional anisotropy (mean = 0.51 ± 0.04 vs. 0.56 ± 0.03, p < 0.001), extra-axonal tortuosity (mean = 2.32 ± 0.17 vs. 2.49 ± 0.17, p = 0.008), and radial kurtosis (mean = 1.40 ± 0.23 vs. 1.62 ± 0.23, p = 0.014) and higher radial diffusivity (mean = 1.09 ∙ 10-3 mm2 /s ± 0.16 vs. 0.98 ± 0.11 ∙ 10-3 mm2 /s, p = 0.036) than controls. Groups did not differ in MTI. No significant association was found between MR neurography markers and clinical/laboratory parameters or CNS lesion load. CONCLUSIONS This study provides further evidence of peripheral nerve involvement in MS already at initial diagnosis. The characteristic pattern of DKI parameters indicates predominant demyelination and suggests a primary coaffection of the peripheral nervous system in MS. This first human study using DKI for peripheral nerves shows its potential and clinical feasibility in providing novel biomarkers.
Collapse
Affiliation(s)
- Olivia Foesleitner
- Department of NeuroradiologyHeidelberg University HospitalHeidelbergGermany
| | - Volker Sturm
- Department of NeuroradiologyHeidelberg University HospitalHeidelbergGermany
| | - Jennifer Hayes
- Department of NeuroradiologyHeidelberg University HospitalHeidelbergGermany
| | - Markus Weiler
- Department of NeurologyHeidelberg University HospitalHeidelbergGermany
- Clinical Cooperation Unit Neuro‐oncology, German Cancer ConsortiumGerman Cancer Research CenterHeidelbergGermany
| | - Georges Sam
- Department of NeurologyHeidelberg University HospitalHeidelbergGermany
| | | | - Wolfgang Wick
- Department of NeurologyHeidelberg University HospitalHeidelbergGermany
- Clinical Cooperation Unit Neuro‐oncology, German Cancer ConsortiumGerman Cancer Research CenterHeidelbergGermany
| | - Martin Bendszus
- Department of NeuroradiologyHeidelberg University HospitalHeidelbergGermany
| | - Sabine Heiland
- Department of NeuroradiologyHeidelberg University HospitalHeidelbergGermany
| | | |
Collapse
|
3
|
Mooshage CM, Schimpfle L, Tsilingiris D, Kender Z, Aziz-Safaie T, Hohmann A, Szendroedi J, Nawroth P, Sturm V, Heiland S, Bendszus M, Kopf S, Jende JME, Kurz FT. Magnetization transfer ratio of the sciatic nerve differs between patients in type 1 and type 2 diabetes. Eur Radiol Exp 2024; 8:6. [PMID: 38191821 PMCID: PMC10774497 DOI: 10.1186/s41747-023-00405-1] [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: 07/27/2023] [Accepted: 11/07/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Previous studies on magnetic resonance neurography (MRN) found different patterns of structural nerve damage in type 1 diabetes (T1D) and type 2 diabetes (T2D). Magnetization transfer ratio (MTR) is a quantitative technique to analyze the macromolecular tissue composition. We compared MTR values of the sciatic nerve in patients with T1D, T2D, and healthy controls (HC). METHODS 3-T MRN of the right sciatic nerve at thigh level was performed in 14 HC, 10 patients with T1D (3 with diabetic neuropathy), and 28 patients with T2D (10 with diabetic neuropathy). Results were subsequently correlated with clinical and electrophysiological data. RESULTS The sciatic nerve's MTR was lower in patients with T2D (0.211 ± 0.07, mean ± standard deviation) compared to patients with T1D (T1D 0.285 ± 0.03; p = 0.015) and HC (0.269 ± 0.05; p = 0.039). In patients with T1D, sciatic MTR correlated positively with tibial nerve conduction velocity (NCV; r = 0.71; p = 0.021) and negatively with hemoglobin A1c (r = - 0.63; p < 0.050). In patients with T2D, we found negative correlations of sciatic nerve's MTR peroneal NCV (r = - 0.44; p = 0.031) which remained significant after partial correlation analysis controlled for age and body mass index (r = 0.51; p = 0.016). CONCLUSIONS Lower MTR values of the sciatic nerve in T2D compared to T1D and HC and diametrical correlations of MTR values with NCV in T1D and T2D indicate that there are different macromolecular changes and pathophysiological pathways underlying the development of neuropathic nerve damage in T1D and T2D. TRIAL REGISTRATION https://classic. CLINICALTRIALS gov/ct2/show/NCT03022721 . 16 January 2017. RELEVANCE STATEMENT Magnetization transfer ratio imaging may serve as a non-invasive imaging method to monitor the diseases progress and to encode the pathophysiology of nerve damage in patients with type 1 and type 2 diabetes. KEY POINTS • Magnetization transfer imaging detects distinct macromolecular nerve lesion patterns in diabetes patients. • Magnetization transfer ratio was lower in type 2 diabetes compared to type 1 diabetes. • Different pathophysiological mechanisms drive nerve damage in type 1 and 2 diabetes.
Collapse
Affiliation(s)
- Christoph M Mooshage
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
| | - Lukas Schimpfle
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, Neuherberg, Germany
| | - Dimitrios Tsilingiris
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, Neuherberg, Germany
| | - Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, Neuherberg, Germany
| | - Taraneh Aziz-Safaie
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
| | - Anja Hohmann
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Julia Szendroedi
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany
| | - Volker Sturm
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, Neuherberg, Germany
| | - Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany.
- German Cancer Research Center, Heidelberg, Germany.
| |
Collapse
|
4
|
Telleman JA, Sneag DB, Visser LH. The role of imaging in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:19-42. [PMID: 38697740 DOI: 10.1016/b978-0-323-90108-6.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Electrodiagnostic testing (EDX) has been the diagnostic tool of choice in peripheral nerve disease for many years, but in recent years, peripheral nerve imaging has been used ever more frequently in daily clinical practice. Nerve ultrasound and magnetic resonance (MR) neurography are able to visualize nerve structures reliably. These techniques can aid in localizing nerve pathology and can reveal significant anatomical abnormalities underlying nerve pathology that may have been otherwise undetected by EDX. As such, nerve ultrasound and MR neurography can significantly improve diagnostic accuracy and can have a significant effect on treatment strategy. In this chapter, the basic principles and recent developments of these techniques will be discussed, as well as their potential application in several types of peripheral nerve disease, such as carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), radial neuropathy, brachial and lumbosacral plexopathy, neuralgic amyotrophy (NA), fibular, tibial, sciatic, femoral neuropathy, meralgia paresthetica, peripheral nerve trauma, tumors, and inflammatory neuropathies.
Collapse
Affiliation(s)
- Johan A Telleman
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Leo H Visser
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| |
Collapse
|
5
|
Gasparotti R, Salvalaggio A, Corbo D, Agazzi G, Cacciavillani M, Lozza A, Fenu S, De Vigili G, Tagliapietra M, Fabrizi GM, Pareyson D, Obici L, Briani C. Magnetic resonance neurography and diffusion tensor imaging of the sciatic nerve in hereditary transthyretin amyloidosis polyneuropathy. J Neurol 2023; 270:4827-4840. [PMID: 37329346 PMCID: PMC10511361 DOI: 10.1007/s00415-023-11813-z] [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: 04/28/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023]
Abstract
The therapeutic advance in hereditary transthyretin amyloidosis (ATTRv amyloidosis) requires quantitative biomarkers of nerve involvement in order to foster early diagnosis and monitor therapy response. We aimed at quantitatively assessing Magnetic Resonance Neurography (MRN) and Diffusion Tensor Imaging (DTI) properties of the sciatic nerve in subjects with ATTRv-amyloidosis-polyneuropathy (ATTRv-PN) and pre-symptomatic carriers (ATTRv-C). Twenty subjects with pathogenic variants of the TTR gene (mean age 62.20 ± 12.04 years), 13 ATTRv-PN, and 7 ATTRv-C were evaluated and compared with 20 healthy subjects (mean age 60.1 ± 8.27 years). MRN and DTI sequences were performed at the right thigh from the gluteal region to the popliteal fossa. Cross-sectional-area (CSA), normalized signal intensity (NSI), and DTI metrics, including fractional anisotropy (FA), mean (MD), axial (AD), and radial diffusivity (RD) of the right sciatic nerve were measured. Increased CSA, NSI, RD, and reduced FA of sciatic nerve differentiated ATTRv-PN from ATTRv-C and healthy subjects at all levels (p < 0.01). NSI differentiated ATTRv-C from controls at all levels (p < 0.05), RD at proximal and mid-thigh (1.04 ± 0.1 vs 0.86 ± 0.11 p < 0.01), FA at mid-thigh (0.51 ± 0.02 vs 0.58 ± 0.04 p < 0.01). According to receiver operating characteristic (ROC) curve analysis, cutoff values differentiating ATTRv-C from controls (and therefore identifying subclinical sciatic involvement) were defined for FA, RD, and NSI. Significant correlations between MRI measures, clinical involvement and neurophysiology were found. In conclusion, the combination of quantitative MRN and DTI of the sciatic nerve can reliably differentiate ATTRv-PN, ATTRv-C, and healthy controls. More important, MRN and DTI were able to non-invasively identify early subclinical microstructural changes in pre-symptomatic carriers, thus representing a potential tool for early diagnosis and disease monitoring.
Collapse
Affiliation(s)
- Roberto Gasparotti
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili Hospital, P.Le Spedali Civili 1, 25123, Brescia, Italy.
| | - Alessandro Salvalaggio
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
- Padova Neuroscience Center (PNC), University of Padova, Padua, Italy
| | - Daniele Corbo
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili Hospital, P.Le Spedali Civili 1, 25123, Brescia, Italy
| | - Giorgio Agazzi
- Neuroradiology Unit, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | | | - Alessandro Lozza
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Fenu
- Rare Neurological Diseases Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Grazia De Vigili
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matteo Tagliapietra
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gian Maria Fabrizi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Davide Pareyson
- Rare Neurological Diseases Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Obici
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Briani
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
| |
Collapse
|
6
|
Foesleitner O, Knop KC, Lindenau M, Preisner F, Bäumer P, Heiland S, Bendszus M, Kronlage M. Quantitative MR Neurography in Multifocal Motor Neuropathy and Amyotrophic Lateral Sclerosis. Diagnostics (Basel) 2023; 13:diagnostics13071237. [PMID: 37046455 PMCID: PMC10093201 DOI: 10.3390/diagnostics13071237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 03/29/2023] Open
Abstract
Background: The aim of this study was to assess the phenotype of multifocal motor neuropathy (MMN) and amyotrophic lateral sclerosis (ALS) in quantitative MR neurography. Methods: In this prospective study, 22 patients with ALS, 8 patients with MMN, and 10 healthy volunteers were examined with 3T MR neurography, using a high-resolution fat-saturated T2-weighted sequence, diffusion-tensor imaging (DTI), and a multi-echo T2-relaxometry sequence. The quantitative biomarkers fractional anisotropy (FA), radial and axial diffusivity (RD, AD), mean diffusivity (MD), cross-sectional area (CSA), T2-relaxation time, and proton spin density (PSD) were measured in the tibial nerve at the thigh and calf, and in the median, radial, and ulnar nerves at the mid-upper arm. Results: MMN showed a characteristic imaging pattern of decreased FA (p = 0.018), increased RD (p = 0.014), increased CSA (p < 0.001), increased T2-relaxation time (p < 0.001), and increased PSD (p = 0.025) in the upper arm nerves compared to ALS and controls. ALS patients did not differ from controls in any imaging marker, nor were there any group differences in the tibial nerve (p > 0.05). Conclusions: MMN shows a characteristic pattern of quantitative DTI and T2-relaxometry parameters in the upper-arm nerves, primarily indicating demyelination. Peripheral nerve changes in ALS seem to be below the detection level of current state-of-the-art quantitative MR neurography.
Collapse
|
7
|
Wade RG, Lu F, Poruslrani Y, Karia C, Feltbower RG, Plein S, Bourke G, Teh I. Meta-analysis of the normal diffusion tensor imaging values of the peripheral nerves in the upper limb. Sci Rep 2023; 13:4852. [PMID: 36964186 PMCID: PMC10039047 DOI: 10.1038/s41598-023-31307-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 03/09/2023] [Indexed: 03/26/2023] Open
Abstract
Peripheral neuropathy affects 1 in 10 adults over the age of 40 years. Given the absence of a reliable diagnostic test for peripheral neuropathy, there has been a surge of research into diffusion tensor imaging (DTI) because it characterises nerve microstructure and provides reproducible proxy measures of myelination, axon diameter, fibre density and organisation. Before researchers and clinicians can reliably use diffusion tensor imaging to assess the 'health' of the major nerves of the upper limb, we must understand the "normal" range of values and how they vary with experimental conditions. We searched PubMed, Embase, medRxiv and bioRxiv for studies which reported the findings of DTI of the upper limb in healthy adults. Four review authors independently triple extracted data. Using the meta suite of Stata 17, we estimated the normal fractional anisotropy (FA) and diffusivity (mean, MD; radial, RD; axial AD) values of the median, radial and ulnar nerve in the arm, elbow and forearm. Using meta-regression, we explored how DTI metrics varied with age and experimental conditions. We included 20 studies reporting data from 391 limbs, belonging to 346 adults (189 males and 154 females, ~ 1.2 M:1F) of mean age 34 years (median 31, range 20-80). In the arm, there was no difference in the FA (pooled mean 0.59 mm2/s [95% CI 0.57, 0.62]; I2 98%) or MD (pooled mean 1.13 × 10-3 mm2/s [95% CI 1.08, 1.18]; I2 99%) of the median, radial and ulnar nerves. Around the elbow, the ulnar nerve had a 12% lower FA than the median and radial nerves (95% CI - 0.25, 0.00) and significantly higher MD, RD and AD. In the forearm, the FA (pooled mean 0.55 [95% CI 0.59, 0.64]; I2 96%) and MD (pooled mean 1.03 × 10-3 mm2/s [95% CI 0.94, 1.12]; I2 99%) of the three nerves were similar. Multivariable meta regression showed that the b-value, TE, TR, spatial resolution and age of the subject were clinically important moderators of DTI parameters in peripheral nerves. We show that subject age, as well as the b-value, TE, TR and spatial resolution are important moderators of DTI metrics from healthy nerves in the adult upper limb. The normal ranges shown here may inform future clinical and research studies.
Collapse
Affiliation(s)
- Ryckie G Wade
- Leeds Institute for Medical Research, The Advanced Imaging Centre, Leeds General Infirmary, University of Leeds, Leeds, LS1 3EX, UK.
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK.
| | - Fangqing Lu
- Leeds Institute for Medical Research, The Advanced Imaging Centre, Leeds General Infirmary, University of Leeds, Leeds, LS1 3EX, UK
| | - Yohan Poruslrani
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Chiraag Karia
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | | | - Sven Plein
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- The Advanced Imaging Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Grainne Bourke
- Leeds Institute for Medical Research, The Advanced Imaging Centre, Leeds General Infirmary, University of Leeds, Leeds, LS1 3EX, UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Irvin Teh
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- The Advanced Imaging Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| |
Collapse
|
8
|
Su X, Kong X, Kong X, Zhu Q, Lu Z, Zheng C. Multisequence magnetic resonance neurography of brachial and lumbosacral plexus in chronic inflammatory demyelinating polyneuropathy: correlations with electrophysiological parameters and clinical features. Ther Adv Neurol Disord 2023; 16:17562864221150540. [PMID: 36762318 PMCID: PMC9905022 DOI: 10.1177/17562864221150540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/23/2022] [Indexed: 02/10/2023] Open
Abstract
Background Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare and challenging demyelinating disorder. It is necessary to increase our understanding of potential connections between imaging, electromyography, and clinical characteristics. Objective The aim of this study was to evaluate the relationships between multisequence magnetic resonance neurography (MRN) findings, electrophysiological parameters, and clinical characteristics in CIDP patients. Design A cross-sectional study. Methods Overall, 51 CIDP patients underwent MRN of the brachial and lumbosacral plexus, and nerve conduction studies. The inflammatory Rasch-built overall disability scale (I-RODS) questionnaire, CIDP disease activity status (CADS) scale, and muscle strength scores were evaluated by two neurologists. Electrophysiological parameters, clinical information, and multiparameter-MRN were analyzed for correlations. Multiparameter-MRN includes diameter, nerve-to-muscle T2 signal intensity ratio (nT2), contrast-enhanced ratio (CR), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of bilateral plexus nerve roots. Results Electrophysiological parameters that were not elicited were significantly higher in the lower extremities than in the upper extremities, and those were higher in sensory nerve conduction than in motor. There were moderate correlations between motor nerve conduction velocity and distal motor latency in nerve diameter, nT2, FA, and ADC, respectively (|r|, 0.45-0.64, p < 0.05). The correlations between CR and sensory nerve conduction velocity and peak latency were moderate, and ADC had a positive correlation with compound motor action potential amplitude (|r|, 0.45-0.63). FA correlated negatively with the course (r = -0.62) and cerebrospinal fluid (CSF) protein (r = -0.41), whereas ADC had correlated positively with CSF protein (r = 0.34). Only CR had a moderately negative correlation with CADS (r's = -0.57). Muscle strength in all extremities was positively correlated with FA (r's range, 0.41-0.49). There was no significant correlation between I-RODS scores and multiparameter-MR. Conclusion MRN-derived multiparameter [nerve size, nT2, and diffusion tensor imaging (DTI) parameters] could serve as quantitative biomarkers of myelin sheath integrity in CIDP. DTI parameters and CR correlated with clinical characteristics better than morphological parameters-MR for CIDP patients.
Collapse
Affiliation(s)
| | - Xiangquan Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Zhu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | | |
Collapse
|
9
|
Kender Z, Jende JME, Kurz FT, Tsilingiris D, Schimpfle L, Sulaj A, von Rauchhaupt E, Bartl H, Mooshage C, Göpfert J, Nawroth P, Herzig S, Szendroedi J, Bendszus M, Kopf S. Sciatic nerve fractional anisotropy and neurofilament light chain protein are related to sensorimotor deficit of the upper and lower limbs in patients with type 2 diabetes. Front Endocrinol (Lausanne) 2023; 14:1046690. [PMID: 37008917 PMCID: PMC10053786 DOI: 10.3389/fendo.2023.1046690] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/06/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Diabetic sensorimotor polyneuropathy (DSPN) is one of the most prevalent and poorly understood diabetic microvascular complications. Recent studies have found that fractional anisotropy (FA), a marker for microstructural nerve integrity, is a sensitive parameter for the structural and functional nerve damage in DSPN. The aim of this study was to investigate the significance of proximal sciatic nerve's FA on different distal nerve fiber deficits of the upper and lower limbs and its correlation with the neuroaxonal biomarker, neurofilament light chain protein (NfL). MATERIALS AND METHODS Sixty-nine patients with type 2 diabetes (T2DM) and 30 healthy controls underwent detailed clinical and electrophysiological assessments, complete quantitative sensory testing (QST), and diffusion-weighted magnetic resonance neurography of the sciatic nerve. NfL was measured in the serum of healthy controls and patients with T2DM. Multivariate models were used to adjust for confounders of microvascular damage. RESULTS Patients with DSPN showed a 17% lower sciatic microstructural integrity compared to healthy controls (p<0.001). FA correlated with tibial and peroneal motor nerve conduction velocity (NCV) (r=0.6; p<0.001 and r=0.6; p<0.001) and sural sensory NCV (r=0.50; p<0.001). Participants with reduced sciatic nerve´s FA showed a loss of function of mechanical and thermal sensation of upper (r=0.3; p<0.01 and r=0.3; p<0.01) and lower (r=0.5; p<0.001 and r=0.3; p=<0.01) limbs and reduced functional performance of upper limbs (Purdue Pegboard Test for dominant hand; r=0.4; p<0.001). Increased levels of NfL and urinary albumin-creatinine ratio (ACR) were associated with loss of sciatic nerve´s FA (r=-0.5; p<0.001 and r= -0.3, p= 0.001). Of note, there was no correlation between sciatic FA and neuropathic symptoms or pain. CONCLUSION This is the first study showing that microstructural nerve integrity is associated with damage of different nerve fiber types and a neuroaxonal biomarker in DSPN. Furthermore, these findings show that proximal nerve damage is related to distal nerve function even before clinical symptoms occur. The microstructure of the proximal sciatic nerve and is also associated with functional nerve fiber deficits of the upper and lower limbs, suggesting that diabetic neuropathy involves structural changes of peripheral nerves of upper limbs too.
Collapse
Affiliation(s)
- Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research [Deutsches Zentrum für Diabetesforschung (DZD)], München, Germany
- *Correspondence: Zoltan Kender,
| | - Johann M. E. Jende
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix T. Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Dimitrios Tsilingiris
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research [Deutsches Zentrum für Diabetesforschung (DZD)], München, Germany
| | - Lukas Schimpfle
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
| | - Alba Sulaj
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research [Deutsches Zentrum für Diabetesforschung (DZD)], München, Germany
| | - Ekaterina von Rauchhaupt
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research [Deutsches Zentrum für Diabetesforschung (DZD)], München, Germany
| | - Hannelore Bartl
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Mooshage
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jens Göpfert
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Peter Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research [Deutsches Zentrum für Diabetesforschung (DZD)], München, Germany
- Joint-IDC Institute for Diabetes and Cancer, Heidelberg University, Heidelberg, Germany
| | - Stephan Herzig
- German Center of Diabetes Research [Deutsches Zentrum für Diabetesforschung (DZD)], München, Germany
- Joint-IDC Institute for Diabetes and Cancer, Heidelberg University, Heidelberg, Germany
- Joint-IDC Institute for Diabetes and Cancer, Helmholtz-Zentrum Munich, Munich, Germany
| | - Julia Szendroedi
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research [Deutsches Zentrum für Diabetesforschung (DZD)], München, Germany
- Joint-IDC Institute for Diabetes and Cancer, Heidelberg University, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research [Deutsches Zentrum für Diabetesforschung (DZD)], München, Germany
| |
Collapse
|
10
|
Rau A, Jungmann PM, Diallo TD, Reisert M, Kellner E, Eisenblaetter M, Bamberg F, Jung M. Application of diffusion microstructure imaging in musculoskeletal radiology - translation from head to shoulders. Eur Radiol 2023; 33:1565-1574. [PMID: 36307552 PMCID: PMC9935724 DOI: 10.1007/s00330-022-09202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Quantitative MRI techniques, such as diffusion microstructure imaging (DMI), are increasingly applied for advanced tissue characterization. We determined its value in rotator cuff (RC) muscle imaging by studying the association of DMI parameters to isometric strength and fat fraction (FF). METHODS Healthy individuals prospectively underwent 3T-MRI of the shoulder using DMI and chemical shift encoding-based water-fat imaging. RC muscles were segmented and quantitative MRI metrics (V-ISO, free fluid; V-intra, compartment inside of muscle fibers; V-extra, compartment outside of muscle fibers, and FF) were extracted. Isometric shoulder strength was quantified using specific clinical tests. Sex-related differences were assessed with Student's t. Association of DMI-metrics, FF, and strength was tested. A factorial two-way ANOVA was performed to compare the main effects of sex and external/internal strength-ratio and their interaction effects on quantitative imaging parameters ratios of infraspinatus/subscapularis. RESULTS Among 22 participants (mean age: 26.7 ± 3.1 years, 50% female, mean BMI: 22.6 ± 1.9 kg/m2), FF of the individual RC muscles did not correlate with strength or DMI parameters (all p > 0.05). Subjects with higher V-intra (r = 0.57 to 0.87, p < 0.01) and lower V-ISO (r = -0.6 to -0.88, p < 0.01) had higher internal and external rotation strength. Moreover, V-intra was higher and V-ISO was lower in all RC muscles in males compared to female subjects (all p < 0.01). There was a sex-independent association of external/internal strength-ratio with the ratio of V-extra of infraspinatus/subscapularis (p = 0.02). CONCLUSIONS Quantitative DMI parameters may provide incremental information about muscular function and microstructure in young athletes and may serve as a potential biomarker. KEY POINTS • Diffusion microstructure imaging was successfully applied to non-invasively assess the microstructure of rotator cuff muscles in healthy volunteers. • Sex-related differences in the microstructural composition of the rotator cuff were observed. • Muscular microstructural metrics correlated with rotator cuff strength and may serve as an imaging biomarker of muscular integrity and function.
Collapse
Affiliation(s)
- Alexander Rau
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
- Department of Neuroradiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.
| | - Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Thierno D Diallo
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Michel Eisenblaetter
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| |
Collapse
|
11
|
Kim SG, Jung JY. Role of MR Neurography for Evaluation of the Lumbosacral Plexus: A Scoping Review. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:1273-1285. [PMID: 36545407 PMCID: PMC9748467 DOI: 10.3348/jksr.2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 06/06/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022]
Abstract
Purpose MR neurography (MRN) is an imaging technique optimized to visualize the peripheral nerves. This review aimed to discover an optimized protocol for MRN of the lumbosacral plexus (LSP) and identify evidence for the clinical benefit of lumbosacral plexopathies. Materials and Methods We performed a systematic search of the two medical databases until September 2021. 'Magnetic resonance imaging', 'lumbosacral plexus', 'neurologic disease', or equivalent terms were used to search the literature. We extracted information on indications, MRN protocols for LSP, and clinical efficacy from 55 studies among those searched. Results MRN of the LSP is useful for displaying the distribution of peripheral nerve disease, guiding perineural injections, and assessing extraspinal causes of sciatica. Three-dimensional short-tau inversion recovery turbo spin-echo combined with vascular suppression is the mainstay of MRN. Conclusion Future work on the MRN of LSP should be directed to technical maturation and clinical validation of efficacy.
Collapse
|
12
|
Preisner F, Behnisch R, Schwehr V, Godel T, Schwarz D, Foesleitner O, Bäumer P, Heiland S, Bendszus M, Kronlage M. Quantitative MR-Neurography at 3.0T: Inter-Scanner Reproducibility. Front Neurosci 2022; 16:817316. [PMID: 35250457 PMCID: PMC8888927 DOI: 10.3389/fnins.2022.817316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Quantitative MR-neurography (MRN) is increasingly applied, however, the impact of the MR-scanner on the derived parameters is unknown. Here, we used different 3.0T MR scanners and applied comparable MR-sequences in order to quantify the inter-scanner reproducibility of various MRN parameters of the sciatic nerve. Methods Ten healthy volunteers were prospectively examined at three different 3.0T MR scanners and underwent MRN of their sciatic nerve using comparable imaging protocols including diffusion tensor imaging (DTI) and T2 relaxometry. Subsequently, inter-scanner agreement was assessed for seven different parameters by calculating the intraclass correlation coefficients (ICCs) and the standard error of measurement (SEM). Results Assessment of inter-scanner reliability revealed good to excellent agreement for T2 (ICC: 0.846) and the quantitative DTI parameters, such as fractional anisotropy (FA) (ICC: 0.876), whereas moderate agreement was observed for proton spin density (PD) (ICC: 0.51). Analysis of variance identified significant inter-scanner differences for several parameters, such as FA (p < 0.001; p = 0.02), T2 (p < 0.01) and PD (p = 0.02; p < 0.01; p = 0.02). Calculated SEM values were mostly within the range of one standard deviation of the absolute mean values, for example 0.033 for FA, 4.12 ms for T2 and 27.8 for PD. Conclusion This study quantifies the measurement imprecision for peripheral nerve DTI and T2 relaxometry, which is associated with the use of different MR scanners. The here presented values may serve as an orientation of the possible scanner-associated fluctuations of MRN biomarkers, which can occur under similar conditions.
Collapse
Affiliation(s)
- Fabian Preisner
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Rouven Behnisch
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Véronique Schwehr
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tim Godel
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Olivia Foesleitner
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Moritz Kronlage
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- *Correspondence: Moritz Kronlage,
| |
Collapse
|
13
|
Tan ET, Zochowski KC, Sneag DB. Diffusion MRI fiber diameter for muscle denervation assessment. Quant Imaging Med Surg 2022; 12:80-94. [PMID: 34993062 PMCID: PMC8666740 DOI: 10.21037/qims-21-313] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND To develop and evaluate a diffusion MRI-based apparent muscle fiber diameter (AFD) method in patients with muscle denervation. It was hypothesized that AFD differences between denervated, non-denervated and control muscles would be greater than those from standard diffusion metrics. METHODS A spin-echo diffusion acquisition with multi-b-valued diffusion sampling was used. An orientation-invariant dictionary approach utilized a cylinder-based forward model and multi-compartment model for obtaining restricted and free fractions. Simulations were performed to determine precision, bias, and optimize dictionary parameters. In all, 18 exams of patients with muscle denervation and 8 exams of healthy subjects were performed at 3T. Six regions of interests (ROIs) within separate shoulder muscles were selected, yielding three groups consisting 47 control (healthy), 36 non-denervated (patients), and 68 denervated (patients) muscle ROIs. Two-sample t-tests (α=0.05) between groups were performed with Holm-Bonferroni correction. T2- and fat fraction (FF)-mapping were acquired for comparison. RESULTS Mean AFD was 89.7±13.6 µm in control, 71.6±15.3 µm in non-denervated, and 60.7±15.9 µm in denervated muscles and were significantly different (P<0.001) in paired comparisons and in 10/12 individual muscle region comparisons. Correlation between AFD and FF (-0.331, P<0.001) was low, but correlation between FA and FF was negligible (0.197, P=0.016). Correlation was low between AFD and T2 (-0.395, P<0.001) and between FA and T2 (0.359, P<0.001). CONCLUSIONS Diffusion MRI-based AFD complements T2- and FF-mapping techniques to non-invasively assess muscle denervation.
Collapse
Affiliation(s)
| | - Kelly C. Zochowski
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Darryl B. Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
14
|
Xia X, Dai L, Zhou H, Chen P, Liu S, Yang W, Zuo Z, Xu X. Assessment of peripheral neuropathy in type 2 diabetes by diffusion tensor imaging: A case-control study. Eur J Radiol 2021; 145:110007. [PMID: 34758418 DOI: 10.1016/j.ejrad.2021.110007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/16/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study aimed to evaluate diabetes peripheral neuropathy (DPN) by diffusion tensor imaging (DTI) and explore the correlation between DTI parameters and electrophysiological parameters. METHODS We examined tibial nerve (TN) and common peroneal nerve (CPN) of 32 DPN patients and 23 healthy controls using T1-weighted magnetic resonance imaging and DTI. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) of TN and CPN were measured and compared between groups. Spearman correlation coefficient was used to explore the relationship between DTI parameters and electrophysiology parameters in the DPN group. Diagnostic value was assessed by receiver operating characteristic (ROC) analysis. RESULTS In the DPN group, FA was decreased (p < 0.0001) and MD and RD were increased (p < 0.05, p < 0.001) in the TN and CPN compared with the values of healthy control group. Moreover, in the DPN group, FA was positively correlated with motor nerve conduction velocity (MCV) (p < 0.0001), and both MD and RD were negatively correlated with MCV (p < 0.05, p < 0.001). However, there was no correlation between AD and any electrophysiological parameters. Among all DTI parameters, FA displayed the best diagnostic accuracy, with an area under the ROC curve of 0.882 in TN and 0.917 in CPN. CONCLUSION FA and RD demonstrate appreciable diagnostic accuracy. Furthermore, they both have a moderate correlation with MCV.
Collapse
Affiliation(s)
- Xinyue Xia
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China; Department of Radiology, Maternal and Child Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
| | - Lisong Dai
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
| | - Hongmei Zhou
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
| | - Panpan Chen
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
| | - Shuhua Liu
- Burn Department, Department of Burns, Tongren Hospital of Wuhan University and Wuhan Third Hospital, Wuhan 430060, China
| | - Wenzhong Yang
- Department of Radiology, Maternal and Child Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
| | - Zhentao Zuo
- State Key Laboratory of Brain and Cognitive Science, Beijing MRI Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, 15 Datun Road, Chaoyang District, Beijing 100101, China; Sino-Danish College, University of Chinese Academy of Sciences, Beijing 100049, China; CAS Center for Excellence in Brain and Science and Intelligence Technology, Chinese Academy of Sciences, Beijing 100049, China.
| | - Xiangyang Xu
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China.
| |
Collapse
|
15
|
Rojoa D, Raheman F, Rassam J, Wade RG. Meta-analysis of the normal diffusion tensor imaging values of the median nerve and how they change in carpal tunnel syndrome. Sci Rep 2021; 11:20935. [PMID: 34686721 PMCID: PMC8536657 DOI: 10.1038/s41598-021-00353-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023] Open
Abstract
Carpal tunnel syndrome (CTS) leads to distortion of axonal architecture, demyelination and fibrosis within the median nerve. Diffusion tensor imaging (DTI) characterises tissue microstructure and generates reproducible proxy measures of nerve 'health' which are sensitive to myelination, axon diameter, fiber density and organisation. This meta-analysis summarises the normal DTI values of the median nerve, and how they change in CTS. This systematic review included studies reporting DTI of the median nerve at the level of the wrist in adults. The primary outcome was to determine the normal fractional anisotropy (FA) and mean diffusivity (MD) of the median nerve. Secondarily, we show how the FA and MD differ between asymptomatic adults and patients with CTS, and how these differences are independent of the acquisition methods. We included 32 studies of 2643 wrists, belonging to 1575 asymptomatic adults and 1068 patients with CTS. The normal FA was 0.58 (95% CI 0.56, 0.59) and the normal MD was 1.138 × 10-3 mm2/s (95% CI 1.101, 1.174). Patients with CTS had a significantly lower FA than controls (mean difference 0.12 [95% CI 0.09, 0.16]). Similarly, the median nerve of patients with CTS had a significantly higher mean diffusivity (mean difference 0.16 × 10-3 mm2/s [95% CI 0.05, 0.27]). The differences were independent of experimental factors. We provide summary estimates of the normal FA and MD of the median nerve in asymptomatic adults. Furthermore, we show that diffusion throughout the length of the median nerve becomes more isotropic in patients with CTS.
Collapse
Affiliation(s)
- Djamila Rojoa
- grid.419248.20000 0004 0400 6485Department of Plastic and Reconstructive Surgery, Leicester Royal Infirmary, Leicester, UK
| | - Firas Raheman
- grid.419248.20000 0004 0400 6485Department of Plastic and Reconstructive Surgery, Leicester Royal Infirmary, Leicester, UK
| | - Joseph Rassam
- grid.419248.20000 0004 0400 6485Department of Plastic and Reconstructive Surgery, Leicester Royal Infirmary, Leicester, UK
| | - Ryckie G. Wade
- grid.415967.80000 0000 9965 1030Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK ,grid.9909.90000 0004 1936 8403Leeds Institute for Medical Research, Advanced Imaging Centre, University of Leeds, Leeds, LS1 3EX UK
| |
Collapse
|
16
|
Foesleitner O, Sulaj A, Sturm V, Kronlage M, Godel T, Preisner F, Nawroth PP, Bendszus M, Heiland S, Schwarz D. Diffusion MRI in Peripheral Nerves: Optimized b Values and the Role of Non-Gaussian Diffusion. Radiology 2021; 302:153-161. [PMID: 34665029 DOI: 10.1148/radiol.2021204740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Diffusion-weighted imaging (DWI) provides specific in vivo information about tissue microstructure, which is increasingly recognized for various applications outside the central nervous system. However, standard sequence parameters are commonly adopted from optimized central nervous system protocols, thus potentially neglecting differences in tissue-specific diffusional behavior. Purpose To characterize the optimal tissue-specific diffusion imaging weighting scheme over the b domain in peripheral nerves under physiologic and pathologic conditions. Materials and Methods In this prospective cross-sectional study, 3-T MR neurography of the sciatic nerve was performed in healthy volunteers (n = 16) and participants with type 2 diabetes (n = 12). For DWI, 16 b values in the range of 0-1500 sec/mm2 were acquired in axial and radial diffusion directions of the nerve. With a region of interest-based approach, diffusion-weighted signal behavior as a function of b was estimated using standard monoexponential, biexponential, and kurtosis fitting. Goodness of fit was assessed to determine the optimal b value for two-point DWI/diffusion tensor imaging (DTI). Results Non-Gaussian diffusional behavior was observed beyond b values of 600 sec/mm2 in the axial and 800 sec/mm2 in the radial diffusion direction in both participants with diabetes and healthy volunteers. Accordingly, the biexponential and kurtosis models achieved a better curve fit compared with the standard monoexponential model (Akaike information criterion >99.9% in all models), but the kurtosis model was preferred in the majority of cases. Significant differences between healthy volunteers and participants with diabetes were found in the kurtosis-derived parameters Dk and K. The results suggest an upper bound b value of approximately 700 sec/mm2 for optimal standard DWI/DTI in peripheral nerve applications. Conclusion In MR neurography, an ideal standard diffusion-weighted imaging/diffusion tensor imaging protocol with b = 700 sec/mm2 is suggested. This is substantially lower than in the central nervous system due to early-occurring non-Gaussian diffusion behavior and emphasizes the need for tissue-specific b value optimization. Including higher b values, kurtosis-derived parameters may represent promising novel imaging markers of peripheral nerve disease. ©RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Jang and Du in this issue.
Collapse
Affiliation(s)
- Olivia Foesleitner
- From the Department of Neuroradiology (O.F., V.S., M.K., T.G., F.P., M.B., S.H., D.S.) and Department of Internal Medicine I and Clinical Chemistry (A.S., P.P.N.), Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Center for Diabetes Research (DZD), Helmholtz Center Munich, Neuherberg, Germany (P.P.N.); Joint Division Molecular Metabolic Control, German Cancer Research Center (DKFZ), Heidelberg Center for Molecular Biology (ZMBH), Heidelberg, Germany (P.P.N.); and Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program, Neuherberg, Germany (P.P.N.)
| | - Alba Sulaj
- From the Department of Neuroradiology (O.F., V.S., M.K., T.G., F.P., M.B., S.H., D.S.) and Department of Internal Medicine I and Clinical Chemistry (A.S., P.P.N.), Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Center for Diabetes Research (DZD), Helmholtz Center Munich, Neuherberg, Germany (P.P.N.); Joint Division Molecular Metabolic Control, German Cancer Research Center (DKFZ), Heidelberg Center for Molecular Biology (ZMBH), Heidelberg, Germany (P.P.N.); and Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program, Neuherberg, Germany (P.P.N.)
| | - Volker Sturm
- From the Department of Neuroradiology (O.F., V.S., M.K., T.G., F.P., M.B., S.H., D.S.) and Department of Internal Medicine I and Clinical Chemistry (A.S., P.P.N.), Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Center for Diabetes Research (DZD), Helmholtz Center Munich, Neuherberg, Germany (P.P.N.); Joint Division Molecular Metabolic Control, German Cancer Research Center (DKFZ), Heidelberg Center for Molecular Biology (ZMBH), Heidelberg, Germany (P.P.N.); and Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program, Neuherberg, Germany (P.P.N.)
| | - Moritz Kronlage
- From the Department of Neuroradiology (O.F., V.S., M.K., T.G., F.P., M.B., S.H., D.S.) and Department of Internal Medicine I and Clinical Chemistry (A.S., P.P.N.), Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Center for Diabetes Research (DZD), Helmholtz Center Munich, Neuherberg, Germany (P.P.N.); Joint Division Molecular Metabolic Control, German Cancer Research Center (DKFZ), Heidelberg Center for Molecular Biology (ZMBH), Heidelberg, Germany (P.P.N.); and Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program, Neuherberg, Germany (P.P.N.)
| | - Tim Godel
- From the Department of Neuroradiology (O.F., V.S., M.K., T.G., F.P., M.B., S.H., D.S.) and Department of Internal Medicine I and Clinical Chemistry (A.S., P.P.N.), Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Center for Diabetes Research (DZD), Helmholtz Center Munich, Neuherberg, Germany (P.P.N.); Joint Division Molecular Metabolic Control, German Cancer Research Center (DKFZ), Heidelberg Center for Molecular Biology (ZMBH), Heidelberg, Germany (P.P.N.); and Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program, Neuherberg, Germany (P.P.N.)
| | - Fabian Preisner
- From the Department of Neuroradiology (O.F., V.S., M.K., T.G., F.P., M.B., S.H., D.S.) and Department of Internal Medicine I and Clinical Chemistry (A.S., P.P.N.), Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Center for Diabetes Research (DZD), Helmholtz Center Munich, Neuherberg, Germany (P.P.N.); Joint Division Molecular Metabolic Control, German Cancer Research Center (DKFZ), Heidelberg Center for Molecular Biology (ZMBH), Heidelberg, Germany (P.P.N.); and Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program, Neuherberg, Germany (P.P.N.)
| | - Peter Paul Nawroth
- From the Department of Neuroradiology (O.F., V.S., M.K., T.G., F.P., M.B., S.H., D.S.) and Department of Internal Medicine I and Clinical Chemistry (A.S., P.P.N.), Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Center for Diabetes Research (DZD), Helmholtz Center Munich, Neuherberg, Germany (P.P.N.); Joint Division Molecular Metabolic Control, German Cancer Research Center (DKFZ), Heidelberg Center for Molecular Biology (ZMBH), Heidelberg, Germany (P.P.N.); and Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program, Neuherberg, Germany (P.P.N.)
| | - Martin Bendszus
- From the Department of Neuroradiology (O.F., V.S., M.K., T.G., F.P., M.B., S.H., D.S.) and Department of Internal Medicine I and Clinical Chemistry (A.S., P.P.N.), Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Center for Diabetes Research (DZD), Helmholtz Center Munich, Neuherberg, Germany (P.P.N.); Joint Division Molecular Metabolic Control, German Cancer Research Center (DKFZ), Heidelberg Center for Molecular Biology (ZMBH), Heidelberg, Germany (P.P.N.); and Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program, Neuherberg, Germany (P.P.N.)
| | - Sabine Heiland
- From the Department of Neuroradiology (O.F., V.S., M.K., T.G., F.P., M.B., S.H., D.S.) and Department of Internal Medicine I and Clinical Chemistry (A.S., P.P.N.), Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Center for Diabetes Research (DZD), Helmholtz Center Munich, Neuherberg, Germany (P.P.N.); Joint Division Molecular Metabolic Control, German Cancer Research Center (DKFZ), Heidelberg Center for Molecular Biology (ZMBH), Heidelberg, Germany (P.P.N.); and Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program, Neuherberg, Germany (P.P.N.)
| | - Daniel Schwarz
- From the Department of Neuroradiology (O.F., V.S., M.K., T.G., F.P., M.B., S.H., D.S.) and Department of Internal Medicine I and Clinical Chemistry (A.S., P.P.N.), Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Center for Diabetes Research (DZD), Helmholtz Center Munich, Neuherberg, Germany (P.P.N.); Joint Division Molecular Metabolic Control, German Cancer Research Center (DKFZ), Heidelberg Center for Molecular Biology (ZMBH), Heidelberg, Germany (P.P.N.); and Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program, Neuherberg, Germany (P.P.N.)
| |
Collapse
|
17
|
Kollmer J, Bendszus M. Magnetic Resonance Neurography: Improved Diagnosis of Peripheral Neuropathies. Neurotherapeutics 2021; 18:2368-2383. [PMID: 34859380 PMCID: PMC8804110 DOI: 10.1007/s13311-021-01166-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 12/15/2022] Open
Abstract
Peripheral neuropathies account for the most frequent disorders seen by neurologists, and causes are manifold. The traditional diagnostic gold-standard consists of clinical neurologic examinations supplemented by nerve conduction studies. Due to well-known limitations of standard diagnostics and atypical clinical presentations, establishing the correct diagnosis can be challenging but is critical for appropriate therapies. Magnetic resonance neurography (MRN) is a relatively novel technique that was developed for the high-resolution imaging of the peripheral nervous system. In focal neuropathies, whether traumatic or due to nerve entrapment, MRN has improved the diagnostic accuracy by directly visualizing underlying nerve lesions and providing information on the exact lesion localization, extension, and spatial distribution, thereby assisting surgical planning. Notably, the differentiation between distally located, complete cross-sectional nerve lesions, and more proximally located lesions involving only certain fascicles within a nerve can hold difficulties that MRN can overcome, when basic technical requirements to achieve sufficient spatial resolution are implemented. Typical MRN-specific pitfalls are essential to understand in order to prevent overdiagnosing neuropathies. Heavily T2-weighted sequences with fat saturation are the most established sequences for MRN. Newer techniques, such as T2-relaxometry, magnetization transfer contrast imaging, and diffusion tensor imaging, allow the quantification of nerve lesions and have become increasingly important, especially when evaluating diffuse, non-focal neuropathies. Innovative studies in hereditary, metabolic or inflammatory polyneuropathies, and motor neuron diseases have contributed to a better understanding of the underlying pathomechanism. New imaging biomarkers might be used for an earlier diagnosis and monitoring of structural nerve injury under causative treatments in the future.
Collapse
Affiliation(s)
- Jennifer Kollmer
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| |
Collapse
|
18
|
Pashkunova-Martic I, Manzano-Szalai K, Friske J, Aszmann O, Theiner S, Klose MHM, Baurecht D, Trattnig S, Keppler BK, Helbich TH. Modified amino-dextrans as carriers of Gd-chelates for retrograde transport and visualization of peripheral nerves by magnetic resonance imaging (MRI). J Inorg Biochem 2021; 222:111495. [PMID: 34098348 DOI: 10.1016/j.jinorgbio.2021.111495] [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: 02/10/2021] [Revised: 04/22/2021] [Accepted: 05/25/2021] [Indexed: 11/21/2022]
Abstract
Amino-dextrans (AD) conjugated with gadolinium (Gd3+) were developed as neuro-specific contrast agents (CA) for the visualization of the sciatic nerve in rats by magnetic resonance imaging (MRI). AD with 3, 10, and 70 kDa molecular weights were assessed as carrier molecules known to be transported with various speed by axonal microtubules. Detailed spectroscopic characterizations, analyses by Fast Protein Liquid Chromatography (FPLC), Sodium Dodecyl Sulfate Polyacrylamide Gel Electrophoresis (SDS-PAGE), and inductively coupled plasma-mass spectrometry (ICP-MS), were carried out. For MRI, the paramagnetic Gd3+ ion was coupled as a T1 signal enhancer. The well-established linear chelator, diethylenetriaminepentaacetic acid (DTPA), was used and subsequently replaced by the more stable cyclic chelator 1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA). In addition, a fluorescently labeled AD-DTPA-Gd was prepared to demonstrate an active transport to the spinal cord by histochemistry. After successful synthesis and characterization, molecular migration of the AD-DTPA-Gd in the sciatic nerve of healthy Sprague Dawley rats was monitored by MRI for up to seven days. Enhancement of nerve structures was evaluated by MRI and correlated with ICP-MS analyses. To investigate the distribution of CA along the neuraxis, all animals were sacrificed after the final MRI monitoring. Nerves, spinal ganglions, and corresponding spinal cord sections were harvested, to determine the localization and concentration of the paramagnetic element. This is the first report that demonstrates the active uptake and transport of AD-Gd conjugates within the sciatic nerve. This new concept may serve as a potential diagnostic tool for the direct visualization and monitoring of the continuity of injured nerves.
Collapse
Affiliation(s)
- Irena Pashkunova-Martic
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, 1090 Vienna, Austria.
| | - Krisztina Manzano-Szalai
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Joachim Friske
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Department of Biomedical Imaging and Image-guided Therapy, High Field MR Center, Lazarettgasse 14, 1090 Vienna, Austria
| | - Oskar Aszmann
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Sarah Theiner
- Institute of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 38, 1090 Vienna, Austria; Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, 1090 Vienna, Austria
| | - Matthias H M Klose
- Institute of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 38, 1090 Vienna, Austria
| | - Dieter Baurecht
- Department of Physical Chemistry, University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image-guided Therapy, High Field MR Center, Lazarettgasse 14, 1090 Vienna, Austria
| | - Bernhard K Keppler
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, 1090 Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| |
Collapse
|
19
|
Su X, Kong X, Alwalid O, Wang J, Zhang H, Lu Z, Zheng C. Multisequence Quantitative Magnetic Resonance Neurography of Brachial and Lumbosacral Plexus in Chronic Inflammatory Demyelinating Polyneuropathy. Front Neurosci 2021; 15:649071. [PMID: 34366769 PMCID: PMC8346234 DOI: 10.3389/fnins.2021.649071] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background and Purpose Chronic inflammatory demyelinating polyneuropathy (CIDP) is an uncommon demyelinating disorder. Although treatable, it is difficult to diagnose. The purpose of this study was to evaluate the diagnostic performance and abnormalities of plexus via quantitative multisequence magnetic resonance neurography (MRN) for CIDP. Methods Brachial and lumbosacral (LS) plexus of 37 CIDP patients and 37 age- and gender-matched controls were examined by using multisequence MRN. Nerve diameter, nerve-to-muscle T2 signal intensity ratio (nT2), contrast-enhanced ratio (CR), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were determined in both plexus, and tractographies were performed. The disease histories and the Inflammatory Rasch-built Overall Disability Scale (I-RODS) questionnaire scores were documented before MRI scans. Results The sizes of nerve roots were larger in CIDP (p < 0.01). CR, nT2, and ADC were significantly higher, while FA was lower in CIDP than in controls (p < 0.01). FA had the highest sensitivity (0.809) and area under the curve (AUC) (0.925), while the highest specificity was 0.961 for CR in single parameters. The combination of FA and CR has the highest sensitivity, specificity, accuracy, and AUC in the LS plexus. CR only had a weak correlation with nT2 (p < 0.05). ADC and diameter had a positive correlation with nT2, and the diameter and nT2 had a negative correlation with FA in CIDP (p < 0.05). FA had a negative correlation with the duration in the CIDP (r’s = −0.404, p < 0.05). There was no significant correlation between the I-RODS scores and MR multiparameters (p < 0.05). Conclusion Multisequence MRN possesses a high diagnostic performance in the LS plexus. Sampling perfection with application-optimized contrasts using different flip angle evolutions (SPACE) combined with DTI and contrast enhancement serves as a recommended composite protocol for CIDP.
Collapse
Affiliation(s)
- Xiaoyun Su
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangquan Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Osamah Alwalid
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Zuneng Lu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
20
|
Goyal A, Wadgera N, Srivastava DN, Ansari MT, Dawar R. Imaging of traumatic peripheral nerve injuries. J Clin Orthop Trauma 2021; 21:101510. [PMID: 34386344 PMCID: PMC8333344 DOI: 10.1016/j.jcot.2021.101510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/26/2023] Open
Abstract
Nerves are commonly injured in case of blunt or penetrating trauma to the extremities. Patients with nerve injuries have profound consequences and thus a timely decision for operative management is a very important. Conventionally, management decisions have been based on clinical findings, patient course and electrophysiological studies. However, imaging modalities have an enormous role not only in localizing and grading of the nerve injuries but also in the follow-up of the nerve recovery. High-resolution ultrasound (HUS) is the modality of choice for evaluation of peripheral nerves. Magnetic resonance neurography (MRN) plays a complementary role, enabling better assessment of muscle changes and deeper nerves. Corresponding to the injured layer of the cross-section of the nerve, imaging manifestations differ in different grades of injury. Since imaging cannot detect ultrastructural changes at the microscopic level, thus there may be overlap in the imaging findings. Herewith, we discuss the imaging findings in different grades of nerve injury and propose a simple 3-tier grading for imaging (HUS and MRN) assessment of peripheral nerve injuries.
Collapse
Affiliation(s)
- Ankur Goyal
- All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi, 110029, India,Corresponding author. Department of Radio-diagnosis All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Nagesh Wadgera
- All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi, 110029, India
| | - Deep Narayan Srivastava
- All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi, 110029, India
| | - Mohammed Tahir Ansari
- All India Institute of Medical Sciences, Department of Orthopaedics, New Delhi, 110029, India
| | - Rakesh Dawar
- All India Institute of Medical Sciences, Department of Plastic Surgery, New Delhi, 110029, India
| |
Collapse
|
21
|
Comparison of electrodiagnosis, neurosonography and MR neurography in localization of ulnar neuropathy at the elbow. J Neuroradiol 2021; 49:9-16. [PMID: 34023361 DOI: 10.1016/j.neurad.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 03/28/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION In patients with ulnar neuropathy at the elbow (UNE) the precise determination of the site of lesion is important for subsequent differential diagnostic considerations and therapeutic management. Due to a paucity of comparable data, to better define the role of different diagnostic tests, we performed the first prospective study comparing the diagnostic accuracy of short segment nerve stimulation, nerve ultrasonography, MR neurography (MRN), and diffusion tensor imaging (DTI) in patients with UNE. METHODS UNE was clinically diagnosed in 17 patients with 18 affected elbows. For all 18 affected elbows in patients and 20 elbows in 10 healthy volunteers, measurements of all different diagnostic tests were performed at six anatomical positions across the elbow with measuring points from distal (D4) to proximal (P6) in relation to the medial epicondyle (P0). Additional qualitative assessment regarding structural changes of surrounding nerve anatomy was conducted. RESULTS The difference between affected arms of patients and healthy control arms were most frequently the largest at measure intervals D2 to P0 and P0 to P2 for electrophysiological testing, or measure points P0 and P2 for all other devices, respectively. At both levels P0 and at P2, T2 contrast-to-noise ratio (CNR) of MRN and mean diffusivity (MD) of DTI-based MRN showed best accuracies. DISCUSSION This study revealed differences in diagnostic performance of tests concerning a specific location of UNE, with better results for T2 contrast to noise ratio (CNR) in MRN and mean diffusivity of DTI-based MRN. Additional testing with MRN and nerve ultrasonography is recommended to uncover anatomical changes.
Collapse
|
22
|
MRI of the ulnar nerve pre- and post-transposition: imaging features and rater agreement. Skeletal Radiol 2021; 50:559-570. [PMID: 32909158 DOI: 10.1007/s00256-020-03598-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/31/2020] [Accepted: 09/02/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Determine the rater agreement of MRI features of the ulnar nerve pre- and post-transposition and association with recurrent symptoms. MATERIALS AND METHODS This IRB-approved retrospective cohort analysis examined 23 subjects who underwent elbow MRI pre- and post-ulnar nerve transposition from 1999 to 2018, 10 of whom developed recurrent symptoms. Pre- and post-transposition MRIs were evaluated by two blinded radiologists for ulnar nerve cross-sectional area, signal intensity, fascicular architecture, caliber change, and perineural scar. Inter-rater agreement was estimated using intraclass correlation coefficients (ICCs) for continuous variables and Gwet's agreement coefficient (AC) for categorical variables. Binary logistic regression modeling probed associations between imaging markers and symptom recurrence. RESULTS The ulnar nerve, post-operatively, demonstrated statistically significant increases in size (p < 0.001), signal intensity (p = 0.021), and abrupt caliber change (p = 0.024). None of the imaging features, except for higher signal intensity of the nerve pre-transposition as demonstrated by one rater, were predictive of symptom recurrence. Inter-rater agreement for cross-sectional area measurements of the ulnar nerve at the cubital tunnel was excellent (ICCs of 0.91 and 0.83). Substantial-to-excellent inter-rater agreement was observed pre-operatively for nerve signal intensity, caliber change, and fascicular architecture. Post-operatively, agreement on nerve signal intensity and perineural scar was excellent (ACs of 0.90 and 0.88), but only slight for caliber change (0.15). CONCLUSION Inter-rater agreement for qualitative and quantitative assessment of the ulnar nerve was generally robust. Post-transposition, the ulnar nerve was generally larger and more T2-hyperintense, but MRI features were not predictive of recurrent ulnar neuropathy, except for perhaps the signal intensity of the nerve pre-transposition.
Collapse
|
23
|
Ibrahim I, Škoch A, Herynek V, Jírů F, Tintěra J. Magnetic resonance tractography of the lumbosacral plexus: Step-by-step. Medicine (Baltimore) 2021; 100:e24646. [PMID: 33578590 PMCID: PMC10545402 DOI: 10.1097/md.0000000000024646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/22/2020] [Accepted: 01/13/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT MR tractography of the lumbosacral plexus (LSP) is challenging due to the difficulty of acquiring high quality data and accurately estimating the neuronal tracts. We proposed an algorithm for an accurate visualization and assessment of the major LSP bundles using the segmentation of the cauda equina as seed points for the initial starting area for the fiber tracking algorithm.Twenty-six healthy volunteers underwent MRI examinations on a 3T MR scanner using the phased array coils with optimized measurement protocols for diffusion-weighted images and coronal T2 weighted 3D short-term inversion recovery sampling perfection with application optimized contrast using varying flip angle evaluation sequences used for LSP fiber reconstruction and MR neurography (MRN).The fiber bundles reconstruction was optimized in terms of eliminating the muscle fibers contamination using the segmentation of cauda equina, the effects of the normalized quantitative anisotropy (NQA) and angular threshold on reconstruction of the LSP. In this study, the NQA parameter has been used for fiber tracking instead of fractional anisotropy (FA) and the regions of interest positioning was precisely adjusted bilaterally and symmetrically in each individual subject.The diffusion data were processed in individual L3-S2 nerve fibers using the generalized Q-sampling imaging algorithm. Data (mean FA, mean diffusivity, axial diffusivity and radial diffusivity, and normalized quantitative anisotropy) were statistically analyzed using the linear mixed-effects model. The MR neurography was performed in MedINRIA and post-processed using the maximum intensity projection method to demonstrate LSP tracts in multiple planes.FA values significantly decreased towards the sacral region (P < .001); by contrast, mean diffusivity, axial diffusivity, radial diffusivity and NQA values significantly increased towards the sacral region (P < .001).Fiber tractography of the LSP was feasible in all examined subjects and closely corresponded with the nerves visible in the maximum intensity projection images of MR neurography. Usage of NQA instead of FA in the proposed algorithm enabled better separation of muscle and nerve fibers.The presented algorithm yields a high quality reconstruction of the LSP bundles that may be helpful both in research and clinical practice.
Collapse
Affiliation(s)
- Ibrahim Ibrahim
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, MR Unit
| | - Antonín Škoch
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, MR Unit
| | - Vít Herynek
- Center for Advanced Preclinical Imaging, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Filip Jírů
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, MR Unit
| | - Jaroslav Tintěra
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, MR Unit
| |
Collapse
|
24
|
Chalasani P, Taljanovic M, Segar J, Farr K, Win H, Wertheim BC, Chu-Pilli M, Ehsani S, Roe DJ, Gimber L. Diffuse tensor imaging of lower extremities: a novel MR imaging technique for chemotherapy-induced peripheral neuropathy. Breast Cancer Res Treat 2020; 184:771-778. [PMID: 32860167 DOI: 10.1007/s10549-020-05897-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/18/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) is caused by drug-induced damage to the axons which is not detected easily due to lack of reliable, clinically applicable modalities. Diffuse tensor imaging (DTI) allows for quantitative measurements of fractional anisotropy (FA) and apparent diffusion coefficient (ADC), which have been shown to detect nerve injury by Magnetic Resonance Imaging (MRI). METHODS We sought to evaluate if DTI could be used for detection of CIPN in patients with breast cancer treated with a taxane. Patients with h/o exposure to neurotoxic chemotherapy, diabetes, or peripheral neuropathy were excluded. Patients completed pre- and post-chemotherapy MRI of bilateral legs and FACT&GOG-Ntx. Genotyping of single-nucleotide variations (SNVs) was performed to detect known associations with CIPN. RESULTS We had 14 evaluable patients in this prospective trial. Mean FA values post-chemotherapy were significantly lower than baseline at mid-calf (p < 0.0001) and ankle (p = 0.03). We did not find any significant change in mean ADC values. In patients without symptomatic neuropathy, mean FA values decreased more than symptomatic patients at mid-calf (p < 0.001). Of the 41 genotyped SNVs, only rs8110536 was found to be significantly associated with development of CIPN. CONCLUSIONS Our results show that FA values are indicative of CIPN and differential changes in FA values in symptomatic versus asymptomatic patients highlights its potential to be further studied as a predictive biomarker for CIPN. This is the first study to highlight a non-invasive, imaging based, objective biomarker which, if validated, can be translated into clinic easily.
Collapse
Affiliation(s)
- Pavani Chalasani
- Department of Medicine, University of Arizona, Tucson, AZ, USA.
- University of Arizona Cancer Center, 1515 N Campbell Ave, PO Box 245024, Tucson, AZ, 85724, USA.
| | | | - Jenn Segar
- Department of Medicine, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, 1515 N Campbell Ave, PO Box 245024, Tucson, AZ, 85724, USA
| | - Kiah Farr
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Hninyee Win
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Betsy C Wertheim
- University of Arizona Cancer Center, 1515 N Campbell Ave, PO Box 245024, Tucson, AZ, 85724, USA
| | - Michele Chu-Pilli
- University of Arizona Cancer Center, 1515 N Campbell Ave, PO Box 245024, Tucson, AZ, 85724, USA
| | - Sima Ehsani
- Department of Medicine, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, 1515 N Campbell Ave, PO Box 245024, Tucson, AZ, 85724, USA
| | - Denise J Roe
- University of Arizona Cancer Center, 1515 N Campbell Ave, PO Box 245024, Tucson, AZ, 85724, USA
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Lana Gimber
- Department of VA, National Teleradiology Program, Uniformed Services University, Bethesda, MD, USA
| |
Collapse
|
25
|
Liu X, Zhou H, Wang Z, Liu X, Li X, Nie C, Li Y. WITHDRAWN: Efficacy of High-frequency Ultrasound Image Information Diagnosis on Neurological-abnormality in Patients with Type-2-diabetes Combined with Peripheral- neuropathy. Neurosci Lett 2020:135205. [PMID: 32590043 DOI: 10.1016/j.neulet.2020.135205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022]
Abstract
This article has been withdrawn at the request of the Editor-in-Chief. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
Collapse
Affiliation(s)
- Xiaoqiang Liu
- Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian City, 116027, Liaoning Province, China
| | - Hongyan Zhou
- Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian City, 116027, Liaoning Province, China
| | - Zhaoyun Wang
- Department of Wound repair, The Second Hospital of Dalian Medical University, Dalian City, 116027, Liaoning Province, China
| | - Xiaoli Liu
- Department of Respiratory, The Second Hospital of Dalian Medical University, Dalian City, 116027, Liaoning Province, China
| | - Xin Li
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian City, 116027, Liaoning Province, China
| | - Chen Nie
- Department of Neurology, The Second Hospital of Dalian Medical University, Dalian City, 116027, Liaoning Province, China
| | - Yang Li
- Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian City, 116027, Liaoning Province, China.
| |
Collapse
|
26
|
Abstract
Nerve imaging is an important component in the assessment of patients presenting with suspected peripheral nerve pathology. Although magnetic resonance neurography and ultrasound are the most commonly utilized techniques, several promising new modalities are on the horizon. Nerve imaging is useful in localizing the nerve injury, determining the severity, providing prognostic information, helping establish the diagnosis, and helping guide surgical decision making. The focus of this article is imaging of damaged nerves, focusing on nerve injuries and entrapment neuropathies.
Collapse
Affiliation(s)
- David A Purger
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sarada Sakamuri
- Department of Neurology and Neurological Sciences, 213 Quarry Road, MC 5979, Palo Alto, CA 94304, USA
| | - Nicholas F Hug
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sandip Biswal
- Department of Radiology, Stanford University, 300 Pasteur Drive, S-068B, Stanford, CA 94305, USA
| | - Thomas J Wilson
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, R293, Stanford, CA 94305, USA.
| |
Collapse
|
27
|
Vaeggemose M, Haakma W, Pham M, Ringgaard S, Tankisi H, Ejskjaer N, Heiland S, Poulsen PL, Andersen H. Diffusion tensor imaging MR Neurography detects polyneuropathy in type 2 diabetes. J Diabetes Complications 2020; 34:107439. [PMID: 31672457 DOI: 10.1016/j.jdiacomp.2019.107439] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 12/17/2022]
Abstract
AIM To evaluate if diffusion-tensor-imaging MR-Neurography (DTI-MRN) can detect lesions of peripheral nerves due to polyneuropathy in patients with type 2 diabetes. METHODS Ten patients with type 2 diabetes with polyneuropathy (DPN), 10 patients with type 2 diabetes without polyneuropathy (nDPN) as well as 20 healthy controls (HC) were included. DTI-MRN covered proximal (sciatic nerve) and distal regions (tibial nerve) of the lower extremity. Fractional-anisotropy (FA) and diffusivity (mean (MD), axial (AD) and radial (RD)) were calculated and compared to neuropathy severity. Conventional T2-relaxation-time and proton-spin-density data were obtained from a multi-echo SE sequence. Furthermore, we evaluated sensitivity and specificity of DTI-MRN from receiver operating characteristics (ROC). RESULTS The proximal and distal FA was lowest in patients with DPN compared with nDPN and HC (p < 0.01). Likewise, proximal and distal RD was highest in patients with DPN (p < 0.01). MD and AD were also significantly different though less pronounced. ROC curve analyses of DTI separated nDPN and DPN with area-under-the-curve values ranging from 0.65 to 0.98. T2-relaxation-time and proton-spin-density could not differentiate between nDPN and DPN. CONCLUSION DTI-MRN accurately detects DPN by lower nerve FA and higher RD. These alterations are likely to reflect both proximal and distal nerve fiber pathology in patients with type 2 diabetes.
Collapse
Affiliation(s)
- M Vaeggemose
- Department of Neurology, Aarhus University Hospital, Denmark; Danish Diabetes Academy, Odense, Denmark.
| | - W Haakma
- Department of Radiology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - M Pham
- Department of Neuroradiology, Heidelberg University Hospital, Germany; Department of Neuroradiology, Würzburg University Hospital, Germany
| | - S Ringgaard
- MR Research Centre, Aarhus University Hospital, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark
| | - N Ejskjaer
- Department of Clinical Medicine, Aalborg University Hospital, Denmark
| | - S Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Germany
| | - P L Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Denmark; The International Diabetic Neuropathy Consortium, Aarhus University Hospital, Denmark
| |
Collapse
|
28
|
Oudeman J, Eftimov F, Strijkers GJ, Schneiders JJ, Roosendaal SD, Engbersen MP, Froeling M, Goedee HS, van Doorn PA, Caan MWA, van Schaik IN, Maas M, Nederveen AJ, de Visser M, Verhamme C. Diagnostic accuracy of MRI and ultrasound in chronic immune-mediated neuropathies. Neurology 2019; 94:e62-e74. [PMID: 31827006 DOI: 10.1212/wnl.0000000000008697] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess and compare the diagnostic performance of qualitative and (semi-)quantitative MRI and ultrasound for distinguishing chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) from segmental spinal muscular atrophy (sSMA). METHODS Patients with CIDP (n = 13), MMN (n = 10), or sSMA (n = 12) and healthy volunteers (n = 30) were included. MRI of the brachial plexus, using short tau inversion recovery (STIR), nerve-specific T2-weighted (magnetic resonance neurography [MRN]), and diffusion tensor imaging (DTI) sequences, was evaluated. Furthermore, with ultrasound, cross-sectional areas of the nerves were evaluated. Three radiologists blinded for diagnosis qualitatively scored hypertrophy and increased signal intensity (STIR and MRN), and intraobserver and interobserver agreement was assessed. For the (semi-)quantitative modalities, group differences and receiver operator characteristics were calculated. RESULTS Hypertrophy and increased signal intensity were found in all groups including healthy controls. Intraobserver and interobserver agreements varied considerably (intraclass correlation coefficients 0.00-0.811 and 0.101-0.491, respectively). DTI showed significant differences (p < 0.05) among CIDP, MMN, sSMA, and controls for fractional anisotropy, axial diffusivity, and radial diffusivity in the brachial plexus. Ultrasound showed significant differences in cross-sectional area (p < 0.05) among CIDP, MMN, and sSMA in upper arm and brachial plexus. For distinguishing immune-mediated neuropathies (CIDP and MMN) from sSMA, ultrasound yielded the highest area under the curve (0.870). CONCLUSION Qualitative assessment of hypertrophy and signal hyperintensity on STIR or MRN is of limited value. DTI measures may discriminate among CIDP, MMN, and sSMA. Currently, ultrasound may be the most appropriate diagnostic imaging aid in the clinical setting.
Collapse
Affiliation(s)
- Jos Oudeman
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands.
| | - Filip Eftimov
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands
| | - Gustav J Strijkers
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands
| | - Joppe J Schneiders
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands
| | - Stefan D Roosendaal
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands
| | - Maurits P Engbersen
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands
| | - Martijn Froeling
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands
| | - H Stephan Goedee
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands
| | - Pieter A van Doorn
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands
| | - Matthan W A Caan
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands
| | - Ivo N van Schaik
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands
| | - Mario Maas
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands
| | - Aart J Nederveen
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands
| | - Marianne de Visser
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands
| | - Camiel Verhamme
- From the Departments of Radiology and Nuclear Medicine (J.O., S.D.R., M.P.E., M.W.A.C., M.M., A.J.N.), Neurology (F.E., I.N.v.S., M.d.V., C.V.), and Biomedical Engineering and Physics (G.J.S., M.W.A.C.), Amsterdam UMC, University of Amsterdam; Departments of Radiology (J.J.S.) and Neurology (P.A.v.D.), Erasmus Medical Center, Rotterdam; and Departments of Radiology (M.F.) and Neurology (H.S.G.), University Medical Center Utrecht, the Netherlands
| |
Collapse
|
29
|
Preisner F, Bäumer P, Wehrstein M, Friedmann-Bette B, Hackbusch M, Heiland S, Bendszus M, Kronlage M. Peripheral Nerve Diffusion Tensor Imaging : Interreader and Test-retest Reliability as Quantified by the Standard Error of Measurement. Clin Neuroradiol 2019; 30:679-689. [PMID: 31807812 DOI: 10.1007/s00062-019-00859-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/16/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Diffusion tensor imaging (DTI) is increasingly being used in magnetic resonance neurography (MRN). The purpose of this study was to determine the interreader and test-retest reliability of peripheral nerve DTI in MRN with focus on the sciatic nerve. METHODS In this prospective study 27 healthy volunteers each underwent 3 scans of a short DTI protocol on separate days consisting of a T2-weighted turbo spin-echo and single-shot DTI sequence of the sciatic nerve of the dominant leg. The DTI parameters fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were obtained after manual nerve segmentation by two independent readers. Intraclass correlation coefficients (ICC), standard error of measurement (SEM), and Bland-Altman plots were calculated as measures for both interreader and test-retest agreement for all readout parameters. RESULTS The mean ± standard deviation was 0.507 ± 0.05 for FA, 1308.5 ± 162.4 × 10-6 mm2/s for MD, 905.6 ± 145.4 ×10-6 mm2/s for RD and 2114.1 ± 219.2 × 10-6 mm2/s for AD. The SEM for FA was 0.02 for interreader and test-retest agreement, the SEM for MD, RD, and AD ranged between 46.2 × 10-6 mm2/s (RD) and 70.1 × 10-6 mm2/s (AD) for interreader reliability and between 45.9 × 10-6 mm2/s (RD) and 70.1 × 10-6 mm2/s (AD) for test-retest reliability. The ICC for interreader reliability of DTI parameters ranged between 0.81 and 0.92 and ICC for test-retest reliability between 0.76 and 0.91. CONCLUSION Peripheral nerve DTI of the sciatic nerve is reliable and reproducible. The measures presented here may serve as first orientation values of measurement accuracy when interpreting parameters of sciatic nerve DTI.
Collapse
Affiliation(s)
- Fabian Preisner
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Philipp Bäumer
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Center for Radiology Dia.log, Vinzenz-von-Paul Str. 8, 84503, Altötting, Germany
| | - Michaela Wehrstein
- Department of Sports Medicine (Internal Medicine VII), Medical Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Birgit Friedmann-Bette
- Department of Sports Medicine (Internal Medicine VII), Medical Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Moritz Kronlage
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| |
Collapse
|
30
|
MR Neurography: Normative Values in Correlation to Demographic Determinants in Children and Adolescents. Clin Neuroradiol 2019; 30:671-677. [DOI: 10.1007/s00062-019-00834-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 08/19/2019] [Indexed: 01/30/2023]
|
31
|
Feasibility of Diffusion Tensor and Morphologic Imaging of Peripheral Nerves at Ultra-High Field Strength. Invest Radiol 2019; 53:705-713. [PMID: 29979328 PMCID: PMC6221405 DOI: 10.1097/rli.0000000000000492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Supplemental digital content is available in the text. Objectives The aim of this study was to describe the development of morphologic and diffusion tensor imaging sequences of peripheral nerves at 7 T, using carpal tunnel syndrome (CTS) as a model system of focal nerve injury. Materials and Methods Morphologic images were acquired at 7 T using a balanced steady-state free precession sequence. Diffusion tensor imaging was performed using single-shot echo-planar imaging and readout-segmented echo-planar imaging sequences. Different acquisition and postprocessing methods were compared to describe the optimal analysis pipeline. Magnetic resonance imaging parameters including cross-sectional areas, signal intensity, fractional anisotropy (FA), as well as mean, axial, and radial diffusivity were compared between patients with CTS (n = 8) and healthy controls (n = 6) using analyses of covariance corrected for age (significance set at P < 0.05). Pearson correlations with Bonferroni correction were used to determine association of magnetic resonance imaging parameters with clinical measures (significance set at P < 0.01). Results The 7 T acquisitions with high in-plane resolution (0.2 × 0.2mm) afforded detailed morphologic resolution of peripheral nerve fascicles. For diffusion tensor imaging, single-shot echo-planar imaging was more efficient than readout-segmented echo-planar imaging in terms of signal-to-noise ratio per unit scan time. Distortion artifacts were pronounced, but could be corrected during postprocessing. Registration of FA maps to the morphologic images was successful. The developed imaging and analysis pipeline identified lower median nerve FA (pisiform bone, 0.37 [SD 0.10]) and higher radial diffusivity (1.08 [0.20]) in patients with CTS compared with healthy controls (0.53 [0.06] and 0.78 [0.11], respectively, P < 0.047). Fractional anisotropy and radial diffusivity strongly correlated with patients' symptoms (r = −0.866 and 0.866, respectively, P = 0.005). Conclusions Our data demonstrate the feasibility of morphologic and diffusion peripheral nerve imaging at 7 T. Fractional anisotropy and radial diffusivity were found to be correlates of symptom severity.
Collapse
|
32
|
Martín Noguerol T, Barousse R, Gómez Cabrera M, Socolovsky M, Bencardino JT, Luna A. Functional MR Neurography in Evaluation of Peripheral Nerve Trauma and Postsurgical Assessment. Radiographics 2019; 39:427-446. [DOI: 10.1148/rg.2019180112] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
33
|
Newhart H, Patterson J, Gunasekaran A, Pandey T, Kumar M, Kazemi N. The Incremental Value of Magnetic Resonance Neurography for the Neurosurgeon: Review of the Literature. World Neurosurg 2019; 122:331-341. [DOI: 10.1016/j.wneu.2018.10.212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
|
34
|
Godel T, Pham M, Kele H, Kronlage M, Schwarz D, Brunée M, Heiland S, Bendszus M, Bäumer P. Diffusion tensor imaging in anterior interosseous nerve syndrome - functional MR Neurography on a fascicular level. NEUROIMAGE-CLINICAL 2019; 21:101659. [PMID: 30642759 PMCID: PMC6412076 DOI: 10.1016/j.nicl.2019.101659] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/21/2018] [Accepted: 01/04/2019] [Indexed: 12/31/2022]
Abstract
Purpose By applying diffusor tensor imaging (DTI) in patients with anterior interosseous nerve syndrome (AINS), this proof of principle study aims to quantify the extent of structural damage of a peripheral nerve at the anatomical level of individual fascicles. Methods In this institutional review board approved prospective study 13 patients with spontaneous AINS were examined at 3 Tesla including a transversal T2-weighted turbo-spin-echo and a spin-echo echo-planar-imaging pulse sequence of the upper arm level. Calculations of quantitative DTI parameters including fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) for median nerve lesion and non-lesion fascicles as well as ulnar and radial nerve were obtained. DTI values were compared to each other and to a previously published dataset of 58 healthy controls using one-way Analysis of Variance with Bonferroni correction and p-values <.05 were considered significant. Receiver operating characteristic (ROC) curves were performed to assess diagnostic accuracy. Results FA of median nerve lesion fascicles was decreased compared to median nerve non-lesion fascicles, ulnar nerve and radial nerve while MD, RD, and AD was increased (p < .001 for all parameters). Compared to median nerve values of healthy controls, lesion fascicles showed a significant decrease in FA while MD, RD, and AD was increased (p < .001 for all parameters). FA of median nerve non-lesion fascicles showed a weak significant decrease compared to healthy controls (p < .01) while there was no difference in MD, RD, and AD. ROC analyses revealed an excellent diagnostic accuracy of FA, MD and RD in the discrimination of median nerve lesion and non-lesion fascicles in AINS patients as well as in the discrimination of lesion fascicles and normative median nerve values of healthy controls. Conclusion By applying this functional MR Neurography technique in patients with AINS, this proof of principle study demonstrates that diffusion tensor imaging is feasible to quantify structural nerve injury at the anatomical level of individual fascicles. DTI is capable to quantify structural nerve injury on a fascicular level. Lesion- and non-lesion fascicles can be discriminated at high diagnostic accuracy. FA seems to be to most sensitive parameter in quantitative DTI.
Collapse
Affiliation(s)
- Tim Godel
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Mirko Pham
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Department of Neuroradiology, Würzburg University Hospital, Josef-Schneider-Str. 11, 97080 Würzburg, Germany.
| | - Henrich Kele
- Center for Neurology and Clinical Neurophysiology, Neuer Wall 19, 20354 Hamburg, Germany.
| | - Moritz Kronlage
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Daniel Schwarz
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Merle Brunée
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Philipp Bäumer
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Center for Radiology Dia.log, Vinzenz-von-Paul Str. 8, 84503 Altötting, Germany.
| |
Collapse
|
35
|
The Multidisciplinary Approach to the Diagnosis and Management of Nonobstetric Traumatic Brachial Plexus Injuries. AJR Am J Roentgenol 2018; 211:1319-1331. [DOI: 10.2214/ajr.18.19887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
36
|
Ho M, Becker A, Ulbrich E, Manoliu A, Kuhn FP, Eberhard M, Filli L. Comparison of simultaneous multi-slice readout-segmented EPI and conventional single-shot EPI for diffusion tensor imaging of the ulnar nerve. Heliyon 2018; 4:e00853. [PMID: 30364500 PMCID: PMC6197173 DOI: 10.1016/j.heliyon.2018.e00853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 08/20/2018] [Accepted: 10/10/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose To compare conventional single-shot echo planar imaging (ss-EPI) and simultaneous multi-slice (SMS) readout-segmented EPI (rs-EPI) for magnetic resonance diffusion tensor imaging (DTI) of the ulnar nerve. Materials and methods This study was approved by the local ethics committee. Ten healthy volunteers (mean age 30.4 ± 4.01 years; range 25–36 years) underwent 3T DTI of the ulnar nerve at the level of the cubital tunnel. DTI was performed based on ss-EPI as well as SMS rs-EPI sequences. Signal-to-noise ratio (SNR), image quality, and DTI parameters in the ulnar nerve (fractional anisotropy, FA; mean diffusivity, MD) were compared between the two sequences by two independent radiologists. Results Acquisition time was 5:12 min for ss-EPI and 5:18 min for SMS rs-EPI. Between the two sequences, no significant differences were found for derived DTI measures FA (p = 0.11) and MD values (p = 0.93). Compared to conventional ss-EPI, SMS rs-EPI yielded significantly less ghosting artifacts (p = 0.04) but inferior nerve depiction (p = 0.001) and worse overall image quality (p = 0.008). Conclusion SMS rs-EPI is not advantageous over ss-EPI in DTI of the ulnar nerve at the level of the cubital tunnel.
Collapse
Affiliation(s)
- Michael Ho
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany
- Corresponding author.
| | - Anton Becker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Erika Ulbrich
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Andrei Manoliu
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Félix P. Kuhn
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Matthias Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Lukas Filli
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| |
Collapse
|
37
|
Cao J, He B, Wang S, Zhou Z, Gao F, Xiao L, Luo X, Wu C, Gong T, Chen W, Wang G. Diffusion Tensor Imaging of Tibial and Common Peroneal Nerves in Patients With Guillain-Barre Syndrome: A Feasibility Study. J Magn Reson Imaging 2018; 49:1356-1364. [PMID: 30252994 DOI: 10.1002/jmri.26324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The development of a noninvasive, objective, and accurate method to assess peripheral nerve disorders in Guillain-Barre syndrome (GBS) is of clinical significance. Diffusion tensor imaging (DTI) has been used to evaluate some peripheral nerve disorders. PURPOSE To investigate the feasibility of DTI in evaluating the peripheral nerve disorders in patients with GBS. STUDY TYPE Case control. SUBJECTS Twenty GBS patients and 16 healthy volunteers. FIELD STRENGTH/SEQUENCE 3.0T, T1 WI-SE, T2 WI-SPAIR, DTI; electrophysiology. ASSESSMENT MRI data were analyzed by two radiologists blindly and independently. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusion coefficient (AD), and radial diffusion coefficient (RD) values of tibial nerve (TN) and common peroneal nerve (CPN) were recorded. Motor nerve conduction velocity (MCV) and motor nerve conduction amplitude of TN and CPN were recorded. STATISTICAL TESTS Intraclass correlation coefficient (ICC), t-test, receiver-operating characteristic (ROC), and area under the curve (AUC) analysis, Pearson correlation coefficient. RESULTS The FA and AD values of TN and CPN in the GBS group were significantly lower and the ADC and RD values were higher than those in the controls (P <0.05). The AUC of the FA values (0.970 for TN and 0.927 for CPN) were higher than that of the ADC, AD, and RD values. FA and AD values were positively correlated and ADC, RD values were negatively correlated with MCV and motor nerve conduction amplitude, respectively (P <0.05). The correlations between FA value and electrophysiology parameters were the highest. DATA CONCLUSION DTI quantitative parameters could evaluate the disorders of peripheral nerves in patients with GBS. A moderate correlation was observed between DTI and electrophysiology parameters. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:1356-1364.
Collapse
Affiliation(s)
- Jinfeng Cao
- Department of Radiology, Zibo Central Hospital, Zibo, Shandong, P.R. China
| | - Bing He
- Department of Radiology, Zibo Central Hospital, Zibo, Shandong, P.R. China
| | - Shanshan Wang
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, P.R. China
| | - Zhongmin Zhou
- Department of Nephrology, Zibo Central Hospital, Shandong, P.R. China
| | - Fei Gao
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, P.R. China
| | - Lianxiang Xiao
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, P.R. China
| | - Xin Luo
- Department of Radiology, Zibo Central Hospital, Zibo, Shandong, P.R. China
| | - Chao Wu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Tao Gong
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, P.R. China
| | - Weibo Chen
- Philips Healthcare, Shanghai, P.R. China
| | - Guangbin Wang
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, P.R. China
| |
Collapse
|
38
|
Saito S, Ozawa H, Fujioka M, Hikishima K, Hata J, Kurihara S, Okano HJ, Ogawa K. Visualization of nerve fibers around the carotid bifurcation with use of a 9.4 Tesla microscopic magnetic resonance diffusion tensor imaging with tractography. Head Neck 2018; 40:2228-2234. [PMID: 29947092 PMCID: PMC6220873 DOI: 10.1002/hed.25318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/03/2018] [Indexed: 12/22/2022] Open
Abstract
Background Precise imaging of nerves have been challenging in the head and neck region, mainly due to low spatial resolution. Here, we investigated how nerves in the head and neck region could be visualized using an ultra‐high magnetic field MR system. Methods We used formol‐carbol‐fixed human cadaveric necks and obtained MR diffusion tensor images (DTIs) using a 9.4 Tesla (T) ultra‐high magnetic field MR system. Afterward, we prepared tissue sections and checked the anatomic relationships between the neurons and the carotid artery in order to confirm that the visualized fibers are indeed neuron fibers. Results We were able to identify nerves, including the vagus nerve, the hypoglossal nerve, and the spinal‐accessory nerve. Hematoxylin‐eosin stained histological sections confirmed neuron fibers in the same anatomic position. Conclusion This technique has the feasibility to be applied for a more accurate anatomic understanding, maybe even close to a histological level.
Collapse
Affiliation(s)
- Shin Saito
- Department of Otolaryngology - Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Ozawa
- Department of Otolaryngology - Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masato Fujioka
- Department of Otolaryngology - Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Junichi Hata
- Department of Physiology, Keio University School of Medicine, Tokyo, Japan
| | - Sho Kurihara
- Department of Otorhinolaryngology, Keio University School of Medicine, Tokyo, Japan
| | - Hirotaka James Okano
- Division of Regenerative Medicine, the Jikei University School of Medicine, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otolaryngology - Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
39
|
Somatotopic Fascicular Lesions of the Brachial Plexus Demonstrated by High-Resolution Magnetic Resonance Neurography. Invest Radiol 2018; 52:741-746. [PMID: 28723713 DOI: 10.1097/rli.0000000000000401] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate whether high-resolution brachial plexus (BP) magnetic resonance neurography (MRN) is capable of (1) distinguishing patients with compressive neuropathy or noncompressive plexopathy from age- and sex-matched controls, (2) discriminating between patients with compressive neuropathy and noncompressive plexopathy, and (3) detecting spatial lesion patterns suggesting somatotopic organization of the BP. MATERIALS AND METHODS Thirty-six patients (50.9 ± 12.7 years) with clinical symptoms, nerve conduction studies, and needle electromyography findings suggestive of brachial plexopathy and 36 control subjects matched for age and sex (50.8 ± 12.6 years) underwent high-resolution MRN of the BP. Lesion determination and localization was performed by 2 blinded neuroradiologists at the anatomical levels of the plexus trunks and cords. RESULTS By applying defined criteria of structural plexus lesions on high-resolution MRN, all patients were correctly rated as affected, whereas 34 of 36 controls were correctly rated as unaffected by independent and blinded reading from 2 neuroradiologists with overall good to excellent interrater reliability. In all cases, plexopathies with a compressive etiology (n = 12) were correctly distinguished from noncompressive plexopathies with inflammatory origin (n = 24). Pathoanatomical contiguity of lesion from trunk into cord level allowed recognition of distinct somatotopical patterns of fascicular involvement, which correlated closely with the spatial distribution of clinical symptoms and electrophysiological data. CONCLUSIONS Brachial plexus MRN is highly accurate for differentiating patients with symptomatic plexopathy from healthy controls and for distinguishing patients with compressive neuropathy and noncompressive plexopathy. Furthermore, BP MRN revealed evidence for somatotopic organization of the BP. Therefore, as an addition to functional information of electrodiagnostic studies, anatomical information gained by BP MRN may help to improve the efficiency and accuracy of patient care.
Collapse
|
40
|
Keller S, Wang ZJ, Golsari A, Kim AC, Kooijman H, Adam G, Yamamura J. Feasibility of peripheral nerve MR neurography using diffusion tensor imaging adapted to skeletal muscle disease. Acta Radiol 2018; 59:560-568. [PMID: 28795588 DOI: 10.1177/0284185117726100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Diffusion tensor imaging (DTI) of peripheral nerves may provide additional information about nerve involvement in muscular disorders, but is considered difficult due to different optimal scan parameters tailored to magnetic resonance (MR) signal properties of muscle and neural tissues. Purpose To assess the feasibility of sciatic nerve DTI using two different approaches of region of interest (ROI)-localization in DTI scans with b-values 500 s/mm2, in participants with muscular disorders and in controls. Material and Methods DTI of the thigh was conducted on a 3T system in ten patients (6 men, 4 women; mean age =54 ± 15 years) with neuromuscular disorders and ten controls. T1-weighted (T1W) images were co-registered to fractional anisotropy (FA) color-encoded images. The apparent diffusion coefficient (ADC), FA, and fiber track length (FTL) were analyzed by two operators using a freehand ROI and a single-point ROI covering the sciatic nerve. Interclass correlation coefficient (ICC) and Bland-Altman analysis were used for evaluation of inter-operator and inter-technical agreement, respectively. Results Three-dimensional visualization of sciatic nerve fiber was achievable using both techniques. The ICC of DTI metrics showed excellent inter-operator agreement both in patients and controls. Bland-Altman analysis revealed good agreement of both techniques. A maximum FTL was achieved using the single-point ROI technique, but with a lower inter-operator agreement (ICC = 0.99 vs. 0.83). The ADC and maximum FTL were significantly decreased in patients compared to controls. Conclusion Both ROI localization techniques are feasible to analyze the sciatic nerve in the setting of muscular disease. A maximum FTL is reached using the single-point ROI, however, at the cost of lower inter-operator agreement.
Collapse
Affiliation(s)
- Sarah Keller
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Zhiyue J Wang
- Childrens Medical Center Dallas, Department of Radiology, University of Texas Southwestern Medical Center, TX, USA
| | - Amir Golsari
- Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne Catherine Kim
- The Permanente Medical Group, Department Stroke and Neurovascular Imaging, San Francisco, CA, USA
| | - Hendrik Kooijman
- Philips Medical Systems, MR Clinical Science SMC, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
41
|
Wang X, Wang H, Sun C, Zhou S, Meng T, Lv F, Ma X, Xia X, Jiang J. Analysis of radiological parameters associated with decreased fractional anisotropy values on diffusion tensor imaging in patients with lumbar spinal stenosis. 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 2018; 28:1397-1405. [PMID: 29700619 DOI: 10.1007/s00586-018-5562-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/04/2018] [Accepted: 03/22/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Previous studies have indicated that decreased fractional anisotropy (FA) values on diffusion tensor imaging (DTI) are well correlated with the symptoms of nerve root compression. The aim of our study is to determine primary radiological parameters associated with decreased FA values in patients with lumbar spinal stenosis involving single L5 nerve root. METHODS Patients confirmed with single L5 nerve root compression by transforaminal nerve root blocks were included in this study. FA values of L5 nerve roots on both symptomatic and asymptomatic side were obtained. Conventional radiological parameters, such as disc height, degenerative scoliosis, dural sac cross-sectional area (DSCSA), foraminal height (FH), hypertrophic facet joint degeneration (HFJD), sagittal rotation (SR), sedimentation sign, sagittal translation and traction spur were measured. Correlation and regression analyses were performed between the radiological parameters and FA values of the symptomatic L5 nerve roots. A predictive regression equation was established. RESULTS Twenty-one patients were included in this study. FA values were significantly lower at the symptomatic side comparing to the asymptomatic side (0.263 ± 0.069 vs. 0.334 ± 0.080, P = 0.038). DSCSA, FH, HFJD, and SR were significantly correlated with the decreased FA values, with r = 0.518, 0.443, 0.472 and - 0.910, respectively (P < 0.05). DSCSA and SR were found to be the primary radiological parameters related to the decreased FA values, and the regression equation is FA = - 0.012 × SR + 0.002 × DSCSA. CONCLUSIONS DSCSA and SR were primary contributors to decreased FA values in LSS patients involving single L5 nerve root, indicating that central canal decompression and segmental stability should be the first considerations in preoperative planning of these patients. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- Xiandi Wang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 210000, People's Republic of China
| | - Hongli Wang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 210000, People's Republic of China
| | - Chi Sun
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 210000, People's Republic of China
| | - Shuyi Zhou
- Department of Radiology, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 210000, People's Republic of China
| | - Tao Meng
- Department of MRI Application, Siemens Healthcare Ltd, Shang, No. 278, Zhouzhu Road, Shanghai, 210031, People's Republic of China
| | - Feizhou Lv
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 210000, People's Republic of China
| | - Xiaosheng Ma
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 210000, People's Republic of China
| | - Xinlei Xia
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 210000, People's Republic of China
| | - Jianyuan Jiang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 210000, People's Republic of China.
| |
Collapse
|
42
|
Rouchy RC, Attyé A, Medici M, Renard F, Kastler A, Grand S, Tropres I, Righini CA, Krainik A. Facial nerve tractography: A new tool for the detection of perineural spread in parotid cancers. Eur Radiol 2018; 28:3861-3871. [PMID: 29633003 DOI: 10.1007/s00330-018-5318-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/29/2017] [Accepted: 01/09/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To determine whether facial nerve MR tractography is useful in detecting PeriNeural Spread in parotid cancers. METHODS Forty-five participants were enrolled. Thirty patients with surgically managed parotid tumors (15 malignant, 15 benign) were compared with 15 healthy volunteers. All of them had undergone 3T-MRI with diffusion acquisition and post-processing constrained spherical deconvolution-based tractography. Parameters of diffusion-weighted sequences were b-value 1,000 s/mm2, 32 directions. Two radiologists performed a blinded visual reading of tractographic maps and graded the facial nerve average pathlength and fractional anisotropy (FA). We also compared diagnostic accuracy of tractography with morphological MRI sequences to detect PeriNeural Spread. Non-parametric methods were used. RESULTS Average pathlength was significantly higher in cases with PeriNeural Spread (39.86 mm [Quartile1: 36.27; Quartile3: 51.19]) versus cases without (16.23 mm [12.90; 24.90]), p<0.001. The threshold above which there was a significant association with PeriNeural Spread was set at 27.36 mm (Se: 100%; Sp: 84%; AUC: 0.96, 95% CI 0.904-1). There were no significant differences in FA between groups. Tractography map visual analyses directly displayed PeriNeural Spread in distal neural ramifications with sensitivity of 75%, versus 50% using morphological sequences. CONCLUSIONS Tractography could be used to identify facial nerve PeriNeural Spread by parotid cancers. KEY POINTS • Tractography could detect facial nerve PeriNeural Spread in parotid cancers. • The average pathlength parameter is increased in case of PeriNeural Spread. • Tractography could map PeriNeural Spread more precisely than conventional imaging.
Collapse
Affiliation(s)
- René-Charles Rouchy
- Department of Neuroradiology and MRI, Grenoble Alpes University Hospital - SFR RMN Neurosciences, F-38043, Grenoble, Cedex 9, France. .,University of Grenoble Alpes, IRMaGe, F-38000, Grenoble, France.
| | - Arnaud Attyé
- Department of Neuroradiology and MRI, Grenoble Alpes University Hospital - SFR RMN Neurosciences, F-38043, Grenoble, Cedex 9, France.,University of Grenoble Alpes, IRMaGe, F-38000, Grenoble, France
| | - Maud Medici
- Clinical Investigation Centre 1406 - Innovative Technology, National Institute of Health and Medical Research, Grenoble, France.,Public Health Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Félix Renard
- University of Grenoble Alpes, IRMaGe, F-38000, Grenoble, France
| | - Adrian Kastler
- Department of Neuroradiology and MRI, Grenoble Alpes University Hospital - SFR RMN Neurosciences, F-38043, Grenoble, Cedex 9, France.,University of Grenoble Alpes, IRMaGe, F-38000, Grenoble, France
| | - Sylvie Grand
- Department of Neuroradiology and MRI, Grenoble Alpes University Hospital - SFR RMN Neurosciences, F-38043, Grenoble, Cedex 9, France.,University of Grenoble Alpes, IRMaGe, F-38000, Grenoble, France
| | - Irène Tropres
- University of Grenoble Alpes, IRMaGe, F-38000, Grenoble, France.,IRMaGe, Inserm US 17, CNRS UMS 3552, Grenoble, France
| | | | - Alexandre Krainik
- Department of Neuroradiology and MRI, Grenoble Alpes University Hospital - SFR RMN Neurosciences, F-38043, Grenoble, Cedex 9, France.,University of Grenoble Alpes, IRMaGe, F-38000, Grenoble, France
| |
Collapse
|
43
|
Weighted Mean of Signal Intensity for Unbiased Fiber Tracking of Skeletal Muscles: Development of a New Method and Comparison With Other Correction Techniques. Invest Radiol 2018; 52:488-497. [PMID: 28240621 DOI: 10.1097/rli.0000000000000364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the origin of random image artifacts in stimulated echo acquisition mode diffusion tensor imaging (STEAM-DTI), assess the role of averaging, develop an automated artifact postprocessing correction method using weighted mean of signal intensities (WMSIs), and compare it with other correction techniques. MATERIALS AND METHODS Institutional review board approval and written informed consent were obtained. The right calf and thigh of 10 volunteers were scanned on a 3 T magnetic resonance imaging scanner using a STEAM-DTI sequence.Artifacts (ie, signal loss) in STEAM-based DTI, presumably caused by involuntary muscle contractions, were investigated in volunteers and ex vivo (ie, human cadaver calf and turkey leg using the same DTI parameters as for the volunteers). An automated postprocessing artifact correction method based on the WMSI was developed and compared with previous approaches (ie, iteratively reweighted linear least squares and informed robust estimation of tensors by outlier rejection [iRESTORE]). Diffusion tensor imaging and fiber tracking metrics, using different averages and artifact corrections, were compared for region of interest- and mask-based analyses. One-way repeated measures analysis of variance with Greenhouse-Geisser correction and Bonferroni post hoc tests were used to evaluate differences among all tested conditions. Qualitative assessment (ie, images quality) for native and corrected images was performed using the paired t test. RESULTS Randomly localized and shaped artifacts affected all volunteer data sets. Artifact burden during voluntary muscle contractions increased on average from 23.1% to 77.5% but were absent ex vivo. Diffusion tensor imaging metrics (mean diffusivity, fractional anisotropy, radial diffusivity, and axial diffusivity) had a heterogeneous behavior, but in the range reported by literature. Fiber track metrics (number, length, and volume) significantly improved in both calves and thighs after artifact correction in region of interest- and mask-based analyses (P < 0.05 each). Iteratively reweighted linear least squares and iRESTORE showed equivalent results, but WMSI was faster than iRESTORE. Muscle delineation and artifact load significantly improved after correction (P < 0.05 each). CONCLUSIONS Weighted mean of signal intensity correction significantly improved STEAM-based quantitative DTI analyses and fiber tracking of lower-limb muscles, providing a robust tool for musculoskeletal applications.
Collapse
|
44
|
Gimber LH, Garland L, Krupinski EA, Chadaz TS, Schwenk M, Najafi B, Taljanovic MS. Diffusion Tensor Imaging of the Ankle as a Possible Predictor of Chemotherapy Induced Peripheral Neuropathy: Pilot Study. Curr Probl Diagn Radiol 2018; 48:121-126. [PMID: 29397266 DOI: 10.1067/j.cpradiol.2017.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/25/2017] [Accepted: 12/12/2017] [Indexed: 01/28/2023]
Abstract
PURPOSE Chemotherapy induced peripheral neuropathy (CIPN) is seen in up to 75% of treated cancer patients and can drastically limit their medical management and affect quality of life. Clinical and electrodiagnostic testing for CIPN have many pitfalls. Magnetic resonance neurography (MRN) is being increasingly used in the evaluation of peripheral nerves. Diffusion tensor imaging (DTI) shows promise in the workup of peripheral nerves. In this prospective pilot study, we investigated a possible relationship between DTI and peripheral neuropathy of the ankle and foot in cancer patients treated with chemotherapy. METHODS Nine cancer patients with and without CIPN were clinically evaluated using vibratory perception threshold (VPT) testing. VPT score of >25Volts defined presence of CIPN. The posterior tibial nerve and branches in both feet were imaged using MRN and DTI. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were measured at the posterior tibial, medial plantar, and lateral plantar nerves. Measurements for the CIPN group were compared to without CIPN by VPT cutoff. Correlations and possible relationships between DTI parameters and CIPN were analyzed. RESULTS A total of 16feet of 9 enrolled patients were imaged (9feet with CIPN and 7feet without CIPN). Average age was 60.6 ± 13.4 years (range: 33-74). Posterior tibial nerve ADC values were significantly lower than the medial plantar nerve ADC values in all feet (F = 3.50, P = 0.04). We found a correlation with FA and ADC values at specific nerve locations with CIPN, with the left medial plantar nerve FA value and left lateral plantar nerve ADC value demonstrating the strongest positive correlations (0.73 and 0.62, respectively). CONCLUSIONS The use of DTI for assessing CIPN is challenging but promising. This pilot study provides preliminary data showing correlations between FA and ADC measurements with CIPN and potential utility of DTI as a predictive marker of onset and severity of CIPN in the ankle and foot, which could aid in preventive strategies. Larger, prospective DTI studies are needed to draw definitive conclusions. CLINICAL RELEVANCE MRN with DTI shows promising results as a potential predictive marker of CIPN in the ankle and foot.
Collapse
Affiliation(s)
- Lana Hirai Gimber
- Department of Medical Imaging, The University of Arizona, College of Medicine, Banner-University Medical Center, Tucson, AZ.
| | | | | | - Tyson S Chadaz
- Department of Medical Imaging, The University of Arizona, College of Medicing, Banner-University Medical Center, Tucson, AZ
| | - Michael Schwenk
- Heidelberg University, Network Aging Research, Heidelberg, Germany
| | - Bijan Najafi
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Mihra S Taljanovic
- Department of Medical Imaging, The University of Arizona, College of Medicine, Banner-University Medical Center, Tucson, AZ
| |
Collapse
|
45
|
High Isotropic Resolution T2 Mapping of the Lumbosacral Plexus with T2-Prepared 3D Turbo Spin Echo. Clin Neuroradiol 2018; 29:223-230. [PMID: 29322233 PMCID: PMC6579865 DOI: 10.1007/s00062-017-0658-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/18/2017] [Indexed: 10/31/2022]
Abstract
PURPOSE Isotropic high-resolution three-dimensional (3D) magnetic resonance neurography (MRN) is increasingly used to depict even small and highly oblique nerves of the lumbosacral plexus (LSP). The present study introduces a T2 mapping sequence (T2-prepared 3D turbo spin echo) that is B1-insensitive and enables quantitative assessment of LSP nerves. METHODS In this study 15 healthy subjects (mean age 28.5 ± 3.8 years) underwent 3 T MRN of the LSP area three times. The T2 values were calculated offline on a voxel-by-voxel basis and measured at three segments (preganglionic, ganglionic, postganglionic) of three LSP nerves (S1, L5, L4) by two independent investigators (experienced and novice). Normative data for the different nerves were extracted and intraclass correlation coefficients (ICCs) were calculated to assess reproducibility and interobserver reliability of T2 measurements. RESULTS The T2 mapping showed excellent reproducibility with ICCs ranging between 0.99 (S1 preganglionic) and 0.89 (L5 postganglionic). Interobserver reliability was less robust with ICCs ranging between 0.78 (S1 preganglionic) and 0.44 (L5 postganglionic) for S1 and L5. A mean T2 value of 74.6 ± 4.7 ms was registered for preganglionic segments, 84.7 ± 4.1 ms for ganglionic and 65.4 ± 2.5 ms for postganglionic segments, respectively. There was a statistically significant variation of T2 values across the nerve (preganglionic vs ganglionic vs postganglionic) for S1, L5, and L4. CONCLUSION Our approach enables isotropic high-resolution and B1-insensitive T2 mapping of LSP nerves with excellent reproducibility. It might reflect a robust and clinically useful method for future diagnostics of LSP pathologies.
Collapse
|
46
|
Kronlage M, Schwehr V, Schwarz D, Godel T, Uhlmann L, Heiland S, Bendszus M, Bäumer P. Peripheral nerve diffusion tensor imaging (DTI): normal values and demographic determinants in a cohort of 60 healthy individuals. Eur Radiol 2017; 28:1801-1808. [PMID: 29230526 DOI: 10.1007/s00330-017-5134-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/14/2017] [Accepted: 10/12/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify demographic determinants of peripheral nerve diffusion tensor imaging (DTI) and to establish normal values for fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD). METHODS Sixty subjects were examined at 3 Tesla by single-shot DTI. FA, AD, RD, and MD were collected for the sciatic, tibial, median, ulnar, and radial nerve and were correlated with demographic variables. RESULTS Mean FA of all nerves declined with increasing age (r = -0.77), which could be explained by RD increasing (r = 0.56) and AD declining (r = -0.40) with age. Moreover, FA was inversely associated with height (r = -0.28), weight (r = -0.38) and BMI (r = -0.35). Although FA tended to be lower in men than women (p = 0.052), this difference became completely negligible after adjustment to body weight. A multiple linear regression model for FA was calculated with age and weight as predictors (defined by backward variable selection), yielding an R 2 = 0.71 and providing a correction formula to adjust FA for age and weight. CONCLUSION Peripheral nerve DTI parameters depend on demographic variables. The most important determinants age and weight should be considered in all studies employing peripheral nerve DTI. KEY POINTS • Peripheral nerve diffusion tensor imaging (DTI) parameters depend on demographic variables. • Fractional anisotropy (FA) declines with increasing age and weight. • Gender does not systematically affect peripheral nerve DTI. • The formula presented here allows adjustment of FA for demographic variables.
Collapse
Affiliation(s)
- Moritz Kronlage
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Véronique Schwehr
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Tim Godel
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute for medical biometry and informatics, Heidelberg University, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Philipp Bäumer
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| |
Collapse
|
47
|
|
48
|
Jeon T, Fung MM, Koch KM, Tan ET, Sneag DB. Peripheral nerve diffusion tensor imaging: Overview, pitfalls, and future directions. J Magn Reson Imaging 2017; 47:1171-1189. [DOI: 10.1002/jmri.25876] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/09/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Tina Jeon
- Department of Radiology and Imaging; Hospital for Special Surgery; New York New York USA
| | - Maggie M. Fung
- MR Apps & Workflow; GE Healthcare; New York New York USA
| | - Kevin M. Koch
- Department of Radiology; Medical College of Wisconsin; Milwaukee Wisconsin USA
| | - Ek T. Tan
- GE Global Research Center; Niskayuna New York USA
| | - Darryl B. Sneag
- Department of Radiology and Imaging; Hospital for Special Surgery; New York New York USA
| |
Collapse
|
49
|
Clinical Robustness of Accelerated and Optimized Abdominal Diffusion-Weighted Imaging. Invest Radiol 2017; 52:590-595. [DOI: 10.1097/rli.0000000000000370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
50
|
Martín Noguerol T, Barousse R, Socolovsky M, Luna A. Quantitative magnetic resonance (MR) neurography for evaluation of peripheral nerves and plexus injuries. Quant Imaging Med Surg 2017; 7:398-421. [PMID: 28932698 DOI: 10.21037/qims.2017.08.01] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Traumatic conditions of peripheral nerves and plexus have been classically evaluated by morphological imaging techniques and electrophysiological tests. New magnetic resonance imaging (MRI) studies based on 3D fat-suppressed techniques are providing high accuracy for peripheral nerve injury evaluation from a qualitative point of view. However, these techniques do not provide quantitative information. Diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) are functional MRI techniques that are able to evaluate and quantify the movement of water molecules within different biological structures. These techniques have been successfully applied in other anatomical areas, especially in the assessment of central nervous system, and now are being imported, with promising results for peripheral nerve and plexus evaluation. DWI and DTI allow performing a qualitative and quantitative peripheral nerve analysis, providing valuable pathophysiological information about functional integrity of these structures. In the field of trauma and peripheral nerve or plexus injury, several derived parameters from DWI and DTI studies such as apparent diffusion coefficient (ADC) or fractional anisotropy (FA) among others, can be used as potential biomarkers of neural damage providing information about fiber organization, axonal flow or myelin integrity. A proper knowledge of physical basis of these techniques and their limitations is important for an optimal interpretation of the imaging findings and derived data. In this paper, a comprehensive review of the potential applications of DWI and DTI neurographic studies is performed with a focus on traumatic conditions, including main nerve entrapment syndromes in both peripheral nerves and brachial or lumbar plexus.
Collapse
Affiliation(s)
| | - Rafael Barousse
- Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina
| | - Mariano Socolovsky
- Peripheral Nerve and Plexus Surgery Unit, Department of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Antonio Luna
- MRI Unit, Neuroradiology Section, Clínica Las Nieves, SERCOSA, Health Time, Jaén, Spain.,Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|