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Chen R, Ran Y, Xu H, Niu J, Wang M, Wu Y, Zhang Y, Cheng J. The guiding value of the cinematic volume rendering technique in the preoperative diagnosis of brachial plexus schwannoma. Front Oncol 2023; 13:1278386. [PMID: 38152370 PMCID: PMC10751301 DOI: 10.3389/fonc.2023.1278386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023] Open
Abstract
This study aimed to explore and compare the guiding value of Maximum Intensity Projection (MIP) and Cinematic Volume Rendering Technique (cVRT) in the preoperative diagnosis of brachial plexus schwannomas. We retrospectively analyzed the clinical and imaging data of 45 patients diagnosed with brachial plexus schwannomas at the First Affiliated Hospital of Zhengzhou University between January 2020 and December 2022. The enhanced three-dimensional short recovery time inversion-recovery fast spin-echo imaging (3D-STIR-SPACE) sequence served as source data for the reconstruction of MIP and cVRT. Two independent observers scored the image quality and evaluated the location of the tumor and the relationship between the tumor and the brachial plexus. The image quality scores of the two reconstruction methods were compared using the nonparametric Wilcoxon signed-rank test, and the consistency between the image and surgical results was assessed using the weighted kappa. Compared to MIP images, cVRT images had a better performance of overall image quality (p < 0.001), nerve and lump visualization (p < 0.001), spatial positional relationship conspicuity (p < 0.001), and diagnostic confidence (p < 0.001). Additionally, the consistency between the cVRT image results and surgical results (kappa =0.913, P<0.001) was higher than that of the MIP images (kappa =0.829, P<0.001). cVRT provides a high guiding value in the preoperative diagnosis of brachial plexus schwannomas and is an important basis for formulating surgical plans.
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Affiliation(s)
- Rui Chen
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuncai Ran
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haowen Xu
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junxia Niu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengzhu Wang
- MR Collaborations, Siemens Healthineers Ltd., Beijing, China
| | - Yanglei Wu
- MR Collaborations, Siemens Healthineers Ltd., Beijing, China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Lao Q, Jia Y, Zhao K, Liu K, Feng J. Value of High-Resolution MRI in the Diagnosis of Brachial Plexus Injury in Infants and Young Children. Int J Gen Med 2022; 15:5673-5680. [PMID: 35755861 PMCID: PMC9215839 DOI: 10.2147/ijgm.s362738] [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: 02/21/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To investigate the value of high-resolution MRI based on 3D-short inversion time inversion recovery sampling perfection with application-optimized contrasts (3D-STIR SPACE) sequence for the diagnosis of brachial plexus injury in infants and young children. Methods Physical examination, electromyography (EMG) and MRI data of 26 children with brachial plexus injury were retrospectively analyzed. Sensitivity, specificity, and accuracy were calculated for the three tests. The agreement among these examinations was analyzed with the Kappa test. P<0.05 was considered statistically significant. Results Of the 26 children, 3 cases had normal MRIs, 23 cases had unilateral brachial plexus injury diagnosed with MRI, and a total of 73 nerve roots and/or sheaths were involved. Among the 23 cases with aberrant MRI findings, there were 19 cases of nerve root thickening (42 nerve roots), 4 cases of nerve root sleeve expansion (5 nerve roots), 17 cases of pseudomeningeal cysts (34 nerve roots), 2 cases of nerve root loosening (2 nerve roots), 8 cases of nerve root dissection (11 nerve roots), 19 cases with increased nerve signal (43 nerve roots), and 9 cases with an increased signal of the muscles on the affected side. As for the diagnosis of brachial plexus injury, the sensitivity and the accuracy of physical examination, EMG and MRI were 0.92, 0.86, and 0.88, respectively. The agreement between MRI and physical examination was substantial (κ=0.780, P=0.000), as did the agreement between MRI and EMG (κ=0.611, P=0.005). Conclusion High-resolution MRI based on 3D-STIR SPACE sequence plays a role in the diagnosis and evaluation of brachial plexus injury in infants and young children. It can accurately identify the injured nerve and characterize related pathological alterations. Besides EMG and physical examination, it can be used as a valuable tool for screening and monitoring of brachial plexus injury in infants and children.
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Affiliation(s)
- Qun Lao
- Department of Radiology, Hangzhou Children's Hospital, Hangzhou, People's Republic of China
| | - Yuzhu Jia
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, People's Republic of China
| | - Kaiyu Zhao
- Department of Radiology, Hangzhou Children's Hospital, Hangzhou, People's Republic of China
| | - Kun Liu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jianju Feng
- Department of Radiology, Zhuji Affiliated Hospital of Shaoxing University, Shaoxing, People's Republic of China
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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.
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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,
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Boulter DJ, Job J, Shah LM, Wessell DE, Lenchik L, Parsons MS, Agarwal V, Appel M, Burns J, Hutchins TA, Kendi AT, Khan MA, Liebeskind DS, Moritani T, Ortiz AO, Shah VN, Singh S, Than KD, Timpone VM, Beaman FD, Corey AS. ACR Appropriateness Criteria® Plexopathy: 2021 Update. J Am Coll Radiol 2021; 18:S423-S441. [PMID: 34794598 DOI: 10.1016/j.jacr.2021.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 10/19/2022]
Abstract
Plexopathy may be caused by diverse pathologies, including trauma, nerve entrapment, neoplasm, inflammation, infection, autoimmune disease, hereditary disease, and idiopathic etiologies. For patients presenting with brachial or lumbosacral plexopathy, dedicated plexus MRI is the most appropriate initial imaging modality for all clinical scenarios and can identify processes both intrinsic and extrinsic to the nerves. Other imaging tests may be appropriate for initial imaging depending on the clinical scenario. This document addresses initial imaging strategies for brachial and lumbosacral plexopathy in the following clinical situations: nontraumatic plexopathy with no known malignancy, traumatic plexopathy (not perinatal), and plexopathy occurring in the context of a known malignancy or posttreatment syndrome. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Daniel J Boulter
- Clinical Director of MRI, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Joici Job
- Research Author, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Matthew S Parsons
- Panel Vice-Chair, Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | - Vikas Agarwal
- Vice Chair of Education, Chief, Neuroradiology, and Director, Spine Intervention, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons
| | - Judah Burns
- Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | - Troy A Hutchins
- Chief Value Officer for Radiology, University of Utah Health, Salt Lake City, Utah
| | | | - Majid A Khan
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David S Liebeskind
- University of California Los Angeles, Los Angeles, California; President, SVIN; and American Academy of Neurology
| | | | - A Orlando Ortiz
- Chairman, Department of Radiology, Jacobi Medical Center, Bronx, New York
| | - Vinil N Shah
- University of California San Francisco, San Francisco, California; and Executive Committee, American Society of Spine Radiology
| | - Simranjit Singh
- Indiana University School of Medicine, Indianapolis, Indiana; Secretary, SHM, Indiana Chapter; Secretary, SGIM, Midwest Region; and American College of Physicians
| | - Khoi D Than
- Duke University, Durham, North Carolina; Neurosurgery expert
| | - Vincent M Timpone
- Co-Director, Neuroradiology Spine Intervention Service, Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | | | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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5
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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.
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[Peripheral nerve reconstruction - diagnostics as a basis for decision-making: report of the Consensus Workshop at the 35th Meeting of the DAM]. HANDCHIR MIKROCHIR P 2021; 53:168-174. [PMID: 33860493 DOI: 10.1055/a-1307-3963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In the early stage of nerve lesions, the clinical differentiation between neurapraxia, axonotmesis and neurotmesis often presents a big challenge. Especially in the early stage, however, it is crucial to correctly classify the type of damage because this is what essentially determines the therapeutic concept, in particular the surgical approach and, therefore, the prognosis. A precise diagnosis not only requires detailed clinical assessment and medical history taking, but also the use of additional electrophysiological (functional) and/or imaging examinations. Electrophysiological diagnostic tests may provide information ion localization, severity, course, type of damage and incipient or past reinnervation. Preoperative functional diagnostic measures should include neurography, needle electromyography (EMG) and, if needed, evoked potentials (EP), while imaging procedures should include neural sonography and magnetic resonance imaging (MRI). As a complimentary procedure, EMG may also be performed during surgery.
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Wade RG, Teh I, Andersson G, Yeh FC, Wiberg M, Bourke G. Fractional anisotropy thresholding for deterministic tractography of the roots of the brachial plexus. Sci Rep 2021; 11:80. [PMID: 33420207 PMCID: PMC7794285 DOI: 10.1038/s41598-020-79840-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 12/07/2020] [Indexed: 02/03/2023] Open
Abstract
Diffusion tensor imaging (DTI) metrics, such as the fractional anisotropy (FA) and estimates of diffusivity are sensitive to the microstructure of peripheral nerves and may be displayed as tractograms. However, the ideal conditions for tractography of the roots of the brachial plexus are unclear, which represents the rationale for this study. Ten healthy adults were scanned using a Siemens Prisma (3T) and single-shot echo-planar imaging (b-value 0/1000 s/mm2, 64 directions, 2.5 mm3 with 4 averages; repeated in opposing phase encoding directions). Susceptibility correction and tractography were performed in DSI Studio by two independent raters. The effect of FA thresholding at increments of 0.01 (from 0.04 to 0.10) were tested. The mean FA varied between subjects by 2% (95% CI 1%, 3%). FA thresholds of 0.04, 0.05 and 0.06 all propagated 96% of tracts representing the roots; thresholding at 0.07 yielded 4% fewer tracts (p = 0.2), 0.08 yielded 11% fewer tracts (p = 0.008), 0.09 yielded 15% fewer tracts (p = 0.001) and 0.1 yielded 20% fewer tracts (p < 0.001). There was < 0.1% inter-rater variability in the measured FA and 99% agreement for tractography (κ = 0.92, p < 0.001). The fractional anisotropy thresholds required to generate tractograms of the roots of the brachial plexus appears to be lower than those used in the brain. We provide estimates of the probability of generating true tracts for each spinal nerve root of the brachial plexus, at different fractional anisotropy thresholds.
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Affiliation(s)
- Ryckie G Wade
- Academic Plastic Surgery Office, Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds Teaching Hospitals Trust, Leeds, LS1 3EX, UK. .,Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK.
| | - Irvin Teh
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Gustav Andersson
- Department of Integrative Medical Biology, Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Surgical and Perioperative Science, Faculty of Medicine, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Mikael Wiberg
- Department of Integrative Medical Biology, Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Surgical and Perioperative Science, Faculty of Medicine, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Grainne Bourke
- Academic Plastic Surgery Office, Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds Teaching Hospitals Trust, Leeds, LS1 3EX, UK.,Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK.,Department of Integrative Medical Biology, Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Surgical and Perioperative Science, Faculty of Medicine, Umeå University, Umeå, Sweden
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8
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Diffusion tensor imaging of the roots of the brachial plexus: a systematic review and meta-analysis of normative values. Clin Transl Imaging 2020; 8:419-431. [PMID: 33282795 PMCID: PMC7708343 DOI: 10.1007/s40336-020-00393-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023]
Abstract
Purpose Diffusion tensor magnetic resonance imaging (DTI) characterises tissue microstructure and provides proxy measures of myelination, axon diameter, fibre density and organisation. This may be valuable in the assessment of the roots of the brachial plexus in health and disease. Therefore, there is a need to define the normal DTI values. Methods The literature was systematically searched for studies of asymptomatic adults who underwent DTI of the brachial plexus. Participant characteristics, scanning protocols, and measurements of the fractional anisotropy (FA) and mean diffusivity (MD) of each spinal root were extracted by two independent review authors. Generalised linear modelling was used to estimate the effect of experimental conditions on the FA and MD. Meta-analysis of root-level estimates was performed using Cohen's method with random effects. Results Nine articles, describing 316 adults (1:1 male:female) of mean age 35 years (SD 6) were included. Increments of ten diffusion sensitising gradient directions reduced the mean FA by 0.01 (95% CI 0.01, 0.03). Each year of life reduced the mean MD by 0.03 × 10-3 mm2/s (95% CI 0.01, 0.04). At 3-T, the pooled mean FA of the roots was 0.36 (95% CI 0.34, 0.38; I 2 98%). The pooled mean MD of the roots was 1.51 × 10-3 mm2/s (95% CI 1.45, 1.56; I 2 99%). Conclusions The FA and MD of the roots of the brachial plexus vary according to experimental conditions and participant factors. We provide summary estimates of the normative values in different conditions which may be valuable to researchers and clinicians alike.
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Rajabian A, Quraishi NA. C5 Palsy After Cervical Spine Decompression: Topographic Correlation With C6 Chassaignac Tubercle?: A Fresh-Cadaveric Study of the Cervical Spine and Rediscussion of Etiological Hypotheses. Spine (Phila Pa 1976) 2020; 45:E903-E908. [PMID: 32675600 DOI: 10.1097/brs.0000000000003479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cadaveric study on fresh unprocessed, nonpreserved, undyed specimens, which has not previously been reported. OBJECTIVE Our aim was to explore the possible topographic correlation of the C5 nerve root with regards to its course and regional relation to C6 Chassaignac tubercle. SUMMARY OF BACKGROUND DATA C5 palsy is reported amongst the most frequent postoperative complications of cervical spinal procedures. We hypothesized that etiologic mechanisms proposed thus far in the current literature, although with some plausible explanation, still cannot explain why the C5 nerve root and not any other level suffer a postoperative palsy. METHODS Six fresh cadavers had extensive layer by layer dissection performed by two surgeons (one of whom has experience as an anatomy demonstrator and dissector). Roots of brachial plexus were exposed in relation to cervical transverse processes. Photographs were taken at each stage of the exposure. RESULTS We observed a close relation of the path of the C5 nerve root with the C6 tubercle bilaterally. Moreover, we noted a steeper descent of C5 in comparison with the other adjacent roots. CONCLUSION Steeper angle of the C5 nerve root and close proximity to C6 Chassaignac tubercle may play a role in predisposing it to neuropraxia. Detailed anatomical photographs on fresh unprocessed cadaveric specimens are novel. Peculiar anatomical features and recent experimental evidence discussed do highlight a postganglionic extraforaminal etiology corresponding well to the demographic meta-analysis data on clinical features of postoperative C5 palsy. Exploring an alternative unified "neurophysiologic stress and critical tipping point" etiological model that encompasses current theories and correlates known metanalyses observations, we believe further studies would be prudent to ascertain/refute these findings. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Ali Rajabian
- Nottingham Centre for Spinal studies and Surgery, Queens Medical Centre, Nottingham University Hospitals, Nottingham, UK
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10
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Ultrafast Intracranial Vessel Imaging With Non-Cartesian Spiral 3-Dimensional Time-of-Flight Magnetic Resonance Angiography at 1.5 T. Invest Radiol 2020; 55:293-303. [DOI: 10.1097/rli.0000000000000641] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Wade RG, Tanner SF, Teh I, Ridgway JP, Shelley D, Chaka B, Rankine JJ, Andersson G, Wiberg M, Bourke G. Diffusion Tensor Imaging for Diagnosing Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Proof-of-Concept Study. Front Surg 2020; 7:19. [PMID: 32373625 PMCID: PMC7177010 DOI: 10.3389/fsurg.2020.00019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/23/2020] [Indexed: 01/09/2023] Open
Abstract
Cross-sectional MRI has modest diagnostic accuracy for diagnosing traumatic brachial plexus root avulsions. Consequently, patients either undergo major exploratory surgery or months of surveillance to determine if and what nerve reconstruction is needed. This study aimed to develop a diffusion tensor imaging (DTI) protocol at 3 Tesla to visualize normal roots and identify traumatic root avulsions of the brachial plexus. Seven healthy adults and 12 adults with known (operatively explored) unilateral traumatic brachial plexus root avulsions were scanned. DTI was acquired using a single-shot echo-planar imaging sequence at 3 Tesla. The brachial plexus was visualized by deterministic tractography. Fractional anisotropy (FA) and mean diffusivity (MD) were calculated for injured and avulsed roots in the lateral recesses of the vertebral foramen. Compared to healthy nerves roots, the FA of avulsed nerve roots was lower (mean difference 0.1 [95% CI 0.07, 0.13]; p < 0.001) and the MD was greater (mean difference 0.32 × 10-3 mm2/s [95% CI 0.11, 0.53]; p < 0.001). Deterministic tractography reconstructed both normal roots and root avulsions of the brachial plexus; the negative-predictive value for at least one root avulsion was 100% (95% CI 78, 100). Therefore, DTI might help visualize both normal and injured roots of the brachial plexus aided by tractography. The precision of this technique and how it relates to neural microstructure will be further investigated in a prospective diagnostic accuracy study of patients with acute brachial plexus injuries.
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Affiliation(s)
- Ryckie G Wade
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Faculty of Medicine and Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Steven F Tanner
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds, United Kingdom.,Department of Medical Physics and Engineering, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Irvin Teh
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - John P Ridgway
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds, United Kingdom.,Department of Medical Physics and Engineering, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - David Shelley
- The Advanced Imaging Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Brian Chaka
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds, United Kingdom
| | - James J Rankine
- Department of Radiology, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Gustav Andersson
- Department of Integrative Medical Biology (Anatomy), Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Surgical and Perioperative Science (Hand and Plastic Surgery), Faculty of Medicine, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Mikael Wiberg
- Department of Integrative Medical Biology (Anatomy), Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Surgical and Perioperative Science (Hand and Plastic Surgery), Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Grainne Bourke
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Faculty of Medicine and Health Sciences, University of Leeds, Leeds, United Kingdom.,Department of Integrative Medical Biology (Anatomy), Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Surgical and Perioperative Science (Hand and Plastic Surgery), Faculty of Medicine, Umeå University, Umeå, Sweden
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12
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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.
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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.
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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.
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14
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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]
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15
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Acer N, Turgut M. Evaluation of Brachial Plexus Using Combined Stereological Techniques of Diffusion Tensor Imaging and Fiber Tracking. J Brachial Plex Peripher Nerve Inj 2019; 14:e16-e23. [PMID: 31198435 PMCID: PMC6561765 DOI: 10.1055/s-0039-1687913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/18/2019] [Indexed: 02/03/2023] Open
Abstract
Background Brachial plexus (BP) is composed of intercommunications among the ventral roots of the nerves C5, C6, C7, C8, and T1 in the neck. The in vivo and in vitro evaluation of axons of the peripheral nervous system is performed using different techniques. Recently, many studies describing the application of fiber tractography and stereological axon number estimation to peripheral nerves have been published. Methods Various quantitative parameters of nerve fibers, including axon number, density, axonal area, and myelin thickness, can be estimated using stereological techniques. In vivo three-dimensional reconstruction of axons of BP can be visualized using a combined technique of diffusion tensor imaging (DTI) and fiber tracking with the potential to evaluate nerve fiber content. Conclusion It is concluded that terminal branches of BP can be successfully visualized using DTI, which is a highly reproducible method for the evaluation of BP as it shows anatomical and functional features of neural structures. We believe that quantitative morphological findings obtained from BP will be useful for new experimental, developmental, and pathological studies in the future.
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Affiliation(s)
- Niyazi Acer
- Department of Anatomy, Erciyes University School of Medicine, Kayseri, Turkey
| | - Mehmet Turgut
- Department of Neurosurgery, Adnan Menderes University School of Medicine, Aydın, Turkey
- Department of Histology and Embryology, Adnan Menderes University Health Sciences Institute, Aydın, Turkey
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16
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Sneag DB, Mendapara P, Zhu JC, Lee SC, Lin B, Curlin J, Bogner EA, Fung M. Prospective respiratory triggering improves high‐resolution brachial plexus MRI quality. J Magn Reson Imaging 2018; 49:1723-1729. [DOI: 10.1002/jmri.26559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Darryl B. Sneag
- Department of Radiology and Imaging Hospital for Special Surgery New York New York USA
| | - Parrykumar Mendapara
- Department of Radiology and Imaging Hospital for Special Surgery New York New York USA
| | - Jacqui C. Zhu
- Department of Radiology and Imaging Hospital for Special Surgery New York New York USA
| | - Susan C. Lee
- Department of Radiology and Imaging Hospital for Special Surgery New York New York USA
| | - Bin Lin
- Department of Radiology and Imaging Hospital for Special Surgery New York New York USA
| | - Jahnavi Curlin
- Department of Radiology and Imaging Hospital for Special Surgery New York New York USA
| | - Eric A. Bogner
- Department of Radiology and Imaging Hospital for Special Surgery New York New York USA
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Quantitative MR neurography of brachial plexus lesions based on diffusivity measurements. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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18
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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]
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19
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Ho MJ, Ciritsis A, Manoliu A, Stieltjes B, Marcon M, Andreisek G, Kuhn FP. Diffusion Tensor Imaging of the Brachial Plexus: A Comparison between Readout-segmented and Conventional Single-shot Echo-planar Imaging. Magn Reson Med Sci 2018; 18:150-157. [PMID: 30416178 PMCID: PMC6460122 DOI: 10.2463/mrms.mp.2018-0004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: Diffusion tensor imaging (DTI) adds functional information to morphological magnetic resonance neurography (MRN) in the assessment of the brachial nerve plexus. To determine the most appropriate pulse sequence in scan times suited for diagnostic imaging in clinical routine, we compared image quality between simultaneous multi-slice readout-segmented (rs-DTI) and conventional single-shot (ss-DTI) echo-planar imaging techniques. Methods: Institutional Review Board (IRB) approved study including 10 healthy volunteers. The supraclavicular brachial plexus, covering the nerve roots and trunks from C5 to C7, was imaged on both sides with rs-DTI and ss-DTI. Both sequences were acquired in scan times <7 min with b-values of 900 s/mm2 and with isotropic spatial resolution. Results: In rs-DTI image, the overall quality was significantly better and distortion artifacts were significantly lower (P = 0.001–0.002 and P = 0.001–0.002, respectively) for both readers. In ss-DTI, a trend toward lower degree of ghosting and motion artifacts was elicited (reader 1, P = 0.121; reader 2, P = 0.264). No significant differences between the two DTI techniques were found for signal-to-noise ratios (SNR), contrast-to-noise ratios (CNR) and fractional anisotropy (FA) (P ≥ 0.475, P ≥ 0.624, and P ≥ 0.169, respectively). Interreader agreement for all examined parameters and all sequences ranged from intraclass correlation coefficient (ICC) 0.064 to 0.905 and Kappa 0.40 to 0.851. Conclusion: Incomparable acquisition times rs-DTI showed higher image quality and less distortion artifacts than ss-DTI. The trend toward a higher degree of ghosting and motion artifacts in rs-DTI did not deteriorate image quality to a significant degree. Thus, rs-DTI should be considered for functional MRN of the brachial plexus.
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Affiliation(s)
- Michael J Ho
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich.,Department of Neuroradiology, University Hospital Freiburg
| | - Alexander Ciritsis
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich
| | - Andrei Manoliu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich
| | | | - Magda Marcon
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich
| | | | - Felix Pierre Kuhn
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich
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20
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Haakma W, Hendrikse J, Uhrenholt L, Leemans A, Warner Thorup Boel L, Pedersen M, Froeling M. Multicenter reproducibility study of diffusion MRI and fiber tractography of the lumbosacral nerves. J Magn Reson Imaging 2018; 48:951-963. [PMID: 29424083 PMCID: PMC6221026 DOI: 10.1002/jmri.25964] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/20/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) has been applied in the lumbar and sacral nerves in vivo, but information about the reproducibility of this method is needed before DTI can be used reliably in clinical practice across centers. PURPOSE In this multicenter study the reproducibility of DTI of the lumbosacral nerves in healthy volunteers was investigated. STUDY TYPE Prospective control series. SUBJECTS Twenty healthy subjects. FIELD STRENGTH/SEQUENCE 3T MRI. 3D turbo spin echo, and 3.0 mm isotropic DTI scan. ASSESSMENT The DTI scan was performed three times (twice in the same session, intrascan reproducibility, and once after an hour, interscan reproducibility). At site 2, 1 week later, the protocol was repeated (interweek reproducibility). Fiber tractography (FT) of the lumbar and sacral nerves (L3-S2) was performed to obtain values for fractional anisotropy, mean, axial, and radial diffusivity. STATISTICAL TESTS Reproducibility was determined using the intraclass correlation coefficient (ICC), and power calculations were performed. RESULTS FT was successful and reproducible in all datasets. ICCs for all diffusion parameters were high for intrascan (ranging from 0.70-0.85), intermediate for interscan (ranging from 0.61-0.73), and interweek reliability (ranging from 0.58-0.62). There were small but significant differences between the interweek diffusivity values (P < 0.0005). Depending on the effect size, nerve location, and parameter of interest, power calculations showed that sample sizes between 10 and 232 subjects are needed for cross-sectional studies. DATA CONCLUSION We found that DTI and FT of the lumbosacral nerves have intermediate to high reproducibility within and between scans. Based on these results, 10-58 subjects are needed to find a 10% change in parameters in cross-sectional studies of the lumbar and sacral nerves. The small significant differences of the interweek comparison suggest that results from longitudinal studies need to be interpreted carefully, since small differences may also be caused by factors other than disease progression or therapeutic effects. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:951-963.
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Affiliation(s)
- Wieke Haakma
- Department of RadiologyUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
- Department of Forensic MedicineAarhus UniversityAarhusDenmark
- Comparative Medicine Lab, Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Jeroen Hendrikse
- Department of RadiologyUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Lars Uhrenholt
- Department of Forensic MedicineAarhus UniversityAarhusDenmark
| | - Alexander Leemans
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtthe Netherlands
| | | | - Michael Pedersen
- Comparative Medicine Lab, Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Martijn Froeling
- Department of RadiologyUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
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Oudeman J, Verhamme C, Engbersen MP, Caan MWA, Maas M, Froeling M, Nederveen AJ, Strijkers GJ. Diffusion tensor MRI of the healthy brachial plexus. PLoS One 2018; 13:e0196975. [PMID: 29742154 PMCID: PMC5942843 DOI: 10.1371/journal.pone.0196975] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/24/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction Diffusion Tensor MRI (DT-MRI) is a promising tool for the evaluation of brachial plexus pathology. Therefore, we introduce and evaluate a fast DT-MRI protocol (8min33s scanning with 5–10 min postprocessing time) for the brachial plexus. Materials and methods Thirty healthy volunteers within three age-groups (18–35, 36–55, and > 56) received DT-MRI of the brachial-plexus twice. Means of fractional-anisotropy (FA), mean-diffusivity (MD), axial-diffusivity (AD), and radial-diffusivity (RD) for the individual roots and trunks were evaluated. A stepwise forward approach was applied to test for correlations with age, sex, body-mass-index (BMI), bodysurface, height, and bodyweight. Within-subject, intra-rater, and inter-rater repeatability were assessed using Bland-Altman analysis, coefficient of variation (CV), intraclass-correlation (ICC), and minimal detectable difference (MDD). Results No differences between sides and root levels were found. MD, AD, and RD correlated (P < 0.05) with bodyweight. Within-subject quantification proved repeatable with CVs for FA, MD, AD, and RD of 16%, 12%, 11%, and 14%, respectively. Discussion The DT-MRI protocol was fast and repeatable. Found correlations should be considered in future studies of brachial plexus pathology.
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Affiliation(s)
- Jos Oudeman
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail:
| | - Camiel Verhamme
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Mattan W. A. Caan
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Mario Maas
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center, Utrecht, the Netherlands
| | - Aart J. Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
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Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions. Diagnostics (Basel) 2018; 8:diagnostics8010021. [PMID: 29558408 PMCID: PMC5872004 DOI: 10.3390/diagnostics8010021] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/09/2018] [Accepted: 03/15/2018] [Indexed: 12/22/2022] Open
Abstract
The diagnosis of thoracic outlet syndrome (TOS) has long been a controversial and challenging one. Despite common presentations with pain in the neck and upper extremity, there are a host of presenting patterns that can vary within and between the subdivisions of neurogenic, venous, and arterial TOS. Furthermore, there is a plethora of differential diagnoses, from peripheral compressive neuropathies, to intrinsic shoulder pathologies, to pathologies at the cervical spine. Depending on the subdivision of TOS suspected, diagnostic investigations are currently of varying importance, necessitating high dependence on good history taking and clinical examination. Investigations may add weight to a diagnosis suspected on clinical grounds and suggest an optimal management strategy, but in this changing field new developments may alter the role that diagnostic investigations play. In this article, we set out to summarise the diagnostic approach in cases of suspected TOS, including the importance of history taking, clinical examination, and the role of investigations at present, and highlight the developments in this field with respect to all subtypes. In the future, we hope that novel diagnostics may be able to stratify patients according to the exact compressive mechanism and thereby suggest more specific treatments and interventions.
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24
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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
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25
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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.
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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
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