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Kimura M, Nagata S, Suzuki M, Nashiki K, Kawata H, Abe T. The relationship between diffusion tensor imaging and the clinical classification of cubital tunnel syndrome. Radiol Phys Technol 2024:10.1007/s12194-024-00813-x. [PMID: 38782839 DOI: 10.1007/s12194-024-00813-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/29/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
The purpose of the study was to investigate the relationship between diffusion tensor imaging (DTI) and the clinical classification of cubital tunnel syndrome (CuTS). Ten patients with CuTS (7 men and 3 women; mean age: 52.7 years) and 5 patients without ulnar neuropathy (2 men and 3 women; mean age: 38.0 years) were enrolled in this retrospective study. Fifteen patients were clinically classified into three groups: "Normal", "1 and 2A", and "2B and 3" by an orthopedic surgeon using the modified McGowan stages. DTI was acquired using a 3.0-T MRI. Fractional anisotropy (FA) of the ulnar nerve was measured in slices covering 20 mm proximal to 20 mm distal to ulnar sulcus. Median FA values in each group were compared by Kruskal-Wallis and Steel-Dwass test (P < 0.05). Five patients with CuTS were classified as "1 and 2A" and five patients as "2B and 3". The FA values, proximal 12 mm to the ulnar sulcus were 0.486 ± 0.117, 0.425 ± 0.166 and 0.298 ± 0.0386 in the "Normal", "1 and 2A" and "2B and 3" groups, respectively. The FA values of patients classified as "Normal" were significantly higher than those classified as "2B and 3" (P = 0.0326 in Steel-Dwass test). FA proximal to the ulnar sulcus might be associated to the modified McGowan stages for the clinical classification of CuTS.
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Affiliation(s)
- Mitsuhiro Kimura
- Department of Radiology, Kurume University Hospital, Fukuoka, Japan.
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Makoto Suzuki
- Department of Radiology, Kurume University Hospital, Fukuoka, Japan
| | - Kazutaka Nashiki
- Department of Radiology, Kurume University Hospital, Fukuoka, Japan
| | - Hidemichi Kawata
- Department of Radiology, Kurume University Hospital, Fukuoka, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
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Chaudhary RK, Karkala N, Nepal P, Gupta E, Kaur N, Batchala P, Sapire J, Alam SI. Multimodality imaging review of ulnar nerve pathologies. Neuroradiol J 2024; 37:137-151. [PMID: 36961518 PMCID: PMC10973834 DOI: 10.1177/19714009231166087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
The ulnar nerve is the second most commonly entrapped nerve after the median nerve. Although clinical evaluation and electrodiagnostic studies remain widely used for the evaluation of ulnar neuropathy, advancements in imaging have led to increased utilization of these newer / better imaging techniques in the overall management of ulnar neuropathy. Specifically, high-resolution ultrasonography of peripheral nerves as well as MRI has become quite useful in evaluating the ulnar nerve in order to better guide treatment. The caliber and fascicular pattern identified in the normal ulnar nerves are important distinguishing features from ulnar nerve pathology. The cubital tunnel within the elbow and Guyon's canal within the wrist are important sites to evaluate with respect to ulnar nerve compression. Both acute and chronic conditions resulting in deformity, trauma as well as inflammatory conditions may predispose certain patients to ulnar neuropathy. Granulomatous diseases as well as both neurogenic and non-neurogenic tumors can also potentially result in ulnar neuropathy. Tumors around the ulnar nerve can also lead to mass effect on the nerve, particularly in tight spaces like the aforementioned canals. Although high-resolution ultrasonography is a useful modality initially, particularly as it can be helpful for dynamic evaluation, MRI remains most reliable due to its higher resolution. Newer imaging techniques like sonoelastography and microneurography, as well as nerve-specific contrast agents, are currently being investigated for their usefulness and are not routinely being used currently.
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Affiliation(s)
| | - Nikitha Karkala
- Department of Radiology, Northwell North Shore University Hospital, Long Island Jewish Medical Center, Queens, NY, USA
| | - Pankaj Nepal
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Elina Gupta
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, USA
| | - Neeraj Kaur
- Department of Radiology, University Hospital of Northern British Columbia, Prince George, BC, Canada
| | - Prem Batchala
- Department of Radiology, University of Virginia, Charlottesville, VA, USA
| | - Joshua Sapire
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, USA
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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.
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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
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Eajazi A, Weinschenk C, Chhabra A. Imaging Biomarkers of Peripheral Nerves: Focus on Magnetic Resonance Neurography and Ultrasonography. Semin Musculoskelet Radiol 2024; 28:92-102. [PMID: 38330973 DOI: 10.1055/s-0043-1776427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Peripheral neuropathy is a prevalent and debilitating condition affecting millions of individuals globally. Magnetic resonance neurography (MRN) and ultrasonography (US) are noninvasive methods offering comprehensive visualization of peripheral nerves, using anatomical and functional imaging biomarkers to ensure accurate evaluation. For optimized MRN, superior and high-resolution two-dimensional and three-dimensional imaging protocols are essential. The anatomical MRN and US imaging markers include quantitative measures of nerve and fascicular size and signal, and qualitative markers of course and morphology. Among them, quantitative markers of T2-signal intensity ratio are sensitive to nerve edema-like signal changes, and the T1-mapping technique reveals nerve and muscle tissue fatty and fibrous compositional alterations.The functional markers are derived from physiologic properties of nerves, such as diffusion characteristics or blood flow. They include apparent diffusion coefficient from diffusion-weighted imaging and fractional anisotropy and tractography from diffusion tensor imaging to delve into peripheral nerve microstructure and integrity. Peripheral nerve perfusion using dynamic contrast-enhanced magnetic resonance imaging estimates perfusion parameters, offering insights into nerve health and neuropathies involving edema, inflammation, demyelination, and microvascular alterations in conditions like type 2 diabetes, linking nerve conduction pathophysiology to vascular permeability alterations.Imaging biomarkers thus play a pivotal role in the diagnosis, prognosis, and monitoring of nerve pathologies, thereby ensuring comprehensive assessment and elevating patient care. These biomarkers provide valuable insights into nerve structure, function, and pathophysiology, contributing to the accurate diagnosis and management planning for peripheral neuropathy.
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Affiliation(s)
- Alireza Eajazi
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Cindy Weinschenk
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
- Department of Radiology & Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas
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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.
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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.
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Yoon D, Lutz AM. Diffusion Tensor Imaging of Peripheral Nerves: Current Status and New Developments. Semin Musculoskelet Radiol 2023; 27:641-648. [PMID: 37935210 DOI: 10.1055/s-0043-1775742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Diffusion tensor imaging (DTI) is an emerging technique for peripheral nerve imaging that can provide information about the microstructural organization and connectivity of these nerves and complement the information gained from anatomical magnetic resonance imaging (MRI) sequences. With DTI it is possible to reconstruct nerve pathways and visualize the three-dimensional trajectory of nerve fibers, as in nerve tractography. More importantly, DTI allows for quantitative evaluation of peripheral nerves by the calculation of several important parameters that offer insight into the functional status of a nerve. Thus DTI has a high potential to add value to the work-up of peripheral nerve pathologies, although it is more technically demanding. Peripheral nerves pose specific challenges to DTI due to their small diameter and DTI's spatial resolution, contrast, location, and inherent field inhomogeneities when imaging certain anatomical locations. Numerous efforts are underway to resolve these technical challenges and thus enable wider acceptance of DTI in peripheral nerve MRI.
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Affiliation(s)
- Daehyun Yoon
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California at San Francisco, San Francisco, California
| | - Amelie M Lutz
- Department of Radiology, Kantonal Hospital Thurgau, Muensterlingen, Switzerland
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Jung JY, Lin Y, Carrino JA. An Updated Review of Magnetic Resonance Neurography for Plexus Imaging. Korean J Radiol 2023; 24:1114-1130. [PMID: 37899521 PMCID: PMC10613850 DOI: 10.3348/kjr.2023.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 10/31/2023] Open
Abstract
Magnetic resonance neurography (MRN) is increasingly used to visualize peripheral nerves in vivo. However, the implementation and interpretation of MRN in the brachial and lumbosacral plexi are challenging because of the anatomical complexity and technical limitations. The purpose of this article was to review the clinical context of MRN, describe advanced magnetic resonance (MR) techniques for plexus imaging, and list the general categories of utility of MRN with pertinent imaging examples. The selection and optimization of MR sequences are centered on the homogeneous suppression of fat and blood vessels while enhancing the visibility of the plexus and its branches. Standard 2D fast spin-echo sequences are essential to assess morphology and signal intensity of nerves. Moreover, nerve-selective 3D isotropic images allow improved visualization of nerves and multiplanar reconstruction along their course. Diffusion-weighted and diffusion-tensor images offer microscopic and functional insights into peripheral nerves. The interpretation of MRN in the brachial and lumbosacral plexi should be based on a thorough understanding of their anatomy and pathophysiology. Anatomical landmarks assist in identifying brachial and lumbosacral plexus components of interest. Thus, understanding the varying patterns of nerve abnormalities facilitates the interpretation of aberrant findings.
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Affiliation(s)
- Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yenpo Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA.
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8
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Chen H, Huang X, Bao Y, Zhao C, Lin J. The diagnostic value of quantitative assessment of MR neurography in chronic inflammatory demyelinating polyradiculoneuropathy: a systematic review and meta-analysis. Br J Radiol 2023; 96:20221037. [PMID: 37393524 PMCID: PMC10607413 DOI: 10.1259/bjr.20221037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/27/2023] [Accepted: 06/04/2023] [Indexed: 07/03/2023] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the diagnostic value of quantitative magnetic resonance neurography (MRN) in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We also compared various MRN parameters and determined the best performing one. METHODS Through literature searches in PubMed, Embase, Cochrane, Ovid MEDLINE and ClinicalTtrials.gov until March 1, 2023, we selected studies with the diagnostic performance of MRN in CIDP patients. The pooled estimated sensitivity and specificity of quantitative MRN parameters were determined by a bivariate random-effects model. Subgroup analysis was performed to evaluate the proper quantitative parameters and nerve sites. RESULTS A total of 14 quantitative MRN studies with 23 results gave a pooled sensitivity of 0.73 (95% CI 0.66-0.79) and a pooled specificity of 0.89 (95% CI 0.84-0.92). The area under the curve (AUC) was 0.89 (95%CI 0.86-0.92). Subgroup analysis of quantitative parameters showed the fractional anisotropy (FA) with the highest sensitivity of 0.85 (95% CI 0.77-0.90) and cross-sectional area (CSA) with the highest specificity of 0.95 (95% CI 0.85-0.99). The pooled correlation coefficient for interobserver agreements was 0.90 (95%CI 0.82-0.95). CONCLUSION Quantitative MRN has considerable diagnostic value in CIDP patients with accuracy and reliability. FA and CSA can be promising parameters in the future diagnosis of CIDP patients. ADVANCES IN KNOWLEDGE This is the first meta-analysis of quantitative MRN in the diagnosis of CIDP.We have selected reliable parameters with cut-off value and provided new insights for subsequent diagnosis of CIDP.
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Affiliation(s)
| | | | - Yifang Bao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
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Kumar S, Mangi MD, Zadow S, Lim W. Nerve entrapment syndromes of the lower limb: a pictorial review. Insights Imaging 2023; 14:166. [PMID: 37782348 PMCID: PMC10545616 DOI: 10.1186/s13244-023-01514-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Peripheral nerves of the lower limb may become entrapped at various points during their anatomical course. While clinical assessment and nerve conduction studies are the mainstay of diagnosis, there are multiple imaging options, specifically ultrasound and magnetic resonance imaging (MRI), which offer important information about the potential cause and location of nerve entrapment that can help guide management. This article overviews the anatomical course of various lower limb nerves, including the sciatic nerve, tibial nerve, medial plantar nerve, lateral plantar nerve, digital nerves, common peroneal nerve, deep peroneal nerve, superficial peroneal nerve, sural nerve, obturator nerve, lateral femoral cutaneous nerve and femoral nerve. The common locations and causes of entrapments for each of the nerves are explained. Common ultrasound and MRI findings of nerve entrapments, direct and indirect, are described, and various examples of the more commonly observed cases of lower limb nerve entrapments are provided.Critical relevance statement This article describes the common sites of lower limb nerve entrapments and their imaging features. It equips radiologists with the knowledge needed to approach the assessment of entrapment neuropathies, which are a critically important cause of pain and functional impairment.Key points• Ultrasound and MRI are commonly used to investigate nerve entrapment syndromes.• Ultrasound findings include nerve hypo-echogenicity, calibre changes and the sonographic Tinel's sign.• MRI findings include increased nerve T2 signal, muscle atrophy and denervation oedema.• Imaging can reveal causative lesions, including scarring, masses and anatomical variants.
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Affiliation(s)
- Shanesh Kumar
- Department of Radiology, Royal Adelaide Hospital, Port Rd, Adelaide, Australia
| | - Mohammad Danish Mangi
- Department of Radiology, Royal Adelaide Hospital, Port Rd, Adelaide, Australia.
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
| | - Steven Zadow
- Department of Medical Imaging, Flinders Medical Centre, Flinders Drive, Bedford Park, Australia
- Jones Radiology, Eastwood, Australia
| | - WanYin Lim
- Department of Radiology, Royal Adelaide Hospital, Port Rd, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Jones Radiology, Eastwood, Australia
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Fasoula NA, Xie Y, Katsouli N, Reidl M, Kallmayer MA, Eckstein HH, Ntziachristos V, Hadjileontiadis L, Avgerinos DV, Briasoulis A, Siasos G, Hosseini K, Doulamis I, Kampaktsis PN, Karlas A. Clinical and Translational Imaging and Sensing of Diabetic Microangiopathy: A Narrative Review. J Cardiovasc Dev Dis 2023; 10:383. [PMID: 37754812 PMCID: PMC10531807 DOI: 10.3390/jcdd10090383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Microvascular changes in diabetes affect the function of several critical organs, such as the kidneys, heart, brain, eye, and skin, among others. The possibility of detecting such changes early enough in order to take appropriate actions renders the development of appropriate tools and techniques an imperative need. To this end, several sensing and imaging techniques have been developed or employed in the assessment of microangiopathy in patients with diabetes. Herein, we present such techniques; we provide insights into their principles of operation while discussing the characteristics that make them appropriate for such use. Finally, apart from already established techniques, we present novel ones with great translational potential, such as optoacoustic technologies, which are expected to enter clinical practice in the foreseeable future.
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Affiliation(s)
- Nikolina-Alexia Fasoula
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Yi Xie
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Nikoletta Katsouli
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Mario Reidl
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Michael A. Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (M.A.K.); (H.-H.E.)
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (M.A.K.); (H.-H.E.)
| | - Vasilis Ntziachristos
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany
| | - Leontios Hadjileontiadis
- Department of Biomedical Engineering, Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates;
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | | | - Alexandros Briasoulis
- Aleksandra Hospital, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece;
| | - Gerasimos Siasos
- Sotiria Hospital, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece;
| | - Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran 1411713138, Iran;
| | - Ilias Doulamis
- Department of Surgery, The Johns Hopkins Hospital, School of Medicine, Baltimore, MD 21287, USA;
| | | | - Angelos Karlas
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (M.A.K.); (H.-H.E.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany
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11
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Chen H, Xu Y, Wang W, Deng R, Li Z, Xie S, Jiao J. Assessment of Lumbosacral Nerve Roots in Patients with Type 2 Diabetic Peripheral Neuropathy Using Diffusion Tensor Imaging. Brain Sci 2023; 13:brainsci13050828. [PMID: 37239300 DOI: 10.3390/brainsci13050828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) has found clinical applications in the evaluation of the central nervous system and has been extensively used to image peripheral neuropathy. However, few studies have focused on lumbosacral nerve root fiber damage in diabetic peripheral neuropathy (DPN). The aim of the study was to evaluate whether DTI of the lumbosacral nerve roots can be used to detect DPN. METHODS Thirty-two type 2 diabetic patients with DPN and thirty healthy controls (HCs) were investigated with a 3T MRI scanner. DTI with tractography of the L4, L5, and S1 nerve roots was performed. Anatomical fusion with the axial T2 sequences was used to provide correlating anatomical information. Mean fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were measured from tractography images and compared between groups. Diagnostic value was assessed using receiver operating characteristic (ROC) analysis. The Pearson correlation coefficient was used to explore the correlation between DTI parameters and clinical data and the nerve conduction study (NCS) in the DPN group. RESULTS In the DPN group, FA was decreased (p < 0.001) and ADC was increased (p < 0.001) compared with the values of the HC group. FA displayed the best diagnostic accuracy, with an area under the ROC curve of 0.716. ADC was positively correlated with HbA1c level (r = 0.379, p = 0.024) in the DPN group. CONCLUSIONS DTI of lumbosacral nerve roots demonstrates appreciable diagnostic accuracy in patients with DPN.
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Affiliation(s)
- He Chen
- Department of Radiology, Peking University China-Japan Friendship School of Clinical Medicine, Yinghua Street 2, Chaoyang District, Beijing 100029, China
| | - Yanyan Xu
- Department of Radiology, China-Japan Friendship Hospital, Yinghua Street 2, Chaoyang District, Beijing 100029, China
| | - Wei Wang
- Department of Neurology, China-Japan Friendship Hospital, Yinghua Street 2, Chaoyang District, Beijing 100029, China
| | - Ruifen Deng
- Department of Endocrinology, China-Japan Friendship Hospital, Yinghua Street 2, Chaoyang District, Beijing 100029, China
| | - Zhaoqing Li
- Department of Endocrinology, China-Japan Friendship Hospital, Yinghua Street 2, Chaoyang District, Beijing 100029, China
| | - Sheng Xie
- Department of Radiology, Peking University China-Japan Friendship School of Clinical Medicine, Yinghua Street 2, Chaoyang District, Beijing 100029, China
| | - Jinsong Jiao
- Department of Neurology, China-Japan Friendship Hospital, Yinghua Street 2, Chaoyang District, Beijing 100029, China
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12
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Boonsuth R, Battiston M, Grussu F, Samlidou CM, Calvi A, Samson RS, Gandini Wheeler-Kingshott CAM, Yiannakas MC. Feasibility of in vivo multi-parametric quantitative magnetic resonance imaging of the healthy sciatic nerve with a unified signal readout protocol. Sci Rep 2023; 13:6565. [PMID: 37085693 PMCID: PMC10121559 DOI: 10.1038/s41598-023-33618-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/15/2023] [Indexed: 04/23/2023] Open
Abstract
Magnetic resonance neurography (MRN) has been used successfully over the years to investigate the peripheral nervous system (PNS) because it allows early detection and precise localisation of neural tissue damage. However, studies demonstrating the feasibility of combining MRN with multi-parametric quantitative magnetic resonance imaging (qMRI) methods, which provide more specific information related to nerve tissue composition and microstructural organisation, can be invaluable. The translation of emerging qMRI methods previously validated in the central nervous system to the PNS offers real potential to characterise in patients in vivo the underlying pathophysiological mechanisms involved in a plethora of conditions of the PNS. The aim of this study was to assess the feasibility of combining MRN with qMRI to measure diffusion, magnetisation transfer and relaxation properties of the healthy sciatic nerve in vivo using a unified signal readout protocol. The reproducibility of the multi-parametric qMRI protocol as well as normative qMRI measures in the healthy sciatic nerve are reported. The findings presented herein pave the way to the practical implementation of joint MRN-qMRI in future studies of pathological conditions affecting the PNS.
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Affiliation(s)
- Ratthaporn Boonsuth
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK.
- Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.
| | - Marco Battiston
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Francesco Grussu
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Christina Maria Samlidou
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Alberto Calvi
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Hospital Clinic Barcelona, Fundació Clinic Per a La Recerca Biomedica, Barcelona, Spain
| | - Rebecca S Samson
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- Brain Connectivity Research Centre, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Marios C Yiannakas
- NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
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13
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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.
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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
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14
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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.
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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
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15
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Sprenger-Svačina A, Haensch J, Weiss K, Große Hokamp N, Maintz D, Schlamann M, Fink GR, Schloss N, Laukamp K, Wunderlich G, Lehmann HC, Lichtenstein T. MRI correlates of motoneuron loss in SMA. J Neurol 2023; 270:503-510. [PMID: 36180649 PMCID: PMC9813025 DOI: 10.1007/s00415-022-11326-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is currently explored as supplemental tool to monitor disease progression and treatment response in various neuromuscular disorders. We here assessed the utility of a multi-parametric magnetic resonance imaging (MRI) protocol including quantitative water T2 mapping, Dixon-based proton density fat fraction (PDFF) estimation and diffusion tensor imaging (DTI) to detect loss of spinal motor neurons and subsequent muscle damage in adult SMA patients. METHODS Sixteen SMA patients and 13 age-matched controls were enrolled in this prospective, longitudinal study. All participants underwent MRI imaging including measurements of Dixon-based PDFF and DTI of the sciatic nerve. SMA patients furthermore underwent measurements of muscle water T2 (T2w) of the biceps femoris muscle (BFM) and quadriceps femoris muscle (QFM). Ten participants returned for a second scan six months later. MRI parameter were correlated with clinical data. All patients were on nusinersen treatment. RESULTS There were significantly higher intramuscular fat fractions in the BFM and QFM of SMA patients compared to healthy controls at baseline and after 6 months. Furthermore, T2 values significantly correlated positively with intramuscular fat fractions. The Hammersmith functional motor scale significantly correlated with the QFM's intramuscular fat fractions. DTI scans of the sciatic nerve were not significantly different between the two groups. CONCLUSION This study demonstrates that, water T2 mapping and Dixon-based PDFF estimation may distinguish between adult SMA patients and controls, due to massive intramuscular fat accumulation in SMA. More extensive long-term studies are warranted to further evaluate these two modalities as surrogate markers in SMA patients during treatment.
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Affiliation(s)
- Alina Sprenger-Svačina
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Johannes Haensch
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kilian Weiss
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Philips GmbH Market DACH, Hamburg, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany
| | - Natalie Schloss
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kai Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gilbert Wunderlich
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Helmar C Lehmann
- Department of Neurology, Medical Faculty and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Thorsten Lichtenstein
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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16
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Pušnik L, Serša I, Umek N, Cvetko E, Snoj Ž. Correlation between diffusion tensor indices and fascicular morphometric parameters of peripheral nerve. Front Physiol 2023; 14:1070227. [PMID: 36909220 PMCID: PMC9995878 DOI: 10.3389/fphys.2023.1070227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction: Diffusion tensor imaging (DTI) is a magnetic resonance imaging (MRI) technique that measures the anisotropy of water diffusion. Clinical magnetic resonance imaging scanners enable visualization of the structural integrity of larger axonal bundles in the central nervous system and smaller structures like peripheral nerves; however, their resolution for the depiction of nerve fascicular morphology is limited. Accordingly, high-field strength MRI and strong magnetic field gradients are needed to depict the fascicular pattern. The study aimed to quantify diffusion tensor indices with high-field strength MRI within different anatomical compartments of the median nerve and determine if they correlate with nerve structure at the fascicular level. Methods: Three-dimensional pulsed gradient spin-echo (PGSE) imaging sequence in 19 different gradient directions and b value 1,150 s/mm2 was performed on a 9.4T wide-bore vertical superconducting magnet. Nine-millimeter-long segments of five median nerve samples were obtained from fresh cadavers and acquired in sixteen 0.625 mm thick slices. Each nerve sample had the fascicles, perineurium, and interfascicular epineurium segmented. The diffusion tensor was calculated from the region-average diffusion-weighted signals for all diffusion gradient directions. Subsequently, correlations between diffusion tensor indices of segmentations and nerve structure at the fascicular level (number of fascicles, fascicular ratio, and cross-sectional area of fascicles or nerve) were assessed. The acquired diffusion tensor imaging data was employed for display with trajectories and diffusion ellipsoids. Results: The nerve fascicles proved to be the most anisotropic nerve compartment with fractional anisotropy 0.44 ± 0.05. In the interfascicular epineurium, the diffusion was more prominent in orthogonal directions with fractional anisotropy 0.13 ± 0.02. Diffusion tensor indices within the fascicles and perineurium differed significantly between the subjects (p < 0.0001); however, there were no differences within the interfascicular epineurium (p ≥ 0.37). There were no correlations between diffusion tensor indices and nerve structure at the fascicular level (p ≥ 0.29). Conclusion: High-field strength MRI enabled the depiction of the anisotropic diffusion within the fascicles and perineurium. Diffusion tensor indices of the peripheral nerve did not correlate with nerve structure at the fascicular level. Future studies should investigate the relationship between diffusion tensor indices at the fascicular level and axon- and myelin-related parameters.
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Affiliation(s)
- Luka Pušnik
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Igor Serša
- Jožef Stefan Institute, Ljubljana, Slovenia
| | - Nejc Umek
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Erika Cvetko
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Žiga Snoj
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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17
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Aman M, Schwarz D, Stolle A, Bergmeister KD, Boecker AH, Daeschler S, Bendszus M, Kneser U, Harhaus L. Modern MRI Diagnostics of Upper-Extremity-Related Nerve Injuries—A Prospective Multi-Center Study Protocol for Diagnostics and Follow Up of Peripheral Nerve Injuries. J Pers Med 2022; 12:jpm12101548. [PMID: 36294687 PMCID: PMC9604736 DOI: 10.3390/jpm12101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Peripheral nerve injuries are severe injuries with potentially devastating impairment of extremity function. Correct and early diagnosis as well as regular regeneration observation is of utmost importance for individualized reconstruction and the best possible results. Currently, diagnoses and follow-up examinations are based on clinical examinations supported with electroneurography, which often causes delays in treatment and can result in impaired healing. However, there is currently no diagnostic device that can reliably correlate the anatomic–pathological parameters with the functional–pathological changes initially and during therapy. With new technologies such as MR neurography (MRN), precise visualization of potential nerve damage and visualization of the reinnervation processes is assumed to accelerate clinical decision making and accompaniment of individualized treatment. (2) Methods/Design: This prospective clinical study will examine 60 patients after peripheral nerve lesion aged 18–65 years from trauma timepoint onward. Patients should be observed over a period of 18–24 months with regular clinical examinations, electroneurography, and ultrasound to compare the potential of MRN to current gold-standard diagnostic tools. Furthermore, 20 patients with the same inclusion criteria stated above, with an internal fixation and osteosyntheses of humerus fractures, will be examined to determine the visibility of peripheral nerve structures in close proximity to metal. (3) Discussion: Peripheral nerve injuries are often accompanied with severe, expensive, and long-lasting impairment of extremity function. An early and precise diagnosis of the nerve lesion, as well as the healing course, is crucial to indicate the right therapy as soon as possible to save valuable time for nerve regeneration. Here, new technologies such as MRN aim to visualize nerve injuries on fascicular level, providing not only early diagnosis and therapy decisions, but also providing a precise tool for monitoring of reinnervation processes. As severe injuries of a nerve are often accompanied with bone fractures and internal fixation, we also aim to evaluate the visualization feasibility of nerves in close proximity to metal, and ultimately improve the outcome and extremity function of patients after a peripheral nerve injury.
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Affiliation(s)
- Martin Aman
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Ludwig-Guttman Str. 13, 67071 Ludwigshafen, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Annette Stolle
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Ludwig-Guttman Str. 13, 67071 Ludwigshafen, Germany
| | - Konstantin Davide Bergmeister
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Ludwig-Guttman Str. 13, 67071 Ludwigshafen, Germany
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
- Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, 3100 St. Poelten, Austria
- Center for Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Arne H. Boecker
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Ludwig-Guttman Str. 13, 67071 Ludwigshafen, Germany
| | - Simeon Daeschler
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Ludwig-Guttman Str. 13, 67071 Ludwigshafen, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Ludwig-Guttman Str. 13, 67071 Ludwigshafen, Germany
| | - Leila Harhaus
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Ludwig-Guttman Str. 13, 67071 Ludwigshafen, Germany
- Correspondence:
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18
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Awais K, Snoj Ž, Cvetko E, Serša I. Diffusion Tensor Imaging of a Median Nerve by Magnetic Resonance: A Pilot Study. Life (Basel) 2022; 12:life12050748. [PMID: 35629414 PMCID: PMC9143877 DOI: 10.3390/life12050748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 12/03/2022] Open
Abstract
The magnetic resonance Diffusion Tensor Imaging (DTI) is a powerful extension of Diffusion Weighted Imaging (DWI) utilizing multiple bipolar gradients, allowing for the evaluation of the microstructural environment of the highly anisotropic tissues. DTI was predominantly used for the assessment of the central nervous system (CNS), but with the advancement in magnetic resonance (MR) hardware and software, it has now become possible to image the peripheral nerves which were difficult to evaluate previously because of their small caliber. This study focuses on the assessment of the human median peripheral nerve ex vivo by DTI microscopy at 9.4 T magnetic field which allowed the evaluation of diffusion eigenvalues, the mean diffusivity and the fractional anisotropy at 35 μm in-plane resolution. The resolution was sufficient for clear depiction of all nerve anatomical structures and therefore further image analysis allowed the obtaining of average values for DT parameters in nerve fascicles (intrafascicular region and perineurium) as well as in the surrounding epineurium. The results confirmed the highest fractional anisotropy of 0.33 and principal diffusion eigenvalue of 1.0 × 10−9 m2/s in the intrafascicular region, somewhat lower values of 0.27 and 0.95 × 10−9 m2/s in the perineurium region and close to isotropic with very slow diffusion (0.15 and 0.05 × 10−9 m2/s) in the epineurium region.
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Affiliation(s)
- Kanza Awais
- Jožef Stefan International Postgraduate School, 1000 Ljubljana, Slovenia;
| | - Žiga Snoj
- Department of Radiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Erika Cvetko
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Igor Serša
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Jožef Stefan Institute, 1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +386-1-477-3696
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19
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Martín-Noguerol T, Barousse R, Luna A, Socolovsky M, Górriz JM, Gómez-Río M. New insights into the evaluation of peripheral nerves lesions: a survival guide for beginners. Neuroradiology 2022; 64:875-886. [PMID: 35212785 DOI: 10.1007/s00234-022-02916-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/09/2022] [Indexed: 12/09/2022]
Abstract
PURPOSE To perform a review of the physical basis of DTI and DCE-MRI applied to Peripheral Nerves (PNs) evaluation with the aim of providing readers the main concepts and tools to acquire these types of sequences for PNs assessment. The potential added value of these advanced techniques for pre-and post-surgical PN assessment is also reviewed in diverse clinical scenarios. Finally, a brief introduction to the promising applications of Artificial Intelligence (AI) for PNs evaluation is presented. METHODS We review the existing literature and analyze the latest evidence regarding DTI, DCE-MRI and AI for PNs assessment. This review is focused on a practical approach to these advanced sequences providing tips and tricks for implementing them into real clinical practice focused on imaging postprocessing and their current clinical applicability. A summary of the potential applications of AI algorithms for PNs assessment is also included. RESULTS DTI, successfully used in central nervous system, can also be applied for PNs assessment. DCE-MRI can help evaluate PN's vascularization and integrity of Blood Nerve Barrier beyond the conventional gadolinium-enhanced MRI sequences approach. Both approaches have been tested for PN assessment including pre- and post-surgical evaluation of PNs and tumoral conditions. AI algorithms may help radiologists for PN detection, segmentation and characterization with promising initial results. CONCLUSION DTI, DCE-MRI are feasible tools for the assessment of PN lesions. This manuscript emphasizes the technical adjustments necessary to acquire and post-process these images. AI algorithms can also be considered as an alternative and promising choice for PN evaluation with promising results.
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Affiliation(s)
| | - Rafael Barousse
- Peripheral Nerve and Plexus Department, Centro Rossi, Sánchez de Loria 117, C1173 AAC, Buenos Aires, Argentina
| | - Antonio Luna
- MRI unit, Radiology Department, HT Medica, Carmelo Torres 2, 23007, Jaén, Spain
| | - Mariano Socolovsky
- Nerve & Plexus Surgery Program, Division of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, Paraguay 2155, C1121 ABG, Buenos Aires, Argentina
| | - Juan M Górriz
- Department of Signal Theory, Networking and Communications, University of Granada, Avenida de Fuente Nueva, s/n, 18071, Granada, Spain.,Department of Psychiatry, University of Cambridge, Cambridge, CB21TN, UK
| | - Manuel Gómez-Río
- Department of Nuclear Medicine, Virgen de las Nieves University Hospital, Av. de las Fuerzas Armadas, 2, 18014, Granada, Spain.,IBS Granada Bio-Health Research Institute, Av. de Madrid, 15, 18012, Granada, Spain
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20
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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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21
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Manu G, Amit M, Asir John S. Effect of massage, passive neural mobilization and transcutaneous electrical nerve stimulation on magnetic resonance diffusion tensor imaging (MR-DTI) of the tibial nerve in a patient with type 2 diabetes mellitus induced neuropathy: a case report. Physiother Theory Pract 2021; 38:3273-3282. [PMID: 34723754 DOI: 10.1080/09593985.2021.1994070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND MR-DTI parameters namely fractional anisotropy (FA) and apparent diffusion coefficient values (ADC) of diffusion imaging demonstrate the directional preference and speed of diffusion of water molecules. The purpose of this case report is to explore the effect of massage, passive neural mobilization and transcutaneous electrical nerve stimulation on MR-DTI of the tibial nerve in a patient with type 2 diabetes mellitus having chronic distal symmetrical sensorimotor neuropathy. CASE DESCRIPTION A 63-year-old male with type 2 diabetes mellitus diagnosed with chronic symmetrical sensorimotor diabetic peripheral neuropathy on the basis of medical examination and electrophysiological testing. Altered mechanosensitivity of the tibial nerve was confirmed through neurodynamic testing. MR-DTI revealed severe damage of the tibial nerve as shown by chaotic diffusion of water molecules and damaged microstructural integrity. INTERVENTION A total six sessions over 3 weeks including nerve massage in a longitudinal and transverse direction; passive neural mobilization consisting of sliders and tensioners of the tibial nerve; and followed by 15 minutes of continuous transcutaneous electrical nerve stimulation directed along the nerve course. OUTCOME FA and ADC values, pain,neuropathy quality of life and range of motion data were collected pre and post intervention. Analysis revealed clinical improvement in all the outcome measures. CONCLUSION This case report identified improvement in radiological MR-DTI outcomes following rehabilitation in a patient with diabetic peripheral neuropathy.
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Affiliation(s)
- Goyal Manu
- Department of Musculoskeletal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, HR, India
| | - Mittal Amit
- Department of Radiodiagnosis and Imaging, Maharishi Markandeshwar (Deemed to be University) Institute of Medical Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Mullana, HR, India
| | - Samuel Asir John
- Department of Pediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, HR, India
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22
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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.
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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.
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23
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Koide K, Sugiyama A, Yokota H, Mukai H, Wang J, Nakamura K, Misawa S, Ito S, Kuwabara S. Nerve Hypertrophy and Altered Diffusion in Anti-Myelin-Associated Glycoprotein Neuropathy Detected by Brachial Plexus Magnetic Resonance Neurography. Eur Neurol 2021; 85:95-103. [PMID: 34583351 DOI: 10.1159/000519128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/14/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study assessed the morphological changes and diffusion tensor imaging (DTI)-derived parameters of the brachial plexus using magnetic resonance neurography (MRN) in patients with anti-myelin-associated glycoprotein (anti-MAG) neuropathy. METHODS Eight patients with anti-MAG neuropathy underwent MRN of the brachial plexus with 3-dimensional (3D) short tau inversion recovery (STIR) and DTI sequences. Two neuroradiologists and a neurologist qualitatively assessed nerve hypertrophy on 3D STIR MRN. The cross-sectional area (CSA) of the nerve roots was measured. Quantitative analyses of fractional anisotropy (FA) and axial, radial, and mean diffusivity (AD, RD, and MD) were obtained after postprocessing on DTI and manual segmentation. RESULTS There was nerve hypertrophy in 37.5% of the patients with anti-MAG neuropathy. All patients with anti-MAG neuropathy with nerve hypertrophy were refractory to rituximab therapy. The CSA of the nerve roots was inversely correlated with FA and positively correlated with MD and RD. FA decreased in the nerve roots and inversely correlated with disease duration. CONCLUSIONS Nerve hypertrophy appears in the proximal portion of peripheral nerves, such as the brachial plexus, in patients with anti-MAG neuropathy. Altered diffusion in the nerve roots might be associated with the loss of myelin integrity due to the demyelination process in anti-MAG neuropathy.
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Affiliation(s)
- Kyosuke Koide
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan,
| | - Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroki Mukai
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Jiaqi Wang
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keigo Nakamura
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sonoko Misawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shoichi Ito
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Medical Education, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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24
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Brown R, Sharafi A, Slade JM, Convit A, Davis N, Baete S, Milton H, Mroczek KJ, Kluding PM, Regatte RR, Parasoglou P, Rao S. Lower extremity MRI following 10-week supervised exercise intervention in patients with diabetic peripheral neuropathy. BMJ Open Diabetes Res Care 2021; 9:9/1/e002312. [PMID: 34518157 PMCID: PMC8438733 DOI: 10.1136/bmjdrc-2021-002312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/17/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The purpose of this study was to characterize using MRI the effects of a 10-week supervised exercise program on lower extremity skeletal muscle composition, nerve microarchitecture, and metabolic function in individuals with diabetic peripheral neuropathy (DPN). RESEARCH DESIGN AND METHODS Twenty participants with DPN completed a longitudinal trial consisting of a 30-day control period, during which subjects made no change to their lifestyle, followed by a 10-week intervention program that included three supervised aerobic and resistance exercise sessions per week targeting the upper and lower extremities. The participants' midcalves were scanned with multinuclear MRI two times prior to intervention (baseline1 and baseline2) and once following intervention to measure relaxation times (T1, T1ρ, and T2), phosphocreatine recovery, fat fraction, and diffusion parameters. RESULTS There were no changes between baseline1 and baseline2 MRI metrics (p>0.2). Significant changes (p<0.05) between baseline2 and postintervention MRI metrics were: gastrocnemius medialis (GM) T1 -2.3%±3.0% and soleus T2 -3.2%±3.1%. Trends toward significant changes (0.05<p<0.1) between baseline2 and postintervention MRI metrics were: calf adipose infiltration -2.6%±6.4%, GM T1ρ -4.1%±7.7%, GM T2 -3.5%±6.4%, and gastrocnemius lateral T2 -4.6±7.4%. Insignificant changes were observed in gastrocnemius phosphocreatine recovery rate constant (p>0.3) and tibial nerve fractional anisotropy (p>0.6) and apparent diffusion coefficient (p>0.4). CONCLUSIONS The 10-week supervised exercise intervention program successfully reduced adiposity and altered resting tissue properties in the lower leg in DPN. Gastrocnemius mitochondrial oxidative capacity and tibial nerve microarchitecture changes were not observed, either due to lack of response to therapy or to lack of measurement sensitivity.
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Affiliation(s)
- Ryan Brown
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Azadeh Sharafi
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Jill M Slade
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Antonio Convit
- Department of Psychiatry, New York University Grossman School of Medicine, New York City, New York, USA
- Department of Psychiatry, Nathan S Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Nathan Davis
- Department of Osteopathic Medicine, New York Institute of Technology, Old Westbury, New York, USA
| | - Steven Baete
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Heather Milton
- Sports Performance Center, New York University Langone Health, New York City, New York, USA
| | - Kenneth J Mroczek
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York City, New York, USA
| | - Patricia M Kluding
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ravinder R Regatte
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Prodromos Parasoglou
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Smita Rao
- Department of Physical Therapy, New York University, New York City, New York, USA
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25
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Park SY, Koh SH, Lee IJ, Lee K, Lee Y. Determination of optimum pixel size and slice thickness for tractography and ulnar nerve diffusion tensor imaging at the cubital tunnel using 3T MRI. Acta Radiol 2021; 62:1063-1071. [PMID: 32854528 DOI: 10.1177/0284185120951965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Small peripheral nerve tractography is challenging because of the trade-off among resolution, image acquisition time, and signal-to-noise ratio. PURPOSE To optimize pixel size and slice thickness parameters for fiber tractography and diffusion tensor imaging (DTI) of the ulnar nerve at the cubital tunnel using 3T magnetic resonance imaging (MRI). MATERIAL AND METHODS Fifteen healthy volunteers (mean age 30 ± 6.8 years) were recruited prospectively. Axial T2-weighted and DTI scans were acquired, covering the cubital tunnel, using different pixel sizes and slice thicknesses. Three-dimensional (3D) nerve tractography was evaluated for the median number and length of the reconstructed fiber tracts and visual score from 0 to 5. Two-dimensional (2D) cross-sectional DTI was evaluated for fractional anisotropy (FA) values throughout the length of the ulnar nerve. RESULTS A pixel size of 1.3 mm2 revealed the highest number of reconstructed nerve fibers compared to that of 1.1 mm2 (P = 0.048), with a good visual score. A slice thickness of 4 mm had the highest number of reconstructed nerve fibers and visual score compared with other thicknesses (all P < 0.05). In 2D cross-sectional images, the median FA values were in the range of 0.40-0.63 at the proximal, central, and distal portions of the cubital tunnel. Inter-observer agreement for all parameters was good to excellent. CONCLUSION For fiber tractography and DTI of the ulnar nerve at the cubital tunnel, optimal image quality was obtained using a 1.3-mm2 pixel size and 4-mm slice thickness under MR parameters of this study at 3T.
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Affiliation(s)
- Sun-Young Park
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Sung Hye Koh
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - In Jae Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Kwanseop Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Yul Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
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26
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Hodel J, Lefaucheur JP, Tolédano S, Badat N, Rondenet C, Zuber M, Zins M, Créange A. Diffusion tensor imaging MR neurography in patients with acute or chronic plexopathy. J Neuroradiol 2021; 49:2-8. [PMID: 34171314 DOI: 10.1016/j.neurad.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/04/2021] [Accepted: 06/15/2021] [Indexed: 01/28/2023]
Abstract
The nerve plexus is susceptible to various pathological processes. In addition to clinical and electrophysiological findings, magnetic resonance neurography (MRN) may contribute to characterize plexus involvement. Diffusion tensor imaging (DTI) was reported feasible for the nerve plexuses imaging but its value in the clinical practice remains uncertain. From 2014 to 2020, we routinely performed MRN including DTI at 3T in patients with acute or chronic plexopathy. DTI images were co-registered with conventional MRN images. MRN images including DTI were reviewed by consensus by two neuroradiologists and one neurologist. They retrospectively identified cases for whom the use of DTI had a potential impact on the diagnostic workup, seven of these clinical cases are presented here. Compared to conventional MRN, the added value of DTI consisted in: (i) improved detection of signal/morphological abnormalities of the plexus (due to removal of background structures, multiplanar reformatted views and large field of view), (ii) additional information regarding the microarchitecture of nerve fibers provided by DTI metrics, (iii) potential alternative for the use of gadolinium. This case series supports the implementation of DTI in MRN protocols.
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Affiliation(s)
- Jérôme Hodel
- Department of Radiology, Saint Joseph Hospital, Paris, France.
| | - Jean-Pascal Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, EA 4391, France; Nerve Excitability and Therapeutic Team (ENT), Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - Sarah Tolédano
- Department of Radiology, Saint Joseph Hospital, Paris, France
| | - Neesmah Badat
- Department of Radiology, Saint Joseph Hospital, Paris, France
| | | | - Mathieu Zuber
- Department of Neurology, Saint Joseph Hospital, Paris, France; INSERM UMR S919, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Marc Zins
- Department of Radiology, Saint Joseph Hospital, Paris, France
| | - Alain Créange
- Department of Neurology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France
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27
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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.
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Advances in imaging technologies for the assessment of peripheral neuropathies in rheumatoid arthritis. Rheumatol Int 2021; 41:519-528. [PMID: 33427917 DOI: 10.1007/s00296-020-04780-5] [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: 11/11/2020] [Accepted: 12/26/2020] [Indexed: 12/22/2022]
Abstract
Peripheral neuropathy in patients with rheumatoid arthritis is associated with a maladaptive autoimmune response that may cause chronic pain and disability. Nerve conduction studies are the routine method performed when rheumatologists presume its presence. However, this approach is invasive, may not reveal subtle malfunctions in the early stages of the disease, and does not expose abnormalities in structures surrounding the nerves and muscles, limiting the possibility of a timely diagnosis. This work aims to present a narrative review of new technologies for the clinical assessment of peripheral neuropathy in Rheumatoid Arthritis. Through a bibliographic search carried out in five repositories, from 1990 to 2020, we identified three technologies that could detect peripheral nerve lesions and perform quantitative evaluations: (1) magnetic resonance neurography, (2) functional magnetic resonance imaging, and (3) high-resolution ultrasonography of peripheral nerves. We found these tools can overcome the main constraints imposed by the previous electrophysiologic methods, enabling early diagnosis.
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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.
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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
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Manoharan D, Sudhakaran D, Goyal A, Srivastava DN, Ansari MT. Clinico-radiological review of peripheral entrapment neuropathies - Part 1 upper limb. Eur J Radiol 2020; 131:109234. [PMID: 32949858 DOI: 10.1016/j.ejrad.2020.109234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 06/21/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This article aims to review the pertinent anatomy, etiopathogenesis, current clinical and radiological concepts and principles of management in case of upper limb entrapment neuropathies. METHODS The review is based on critical analysis of the existing literature as well as our experience in dealing with entrapment neuropathies. RESULTS Entrapment neuropathies of the upper limb peripheral nerves are common conditions that are often misdiagnosed because of their varying clinical presentations and lack of standardized diagnostic methods. Clinical assessment and electrodiagnostic studies have been the mainstay; however, imaging techniques have provided newer insights into the pathophysiology of these entities, leading to a paradigm shift in their diagnosis and management. The current best practice protocols for entrapment syndromes are constantly evolving with increasing emphasis on the role high-resolution ultrasound and magnetic resonance imaging. Many imaging criteria are described and we have tried to present the most validated measurements for diagnosing entrapment neuropathies. CONCLUSION It is imperative for a clinical radiologist to be familiar with the etiopathogenesis and clinical features of these conditions, in addition to being thorough with the anatomy and the latest imaging strategies.
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Affiliation(s)
- Dinesh Manoharan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipin Sudhakaran
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Mohd Tahir Ansari
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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Edward R, Abdelalim AM, Ashour AS, Afifi L, Al-Athwari A. A study of diffusion tensor imaging of median nerve in diabetic peripheral neuropathy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00172-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Objective
To evaluate the role of diffusion tensor imaging (DTI) in the evaluation of diabetic peripheral neuropathy (DPN) compared to clinical scores and nerve conduction studies (NCS).
Patients and methods
We included 30 patients with diabetes mellitus complaining of neuropathy symptoms and 15 healthy volunteers. All subjects underwent evaluation using 1.5-T DTI of median nerves and NCS. Patients underwent clinical evaluation using the Neuropathy Deficit Score (NDS), Neuropathy Impairment Score in the Lower Limbs (NIS-LL), and Diabetic Neuropathy Examination (DNE) score.
Results
We found statistically significant differences between healthy volunteers and patients in fractional anisotropy (FA) of the distal segment (P = 0.016) and whole median nerve (P = 0.024), apparent diffusion coefficient (ADC) of proximal (P = 0.027) and distal (P < 0.001) segments, and whole median nerve (P = 0.019). Distal segment FA was significantly correlated with NDS (P = 0.003), DNEs (P = 0.003), sensory amplitude (P = 0.048), and motor CV (P = 0.020). Distal segment ADC was significantly correlated with NDS (P = 0.007), NIS-LL (P = 0.003), DNEs (P = 0.01), and sensory amplitude (P = 0.032). The best cut-off value of distal segment for FA was 0.45 (87% sensitivity, 80% specificity) and of distal segment ADC was 1.217 (80% sensitivity and specificity).
Conclusions
Our results suggest that 1.5-T DTI examination of the median nerve can provide useful non-invasive information in patients with DPN.
Trial registration
ClinicalTrials.gov, NCT03934970. Registered on May 1, 2019
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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.
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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.
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Abstract
OBJECTIVE This review details the agents for fluorescence-guided nerve imaging in both preclinical and clinical use to identify factors important in selecting nerve-specific fluorescent agents for surgical procedures. BACKGROUND Iatrogenic nerve injury remains a significant cause of morbidity in patients undergoing surgical procedures. Current real-time identification of nerves during surgery involves neurophysiologic nerve stimulation, which has practical limitations. Intraoperative fluorescence-guided imaging provides a complimentary means of differentiating tissue types and pathology. Recent advances in fluorescence-guided nerve imaging have shown promise, but the ideal agent remains elusive. METHODS In February 2018, PubMed was searched for articles investigating peripheral nerve fluorescence. Key terms used in this search include: "intraoperative, nerve, fluorescence, peripheral nerve, visualization, near infrared, and myelin." Limits were set to exclude articles exclusively dealing with central nervous system targets or written in languages other than English. References were cross-checked for articles not otherwise identified. RESULTS Of the nonspecific agents, tracers that rely on axonal transport showed the greatest tissue specificity; however, neurovascular dyes already enjoy wide clinical use. Fluorophores specific to nerve moieties result in excellent nerve to background ratios. Although noteworthy findings on tissue specificity, toxicity, and route of administration specific to each fluorescent agent were reported, significant data objectively quantifying nerve-specific fluorescence and toxicity are lacking. CONCLUSIONS Fluorescence-based nerve enhancement has advanced rapidly over the past 10 years with potential for continued utilization and progression in translational research. An ideal agent would be easily administered perioperatively, would not cross the blood-brain barrier, and would fluoresce in the near-infrared spectrum. Agents administered systemically that target nerve-specific moieties have shown the greatest promise. Based on the heterogeneity of published studies and methods for reporting outcomes, it appears that the development of an optimal nerve imaging agent remains challenging.
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Ha DH. MR Neurography: Current Several Issues for Novice Radiologists. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:81-100. [PMID: 36238129 PMCID: PMC9432089 DOI: 10.3348/jksr.2020.81.1.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/24/2019] [Accepted: 01/08/2020] [Indexed: 11/15/2022]
Abstract
말초신경병증의 진단을 위해 MR neurography의 사용이 점차 증가하고 있다. 고대조도와 고해상도로 말초신경을 직접 영상화한 MR 영상을 MR neurography라고 하고, 지방억제 T2 강조영상과 확산강조영상이 흔히 사용되는 시퀀스이다. 작은 직경, 복잡한 해부학적 구조를 가진 말초신경을 합리적 시간 안에 영상화하기 위해서 최신의 isotropic 3차원 기법, 다양한 고속영상기법, post-processing 영상 기법 등이 사용된다. 이런 발전들로 인해 MR neurography가 유용하게 사용되지만 항상 적절한 MR neurography 영상을 얻을 수 있는 것은 아니다. 적절한 MR neurography 영상을 얻기 위해 영상의학과 의사가 고려해야 할 다음의 몇가지 쟁점들이 있다. 이에는 적절한 표준 프로토콜의 선책, 지방억제 기법의 선택, 해상도와 field of view와 slice thickness 간의 상호 관계의 이해, 적절한 post-processing 영상 기법의 적용, 2차원 영상획득 기법과 3차원 영상획득 기법의 장단점, 근위부 말초신경과 말단부 말초신경의 T2 대조도의 차이, 말초신경에 인접한 정맥이 MR neurography에 미치는 영향, 확산강조영상에서 기하학적 왜곡의 발생과 적절한 b value의 선택 등이다. 이런 쟁점들을 잘 이해하는 것이 경험이 적은 영상의학과 의사가 적절한 MR neurography 영상을 얻고, 말초신경병증을 정확히 평가하는 데 많은 도움이 될 것이다.
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Affiliation(s)
- Dong-ho Ha
- Department of Radiology, Dong-A University, Busan, Korea
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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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Agarwal A, Chandra A, Jaipal U, Bagarhatta M, Mendiratta K, Goyal A, Kumar R, Mangalhara N. Can imaging be the new yardstick for diagnosing peripheral neuropathy?-a comparison between high resolution ultrasound and MR neurography with an approach to diagnosis. Insights Imaging 2019; 10:104. [PMID: 31676930 PMCID: PMC6825074 DOI: 10.1186/s13244-019-0787-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Peripheral neuropathies are a group of disorders which affect the peripheral nervous system which have been conventionally diagnosed using electrodiagnostic studies. This study was carried out to assess the role of imaging in diagnosing peripheral mononeuropathy as exact anatomical localisation of the pathology is possible using high-resolution ultrasound and MR neurography, the modalities assessed in this study. METHOD A hospital-based prospective analytical study was carried out in a resource-limited setting on 180 peripheral nerves in 131 patients with symptoms of peripheral mononeuropathy after taking IRB approval. Each patient underwent high-resolution ultrasound examination and MR neurography, findings of which were then compared and statistically analysed assuming electrodiagnostic findings as the gold standard. RESULTS Overall, the diagnostic accuracy was highest for the proton density fat-saturated MR sequence (93.89%) followed by high-resolution ultrasound (80%). The sensitivity was highest for proton density fat-saturated sequence while the T1 MR sequence had the highest specificity. Combined diagnostic accuracy of both modalities was calculated to be 93.33% with a negative predictive value of 80%. High-resolution ultrasound and MRI equally detected the cases with nerve discontinuity, while neuromas were better identified on MRI. CONCLUSION With the advent of higher frequency probes and improved MR field strength, imaging of peripheral nerves is possible with better accuracy. Imaging assessment of nerves allows anatomical delineation with identification of exact site of involvement. This comparative study demonstrates the role of imaging in diagnosing peripheral nerve pathologies with the accuracy of MRI as high as 93.89% which may serve as an imaging gold standard. High-resolution ultrasound, being quicker, cost effective and a comparable accuracy of 80% can serve as a reliable screening tool. This study incorporates a larger study group and compares HRUS with MRI, taking NCV as gold standard, which has not been done in the preceding studies. With this study, we conclude that these two imaging modalities are not mutually exclusive. Rather, they complement each other and can be used in conjunction as an imaging yardstick for diagnosing peripheral neuropathies.
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Affiliation(s)
- Aakanksha Agarwal
- Department of Radiodiagnosis, SMS Medical College, Jaipur, India. .,Malviya Nagar, Jaipur, India.
| | | | - Usha Jaipal
- Department of Radiodiagnosis, SMS Medical College, Jaipur, India
| | - Meenu Bagarhatta
- Department of Radiodiagnosis, SMS Medical College, Jaipur, India
| | | | - Alka Goyal
- Department of Radiodiagnosis, SMS Medical College, Jaipur, India
| | - Raghav Kumar
- Department of Radiodiagnosis, SMS Medical College, Jaipur, India
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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]
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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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Agarwal A, Chandra A, Jaipal U, Saini N. Imaging in the diagnosis of ulnar nerve pathologies-a neoteric approach. Insights Imaging 2019; 10:37. [PMID: 30895491 PMCID: PMC6426899 DOI: 10.1186/s13244-019-0714-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023] Open
Abstract
The ulnar nerve is a branch of the C8 and T1 nerve roots and arises from the medial cord of the brachial plexus. It supplies the intrinsic muscles of the hand and assists the median nerve in functioning of the flexors. Also known as the musician’s nerve, it is the second most common nerve involved in compressive neuropathy following the median nerve. Common sites of entrapment include cubital tunnel at the elbow, the ulnar groove in the humerus and the Guyon’s canal at the wrist. Patients present with altered sensation in the ulnar fourth and the fifth digit and the medial side of arm with loss of function of intrinsic muscles of the hand, the flexor carpi ulnaris and ulnar fibres of flexor digitorum superficialis in more severe cases. Diagnosis relies on clinical examination, electrodiagnostic studies and imaging findings. Plain radiographs are used to identify fracture sites, callus, or tumours as cause of compression. Technological advances in ultrasonography have allowed direct visualisation of the involved nerve with assessment of exact site, extent and type of injury. It yields unmatched information about anatomical details of the nerve. MR imaging adds to soft tissue details and helps in characterising the lesion. This pictorial review aims to illustrate a wide spectrum of causes of ulnar neuropathies as seen on ultrasound and MRI and emphasises upon the importance of imaging modalities in the diagnosis of neuropathies.
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Affiliation(s)
- Aakanksha Agarwal
- Department of Radiodiagnosis, SMS Medical College, Jaipur, Rajasthan, India. .,, A 235, Shivanand Marg, Malviya Nagar, Jaipur, India.
| | - Abhishek Chandra
- Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India
| | - Usha Jaipal
- Department of Radiodiagnosis, SMS Medical College, Jaipur, Rajasthan, India
| | - Narender Saini
- Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India
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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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MRI detects peripheral nerve and adjacent muscle pathology in non-systemic vasculitic neuropathy (NSVN). J Neurol 2019; 266:975-981. [DOI: 10.1007/s00415-019-09224-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 12/18/2022]
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Kim HS, Yoon YC, Choi BO, Jin W, Cha JG, Kim JH. Diffusion tensor imaging of the sciatic nerve in Charcot-Marie-Tooth disease type I patients: a prospective case-control study. Eur Radiol 2019; 29:3241-3252. [PMID: 30635758 DOI: 10.1007/s00330-018-5958-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/19/2018] [Accepted: 12/05/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVES This study aimed to evaluate whether diffusion tensor imaging (DTI) parameters and cross-sectional area (CSA) can differentiate between the sciatic nerve of Charcot-Marie-Tooth (CMT) disease type I (demyelinating form) patients and that of controls. METHODS This prospective comparison study included 18 CMT type I patients and 18 age/sex-matched volunteers. Magnetic resonance imaging including DTI and axial T2-weighted Dixon sequence was performed for each subject. Region of interest analysis was independently performed by two radiologists on each side of the sciatic nerve at four levels: hamstring tendon origin (level 1), lesser trochanter of the femur (level 2), gluteus maximus tendon insertion (level 3), and mid-femur (level 4). Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were calculated. The CSA of the sciatic nerve bundle was measured using axial water-only image at each level. Comparisons of DTI parameters between the two groups were performed using the two-sample t test and Mann-Whitney U test. Interobserver agreement analysis was also conducted. RESULTS Interobserver agreement was excellent for all DTI parameter analyses. FA was significantly lower at all four levels in CMT patients than controls. RD, MD, and CSA were significantly higher at all four levels in CMT patients. AD was significantly higher at level 2 in CMT patients. CONCLUSION DTI assessment of the sciatic nerve is reproducible and can discriminate the demyelinating nerve pathology of CMT type I patients from normal nerves. The CSA of the sciatic nerve is also a potential parameter for diagnosing nerve abnormality in CMT type I patients. KEY POINTS • Diffusion tensor imaging parameters of the sciatic nerve at proximal to mid-femur level revealed significant differences between the Charcot-Marie-Tooth disease patients and controls. • The cross-sectional area of the sciatic nerve was significantly larger in the Charcot-Marie-Tooth disease patients. • Interobserver agreement was excellent (intraclass coefficient > 0.8) for all diffusion tensor imaging parameter analyses.
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Affiliation(s)
- Hyun Su Kim
- Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Ilwon-Ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Ilwon-Ro, Gangnam-gu, Seoul, 135-710, South Korea. .,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.
| | - Byung-Ok Choi
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Jae-Hun Kim
- Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Ilwon-Ro, Gangnam-gu, Seoul, 135-710, South Korea
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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.
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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.
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Mazal AT, Ashikyan O, Cheng J, Le LQ, Chhabra A. Diffusion-weighted imaging and diffusion tensor imaging as adjuncts to conventional MRI for the diagnosis and management of peripheral nerve sheath tumors: current perspectives and future directions. Eur Radiol 2018; 29:4123-4132. [PMID: 30535638 DOI: 10.1007/s00330-018-5838-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/29/2018] [Accepted: 10/17/2018] [Indexed: 12/21/2022]
Abstract
Peripheral nerve sheath tumors (PNSTs) account for ~ 5% of soft tissue neoplasms and are responsible for a wide spectrum of morbidities ranging from localized neuropathy to fulminant metastatic spread and death. MR imaging represents the gold standard for identification of these neoplasms, however, current anatomic MR imaging markers do not reliably detect or differentiate benign and malignant lesions, and therefore, biopsy or excision is required for definitive diagnosis. Diffusion-weighted MR imaging (DWI) serves as a useful tool in the evaluation and management of PNSTs by providing functional information regarding the degree of diffusion, while diffusion tensor imaging (DTI) aids in determining the directional information of predominant diffusion and has been shown to be particularly useful for pre-operative planning of these tumors by delineating healthy and pathologic fascicles. The article focuses on these important neurogenic lesions, highlighting the current utility of diffusion MR imaging and future directions including computerized radiomic analysis. KEY POINTS: • Anatomic MRI is moderately accurate in differentiating benign from malignant PNST. • Diffusion tensor imaging facilitates pre-operative planning of PNSTs by depicting neuropathy and tractography. • Radiomics will likely augment current observer-based diagnostic criteria for PNSTs.
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Affiliation(s)
- Alexander T Mazal
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75022, USA
| | - Oganes Ashikyan
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75022, USA
| | - Jonathan Cheng
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Lu Q Le
- Department of Dermatology and Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75022, USA.
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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.
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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
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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.
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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
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Schwarz D, Pedro MT, Brand C, Bendszus M, Antoniadis G. [Nerve injuries and traumatic lesions of the brachial plexus : Imaging diagnostics and therapeutic options]. Radiologe 2018; 57:184-194. [PMID: 28175932 DOI: 10.1007/s00117-017-0207-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CLINICAL/METHODICAL ISSUE Traumatic lesions of peripheral nerves and the brachial plexus are feared complications because they frequently result in severe functional impairment. The prognosis is greatly dependent on the correct early diagnosis and the right choice of treatment regimen. It is important to distinguish between open and closed injuries. STANDARD RADIOLOGICAL METHODS Initial imaging must critically evaluate or prove nerve continuity and is commonly achieved by high-resolution ultrasonography. During the further course, reactive soft tissue alterations, such as constrictive scarring or neuroma formation can be detected. In the case of deep nerve and plexus injuries this can be excellently achieved by dedicated magnetic resonance neurography (MRN) sequences. METHODICAL INNOVATIONS The signal yield from brachial plexus imaging can be critically enhanced by the use of dedicated surface coil arrays. Furthermore, diffusion tensor imaging (DTI) may enable the regeneration potential of a nerve lesion to be recognized in the future. PERFORMANCE Multiple reports have shown that neurosonography enables a precise evaluation of peripheral nerve structures (up to 90% sensitivity and 95% specificity in nerve transection) and that the method can critically impact on therapeutic decision-making in 60%. Currently, there are only few quantitative data on the exact performance of MRN in traumatic nerve lesions; however, individual reports indicate a high level of agreement with intraoperative findings. PRACTICAL RECOMMENDATIONS In the initial work-up, especially in the case of peripheral, superficial and lesser nerve injuries, neurosonography is the preferred imaging approach to evaluate nerve integrity and the extent of nerve lesions. In the case of extensive nerve injury of proximal nerves and structures of the plexus as well as in the case of suspected root avulsion MRN is the method of choice.
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Affiliation(s)
- D Schwarz
- AG MR-Neurographie, Abteilung für Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - M T Pedro
- Sektion Periphere Nervenchirurgie, Neurochirurgische Klinik der Universität Ulm, Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Straße 2, 89312, Günzburg, Deutschland
| | - C Brand
- Sektion Periphere Nervenchirurgie, Neurochirurgische Klinik der Universität Ulm, Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Straße 2, 89312, Günzburg, Deutschland
| | - M Bendszus
- AG MR-Neurographie, Abteilung für Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - G Antoniadis
- Sektion Periphere Nervenchirurgie, Neurochirurgische Klinik der Universität Ulm, Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Straße 2, 89312, Günzburg, Deutschland.
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Godel T, Weiler M. [Clinical indications for high-resolution MRI diagnostics of the peripheral nervous system]. Radiologe 2018; 57:148-156. [PMID: 28188346 DOI: 10.1007/s00117-017-0210-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
CLINICAL/METHODICAL ISSUE Peripheral neuropathies are common and diagnostically often challenging disorders. Difficulties particularly exist in lesion localization and recognition of complex spatial lesion patterns. STANDARD DIAGNOSTIC METHODS Medical history taking, neurological examination, neurophysiological tests and nerve ultrasonography represent the gold standard in the diagnosis of peripheral nerve lesions but have known methodical limitations. METHODICAL INNOVATIONS The use of 3 Tesla magnetic resonance neurography (MRN) is an additional diagnostic imaging tool recently developed for the high-resolution visualization of long segments of peripheral nerves. Reasonable clinical indications for MRN are exemplarily presented. PERFORMANCE Using MRN a direct visualization and thus precise localization of focal and non-focal peripheral nerve lesions of various origins can be achieved with high spatial resolution down to the anatomical level of nerve fascicles. ACHIEVEMENTS Using MRN large anatomical areas of the peripheral nervous system (PNS) can be covered in a single examination session, spatial nerve lesion patterns can be evaluated and the underlying causes can often be detected. PRACTICAL RECOMMENDATIONS The MRN is a valuable supplement to the diagnostic work-up of the PNS, especially in cases that cannot be clarified with standard diagnostic methods. Evaluation of the spatial nerve lesion pattern gives additional information on the origin of the underlying disease. Reasonable indications for MRN are the assessment of proximal nerve structures including the brachial and lumbosacral nerve plexi, the clarification of inconclusive diagnostic results, preoperative, postoperative and posttraumatic assessments, the identification of fascicular nerve lesions and the differential diagnosis of an alleged somatoform disorder.
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Affiliation(s)
- T Godel
- Abteilung für Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Weiler
- Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
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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.
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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
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