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Chin J, Settell ML, Brucker-Hahn MK, Lust D, Zhang J, Upadhye AR, Knudsen B, Deshmukh A, Ludwig KA, Lavrov IA, Crofton AR, Lempka SF, Zhang M, Shoffstall AJ. Quantification of porcine lower thoracic spinal cord morphology with intact dura mater using high-resolution μCT. J Neuroimaging 2024. [PMID: 39390716 DOI: 10.1111/jon.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 09/04/2024] [Accepted: 09/17/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND AND PURPOSE Spinal cord stimulation (SCS) is approved by the Food and Drug Administration for treating chronic intractable pain in the back, trunk, or limbs through stimulation of the dorsal column. Numerous studies have used swine as an analog of the human spinal cord to better understand SCS and further improve its efficacy. We performed high-resolution imaging of the porcine spinal cord with intact dura mater using micro-computed tomography (μCT) to construct detailed 3-dimensional (3D) visualizations of the spinal cord and characterize the morphology of the dorsal and ventral rootlets. METHODS We obtained spinal cords from Yorkshire/Landrace crossbred swine (N = 7), stained samples with osmium tetroxide, and performed μCT imaging of the T12-T15 levels at isotropic voxel resolutions ranging from 3.3 to 50 μm. We measured the anatomical morphology using the 3D volumes and compared our results to measurements previously collected from swine and human spinal cords via microdissection techniques in prior literature. RESULTS While the porcine thoracic-lumbar spinal cord is a popular model for SCS, we highlight multiple notable differences compared to previously published T8-T12 human measurements including rootlet counts (porcine dorsal/ventral: 12.2 ± 2.6, 26.6 ± 3.4; human dorsal/ventral: 5.3 ± 1.3, 4.4 ± 2.4), rootlet angles (porcine ventral-rostral: 161 ± 1°, ventral-caudal: 155 ± 6°, dorsal-rostral: 148 ± 9°, dorsal-caudal: 142 ± 6°; human ventral-rostral: 170 ± 3°, ventral-caudal: 22 ± 10°, dorsal-rostral: 171 ± 3°, dorsal-caudal: 15 ± 7°), and the presence and count of dorsal rootlet bundles. CONCLUSIONS Detailed measurements and highlighted differences between human and porcine spinal cords can inform variations in modeling and electrophysiological experiments between the two species. In contrast to other approaches for measuring the spinal cord and rootlet morphology, our method keeps the dura intact, reducing potential artifacts from dissection.
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Affiliation(s)
- Justin Chin
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veteran Affairs Medical Center, Rehabilitation Research and Development, Cleveland, Ohio, USA
| | - Megan L Settell
- Wisconsin Institute for Translational Neuroengineering, Madison, Wisconsin, USA
- Department of Neurosurgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Meagan K Brucker-Hahn
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Lust
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veteran Affairs Medical Center, Rehabilitation Research and Development, Cleveland, Ohio, USA
| | - Jichu Zhang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Aniruddha R Upadhye
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veteran Affairs Medical Center, Rehabilitation Research and Development, Cleveland, Ohio, USA
| | - Bruce Knudsen
- Wisconsin Institute for Translational Neuroengineering, Madison, Wisconsin, USA
| | - Ashlesha Deshmukh
- Wisconsin Institute for Translational Neuroengineering, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kip A Ludwig
- Wisconsin Institute for Translational Neuroengineering, Madison, Wisconsin, USA
- Department of Neurosurgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Igor A Lavrov
- Department Neurology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew R Crofton
- Department of Anatomy, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Pathology and Cell Biology, University of South Florida, Tampa, Florida, USA
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Andrew J Shoffstall
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veteran Affairs Medical Center, Rehabilitation Research and Development, Cleveland, Ohio, USA
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Felisaz PF, Napolitano A, Terrani S, Parisi C, Toto-Brocchi M, Cè M, Alessandrino F, Oliva G, Cellina M, Gerevini S. An optimized 1.5 Tesla MRI protocol of the brachial plexus. Neuroradiol J 2024; 37:43-53. [PMID: 37621183 PMCID: PMC10863567 DOI: 10.1177/19714009231196475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
PURPOSE Creating an effective MRI protocol for examining the brachial plexus poses significant challenges, and despite the abundance of protocols in the literature, there is a lack of reference standards for basic sequences and essential parameters needed for replication. The aim of this study is to establish a reproducible 1.5 T brachial plexus imaging protocol, including patient positioning, coil selection, imaging planes, and essential sequence parameters. METHODS We systematically investigated MRI sequences, testing each parameter through in vivo experiments, examining their effects on signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), visual quality scores, and acquisition time. Sequences were refined based on optimal quality and timing scores. The final protocol was tested on scanners from two other vendors for reliability. RESULTS The final protocol included a combination of 2D turbo-spin-echo and 3D SPACE T1, SPACE STIR, and VIBE DIXON sequences. Recommendations for imaging planes, phase encoding, field of view, TR, TE, resolution, number of slices, slice thickness, fat and blood suppression, and acceleration strategies are provided. The protocol was successfully translated to other vendor's scanners with comparable quality. CONCLUSION We present an optimized protocol detailing the essential parameters for reproducibility. Our comprehensive list of experiments describes the impact of each parameter on image quality and scan time, addressing common artifacts and potential solutions. This protocol can benefit both young radiologists new to the field and experienced professionals seeking to refine their existing protocols.
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Affiliation(s)
| | | | | | | | - Marco Toto-Brocchi
- Postgraduate School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Maurizio Cè
- Postgraduate School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Francesco Alessandrino
- Division of Abdominal Imaging, Department of Radiology, University of Miami Health System, Miami, FL, USA
| | - Giancarlo Oliva
- Radiology Department, Ospedale Fatebenefratelli e Oftalmico, Milano, Italy
| | - Michaela Cellina
- Radiology Department, Ospedale Fatebenefratelli e Oftalmico, Milano, Italy
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Cheng H, Lan H, Bao Y, Yin L. Application of Magnetic Resonance Diffusion Tensor Imaging in Diagnosis of Lumbosacral Nerve Root Compression. Curr Med Imaging 2024; 20:e120623217889. [PMID: 37309765 DOI: 10.2174/1573405620666230612122725] [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: 02/03/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of this study was to assess the value of 3.0T magnetic resonance (MR) Diffusion tensor imaging (DTI) in the diagnosis of lumbosacral nerve root compression. METHODS The radiology reports, and clinical records of 34 patients with nerve root compression caused by lumbar disc herniation or bulging and 21 healthy volunteers who had undergone magnetic resonance imaging (MRI) and DTI scan were retrospectively reviewed. The differences in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) between compressed and non-compressed nerve roots from patients and the normal nerve roots from healthy volunteers were compared. Meanwhile, the nerve root fiber bundles were observed and analyzed. RESULTS The average FA and ADC values of the compressed nerve roots were 0.254 ± 0.307 and 1.892 ± 0.346 10^-3mm2/s, respectively. The average FA and ADC values of the non-compressed nerve roots were 0.377 ± 0.659 and 1.353 ± 0.344 10^-3mm2/s, respectively. The FA value of compressed nerve roots was significantly lower than that of non-compressed nerve roots (P < 0.01). The ADC value of compressed nerve roots was significantly higher than that of non-compressed nerve roots. There were no significant differences between the left and right nerve roots of normal volunteers in FA and ADC values (P > 0.05). The nerve roots at different levels of L3-S1 had significantly different FA and ADC values (P < 0.01). Incomplete fiber bundles with extrusion deformation, displacement or partial defect were observed in the compressed nerve root fiber bundles. The real diagnosis of the clinical situation of the nerve can provide neuroscientists with an important computer tool to help them infer and understand the possible working mechanism from the experimental data of behavior and electrophysiology. CONCLUSION The compressed lumbosacral nerve roots can be accurately localized through 3.0T magnetic resonance DTI, which is instructive for accurate clinical diagnosis and preoperative localization.
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Affiliation(s)
- Haiyan Cheng
- Department of MRI room, Jincheng People's Hospital, No.456, Wenchang East Road, Jincheng City, Shanxi Province 048026, China
| | - Honglin Lan
- Department of MRI room, Jincheng People's Hospital, No.456, Wenchang East Road, Jincheng City, Shanxi Province 048026, China
| | - Yuanyuan Bao
- Department of MRI room, Jincheng People's Hospital, No.456, Wenchang East Road, Jincheng City, Shanxi Province 048026, China
| | - Liqiang Yin
- Department of Orthopedics, Jincheng People's Hospital, No.456, Wenchang East Road, Jincheng City, Shanxi Province 048026, China
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Dannebrock FA, Zardo EDA, Ziegler MS, Vialle E, Soder RB, Schwanke CHA. Lumbar safety triangle: comparative study of coronal and coronal oblique planes in 3.0-T magnetic resonance imaging. Radiol Bras 2023; 56:327-335. [PMID: 38504808 PMCID: PMC10948153 DOI: 10.1590/0100-3984.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/31/2023] [Accepted: 09/26/2023] [Indexed: 03/21/2024] Open
Abstract
Objective To compare the measurements of the lumbar safety triangle (Kambin's triangle) and the invasion of the dorsal root ganglion in the triangle in coronal and coronal oblique planes. Materials and Methods A cross-sectional study, in which 210 3.0-T magnetic resonance images of L2-L5 were analyzed in coronal and coronal oblique planes. Exams with lumbar spine anomalies were excluded. Demographic (sex and age) and radiological variables were recorded by a single evaluator. Results Most sample was female (57.1%), mean age 45.5 ± 13.3 (18-98 years). The measurements average, as well as the areas, gradually increased from L2 to L5. The dorsal root ganglion invaded the triangle in all images. The safety triangle average area was smaller in the coronal oblique plane than in the coronal plane. Of the seven dimensions of safety triangle obtained for each level of the lumbar spine, six were significantly smaller in the coronal oblique plane than in the coronal plane. The only dimension that showed no difference was the smallest ganglion dimension. Conclusion The dimensions and areas investigated were smaller in coronal oblique plane, especially the area (difference > 1 mm). The analysis of the triangular zone in this plane becomes important in the preoperative assessment of minimally invasive procedures.
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Affiliation(s)
| | - Erasmo de Abreu Zardo
- Pontifícia Universidade Católica do Rio Grande do Sul
(PUCRS), Porto Alegre, RS, Brazil
- Instituto Gaúcho de Cirurgia da Coluna Vertebral, Porto
Alegre, RS, Brazil
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Al-Haj Husain A, Schmidt V, Valdec S, Stadlinger B, Winklhofer S, Schönegg D, Sommer S, Özcan M, Al-Haj Husain N, Piccirelli M. MR-orthopantomography in operative dentistry and oral and maxillofacial surgery: a proof of concept study. Sci Rep 2023; 13:6228. [PMID: 37069287 PMCID: PMC10110573 DOI: 10.1038/s41598-023-33483-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/13/2023] [Indexed: 04/19/2023] Open
Abstract
This prospective study aimed to present, compare, and evaluate the suitability of five different magnetic resonance imaging (MRI) protocols (3D double-echo steady-state (DESS), 3D fast spin echo short-tau inversion recovery (SPACE-STIR), 3D fast spin echo spectral attenuated inversion recovery (SPACE-SPAIR), volumetric interpolated breath-hold examination (T1-VIBE-Dixon), and ultrashort echo time (UTE)) and for orthopantomogram (OPG)-like MRI reconstructions using a novel mandibular coil. Three readers assessed MR-OPGs of 21 volunteers regarding technical image quality (4, excellent; 0, severely reduced), susceptibility to artifacts (3, absence; 0, massive), and visualization of anatomical structures in the oral cavity and surrounding skeletal structures (4, fine details visible; 0, no structures visible). Average image quality was good (3.29 ± 0.83) for all MRI protocols, with UTE providing the best image quality (3.52 ± 0.62) and no to minor artifacts (2.56 ± 0.6). Full diagnostic interpretability of the osseous structures is best in VIBE-Dixon and UTE MR-OPGs. DESS provided excellent visualization of the finest details of the nervous tissue (3.95 ± 0.22). Intra-reader and inter-reader agreement between the readers was good to excellent for all protocols (ICCs 0.812-0.957). MR-OPGs provide indication-specific accurate imaging of the oral cavity and could contribute to the early detection of pathologies, staging, and radiological follow-up of oral and maxillofacial diseases.
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Affiliation(s)
- Adib Al-Haj Husain
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland.
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Valérie Schmidt
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Silvio Valdec
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Sebastian Winklhofer
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daphne Schönegg
- Departement of Cranio-Maxillo-Facial and Oral Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Sommer
- Siemens Healthineers International AG, Zurich, Switzerland
- Swiss Center for Musculoskeletal Imaging (SCMI), Balgrist Campus, Zurich, Switzerland
- Advanced Clinical Imaging Technology (ACIT), Siemens Healthcare AG, Lausanne, Switzerland
| | - Mutlu Özcan
- Division of Dental Biomaterials, Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Nadin Al-Haj Husain
- Division of Dental Biomaterials, Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Departement of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Marco Piccirelli
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Multi-echo in steady-state acquisition improves MRI image quality and lumbosacral radiculopathy diagnosis efficacy compared with T2 fast spin-echo sequence. Neuroradiology 2023; 65:969-977. [PMID: 36862186 DOI: 10.1007/s00234-023-03130-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/05/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE This study compares the performance of a 4-min multi-echo in steady-state acquisition (MENSA) with a 6-min fast spin echo with variable flip angle (CUBE) protocol for the assessment of lumbosacral plexus nerve root lesions. METHODS Seventy-two subjects underwent MENSA and CUBE sequences on a 3.0-T MRI scanner. Two musculoskeletal radiologists independently assessed the images for quality and diagnostic capability. A qualitative assessment scoring system for image quality and quantitative nerve signal-to-noise ratio (SNR) and iliac vein and muscle contrast-to-noise ratios (CNR) was applied. Using surgical reports as the reference, sensitivity, specificity, accuracy, and area under the receiver operating characteristic curves (AUC) were evaluated. Intraclass correlation coefficients (ICC) and weighted kappa were used to calculate reliability. RESULTS MENSA image quality rating (3.679 ± 0.47) was higher than for CUBE images (3.038 ± 0.68), and MENSA showed higher mean nerve root SNR (36.935 ± 8.33 vs. 27.777 ± 7.41), iliac vein CNR (24.678 ± 6.63 vs. 5.210 ± 3.93), and muscle CNR (19.414 ± 6.07 vs. 13.531 ± 0.65) than CUBE (P < 0.05). Weighted kappa and ICC values indicated good reliability. Sensitivity, specificity, and accuracy of diagnosis based on MENSA images were 96.23%, 89.47%, and 94.44%, respectively, and AUC was 0.929, compared with 92.45%, 84.21%, 90.28%, and 0.883 for CUBE images. The two correlated ROC curves were not significantly different. Weighted kappa values for intraobserver (0.758) and interobserver (0.768-0.818) reliability were substantial to perfect. CONCLUSION A time-efficient 4-min MENSA protocol exhibits superior image quality and high vascular contrast with the potential to produce high-resolution lumbosacral nerve root images.
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Yoon D, Antil N, Biswal S, Lutz AM. A robust 3D fast spin-echo technique for fast examination of the brachial plexus. Skeletal Radiol 2022; 51:1865-1872. [PMID: 35347408 DOI: 10.1007/s00256-022-04021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/17/2022] [Accepted: 02/17/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To introduce a 3D fast spin-echo (FSE) sequence technique that may replace conventional clinical 2D FSE sequences for examining the brachial plexus. MATERIALS AND METHODS A 3D FSE sequence with motion-sensitized driven equilibrium magnitude preparation, triple-echo Dixon, and outer-volume suppression techniques, dubbed as MSDE-CUBE-fTED, was compared with clinical 2D T2-weighted and T1-weighted FSE sequences on the conventional brachial plexus exam of 14 volunteers. The resulting images were evaluated by two radiologists for fat suppression, blood flow suppression, nerve visualization, scalene muscle shape, surrounding fat planes, and diagnostic confidence. The inter-rater agreement of the reviewers was also measured. In addition, the signal magnitude ratios and contrast-to-noise ratios between nerve-to-vessel, nerve-to-muscle, and fat-to-muscle were compared. RESULTS The MSDE-CUBE-fTED sequence scored significantly higher than the T2-weighed FSE sequence in all visualization categories (P < 0.05). Its score was not significantly different from that of the T1-weighted FSE in muscle and fat visualization (P ≥ 0.5). The inter-rater agreements were substantial (Gwet's agreement coefficient ≥ 0.7). The signal magnitude and contrast ratios were significantly higher in the MSDE-CUBE-fTED sequence (P < 0.05). CONCLUSION Our results suggest that the MSDE-CUBE-fTED sequence can make a potential alternative to standard T2- and T1-weighted FSE sequences for examining the brachial plexus.
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Affiliation(s)
- Daehyun Yoon
- Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Neha Antil
- Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Sandip Biswal
- Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Amelie M Lutz
- Radiology, Stanford University, Stanford, CA, 94305, USA.
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Nair PP, Mariappan YK, Paruthikunnan SM, Kamath A, Rolla NK, Saha I, Kadavigere R. Magnetic Resonance Neurography of the Brachial Plexus Using 3D SHINKEI: Comparative Evaluation with Conventional Magnetic Resonance Sequences for the Visualization of Anatomy and Detection of Nerve Injury at 1.5T. J Med Phys 2021; 46:140-147. [PMID: 34703097 PMCID: PMC8491319 DOI: 10.4103/jmp.jmp_13_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Purpose This work aims at optimizing and studying the feasibility of imaging the brachial plexus at 1.5T using 3D nerve-SHeath signal increased with INKed rest-tissue RARE imaging (3D SHINKEI) neurography sequence by comparing with routine sequences. Materials and Methods The study was performed on a 1.5T Achieva scanner. It was designed in two parts: (a) Optimization of SHINKEI sequence at 1.5T; and (b) Feasibility study of the optimized SHINKEI sequence for generating clinical quality magnetic resonance neurography images at 1.5T. Simulations and volunteer experiments were conducted to optimize the T2 preparation duration for optimum nerve-muscle contrast at 1.5T. Images from the sequence under study and other routine sequences from 24 patients clinically referred for brachial plexus imaging were scored by a panel of radiologists for diagnostic quality. Injury detection efficacy of these sequences were evaluated against the surgical information available from seven patients. Results T2 preparation duration of 50 ms gives the best contrast to noise between nerve and muscle. The images of 3D SHINKEI and short-term inversion recovery turbo spin-echo sequences are of similar diagnostic quality but significantly better than diffusion weighted imaging with background signal suppression. In comparison with the surgical findings, 3D SHINKEI has the lowest specificity; however, it had the highest sensitivity and predictive efficacy compared to other routine sequences. Conclusion 3D SHINKEI sequence provides a good nerve-muscle contrast and has high predictive efficacy of nerve injury, indicating that it is a potential screening sequence candidate for brachial plexus scans at 1.5T also.
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Affiliation(s)
- Prashant Prabhakaran Nair
- Department of Radiodiagnosis and Imaging, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
| | | | - Samir M Paruthikunnan
- Department of Radiodiagnosis and Imaging, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
| | - Asha Kamath
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Gurgaon, Haryana, India
| | | | | | - Rajagopal Kadavigere
- Department of Radiodiagnosis and Imaging, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
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New and Advanced Magnetic Resonance Imaging Diagnostic Imaging Techniques in the Evaluation of Cranial Nerves and the Skull Base. Neuroimaging Clin N Am 2021; 31:665-684. [PMID: 34689938 DOI: 10.1016/j.nic.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The skull base and cranial nerves are technically challenging to evaluate using magnetic resonance (MR) imaging, owing to a combination of anatomic complexity and artifacts. However, improvements in hardware, software and sequence development seek to address these challenges. This section will discuss cranial nerve imaging, with particular attention to the techniques, applications and limitations of MR neurography, diffusion tensor imaging and tractography. Advanced MR imaging techniques for skull base pathology will also be discussed, including diffusion-weighted imaging, perfusion and permeability imaging, with a particular focus on practical applications.
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Al-Haj Husain A, Valdec S, Stadlinger B, Rücker M, Piccirelli M, Winklhofer S. Preoperative visualization of the lingual nerve by 3D double-echo steady-state MRI in surgical third molar extraction treatment. Clin Oral Investig 2021; 26:2043-2053. [PMID: 34586501 PMCID: PMC8816737 DOI: 10.1007/s00784-021-04185-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/18/2021] [Indexed: 11/28/2022]
Abstract
Objectives To assess the lingual nerve (LN) visualization using a 3D double-echo steady-state MRI sequence (3D-DESS). Materials and methods Three readers prospectively evaluated the LN for its continuous visibility in 3D-DESS MRI in 19 patients with an indication for removal of mandibular impacted third molars, using a 5-point scale (4 = excellent to 0 = none). Six LN anatomical intermediate points (IP) were selected and checked for their detectability by a 4-point scale (4 = yes to1 = no). Inter- and intra-rater agreement was evaluated using intraclass correlation coefficient and percentage of agreement. Results The average nerve continuity score was 3.3 ± 0.46. In 35% of the cases, the entire course was continuously visible. In 10%, the proximal and 60%, the distal part of the nerve was not continuously visible. Inter- and intra-reader agreement was good (ICC = 0.76, ICC = 0.75). The average detectability score of all IP was 3.7 ± 0.41. From IP1 to IP5, the detectability was excellent; meanwhile, IP6 had lower visibility. The inter- and intra-reader percentage of agreement was 77% and 87%. Conclusions The 3D-DESS sequence allowed accurate and continuous visualization of the LN with high reproducibility in more than one-third of the patients. This could improve the preoperative clarification of the LN position and thereby reduce complications during dentoalveolar surgical interventions. Clinical relevance 3D-DESS MRI might be beneficial in clinical scenarios where the second molar is elongated or presents a difficult rotational position while simultaneously having a close positional relationship to the third molar. Thereby, osteotomy performed more lingually, indicating extended lingual flap detachment may increase the risk of LN damage. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04185-z.
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Affiliation(s)
- Adib Al-Haj Husain
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Silvio Valdec
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Martin Rücker
- Clinic of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Marco Piccirelli
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Sebastian Winklhofer
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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Felisaz PF, Belatti E, Deligianni X, Bergsland N, Santini F, Paoletti M, Solazzo F, Germani G, Cortese A, Vegezzi E, Bieri O, Bastianello S, Pichiecchio A. Variable echo time imaging for detecting the short T2* components of the sciatic nerve: a validation study. MAGMA (NEW YORK, N.Y.) 2021; 34:411-419. [PMID: 32964300 PMCID: PMC8154754 DOI: 10.1007/s10334-020-00886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 12/02/2022]
Abstract
OBJECTIVE The aim of this study was to develop and validate an MRI protocol based on a variable echo time (vTE) sensitive to the short T2* components of the sciatic nerve. MATERIALS AND METHODS 15 healthy subjects (M/F: 9/6; age: 21-62) were scanned at 3T targeting the sciatic nerve at the thigh bilaterally, using a dual echo variable echo time (vTE) sequence (based on a spoiled gradient echo acquisition) with echo times of 0.98/5.37 ms. Apparent T2* (aT2*) values of the sciatic nerves were calculated with a mono-exponential fit and used for data comparison. RESULTS There were no significant differences in aT2* related to side, sex, age, and BMI, even though small differences for side were reported. Good-to-excellent repeatability and reproducibility were found for geometry of ROIs (Dice indices: intra-rater 0.68-0.7; inter-rater 0.70-0.72) and the related aT2* measures (intra-inter reader ICC 0.95-0.97; 0.66-0.85) from two different operators. Side-related signal-to-noise-ratio non-significant differences were reported, while contrast-to-noise-ratio measures were excellent both for side and echo. DISCUSSION Our study introduces a novel MR sequence sensitive to the short T2* components of the sciatic nerve and may be used for the study of peripheral nerve disorders.
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Affiliation(s)
- Paolo Florent Felisaz
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
- Department of Radiology, Desio Hospital, ASST Monza, Desio, Italy
| | - Eugenio Belatti
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Xeni Deligianni
- Department of Radiology, Division of Radiological Physics, University Hospital Basel, Basel, Switzerland.
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.
| | - Niels Bergsland
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Francesco Santini
- Department of Radiology, Division of Radiological Physics, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Matteo Paoletti
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Francesca Solazzo
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Giancarlo Germani
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Andrea Cortese
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, PV, Italy
- Department for Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology, London, UK
| | - Elisa Vegezzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, PV, Italy
| | - Oliver Bieri
- Department of Radiology, Division of Radiological Physics, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Stefano Bastianello
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, PV, Italy
| | - Anna Pichiecchio
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, PV, Italy
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12
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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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13
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Ku V, Cox C, Mikeska A, MacKay B. Magnetic Resonance Neurography for Evaluation of Peripheral Nerves. J Brachial Plex Peripher Nerve Inj 2021; 16:e17-e23. [PMID: 34007307 PMCID: PMC8121558 DOI: 10.1055/s-0041-1729176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/29/2021] [Indexed: 12/17/2022] Open
Abstract
Peripheral nerve injuries (PNIs) continue to present both diagnostic and treatment challenges. While nerve transections are typically a straightforward diagnosis, other types of PNIs, such as chronic or traumatic nerve compression, may be more difficult to evaluate due to their varied presentation and limitations of current diagnostic tools. As a result, diagnosis may be delayed, and these patients may go on to develop progressive symptoms, impeding normal activity. In the past, PNIs were diagnosed by history and clinical examination alone or techniques that raised concerns regarding accuracy, invasiveness, or operator dependency. Magnetic resonance neurography (MRN) has been increasingly utilized in clinical settings due to its ability to visualize complex nerve structures along their entire pathway and distinguish nerves from surrounding vasculature and tissue in a noninvasive manner. In this review, we discuss the clinical applications of MRN in the diagnosis, as well as pre- and postsurgical assessments of patients with peripheral neuropathies.
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Affiliation(s)
- Vanessa Ku
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| | - Cameron Cox
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| | - Andrew Mikeska
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| | - Brendan MacKay
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
- Department of Orthopaedic Surgery, University Medical Center, Lubbock, Texas, United States
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14
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Kim BR, Ha DH, Kim JK, Kim YH. Comparison of MR findings of acute traumatic peripheral nerve injury and acute compressive neuropathy in a rat model. PLoS One 2020; 15:e0240911. [PMID: 33211695 PMCID: PMC7676645 DOI: 10.1371/journal.pone.0240911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose The treatment strategy is different for acute traumatic peripheral nerve injury and acute compressive neuropathy. This study aimed to compare magnetic resonance imaging (MRI) features of acute traumatic peripheral nerve injury and acute compressive neuropathy in a rat model. Materials and methods Twenty female Sprague-Dawley rats were divided into two groups. In the crush injury group (n = 10), the unilateral sciatic nerve was crushed using forceps to represent acute traumatic peripheral nerve injury. In the compression injury group (n = 10), the unilateral sciatic nerve was ligated using silk to represent acute compressive neuropathy. The MRI of eight rats from each group were acquired on postoperative days 3 and 10. Fat-suppressed T2-weighted images were acquired. Changes in the injured nerve were divided into three grades. A Fisher’s exact test was used to compare the changes in the nerves of the two groups. Histological staining and a western blot analysis were performed on one rat in each group on day 3. Neurofilament, myelin basic protein (MBP), and p75NTR staining were performed. Expression of neurofilament, MBP, p75NTR, and c-jun was evaluated by western blot analysis. Results MR neurography revealed substantial nerve changes in the compression injury group compared with the crush injury group at two-time points (p = 0.001 on day 3, p = 0.026 on day 10). The histopathological analysis indicated the destruction of the axon and myelin, mainly at the injury site and the distal portion of the injury in the crush injury group. It was prominent in the proximal portion, the injury site, and the distal portion of the injury in the compression injury group. The degree of axonal and myelin destruction was more pronounced in the compression injury group than in the crush injury group. Conclusion MR neurography showed prominent and long-segmental changes associated with the injured nerve in acute compressive neuropathy compared with acute traumatic peripheral nerve injury.
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Affiliation(s)
- Bo Ra Kim
- Department of Radiology, Dong-A University Medical Center, Busan, Republic of Korea
| | - Dong-Ho Ha
- Department of Radiology, Dong-A University Medical Center, Busan, Republic of Korea
- * E-mail:
| | - Jong Kuk Kim
- Department of Neurology, Dong-A University Medical Center, Busan, Republic of Korea
- Peripheral Neuropathy Research Center (PNRC), Dong-A University College of Medicine, Busan, Republic of Korea
| | - Young Hee Kim
- Peripheral Neuropathy Research Center (PNRC), Dong-A University College of Medicine, Busan, Republic of Korea
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15
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Mazal AT, Faramarzalian A, Samet JD, Gill K, Cheng J, Chhabra A. MR neurography of the brachial plexus in adult and pediatric age groups: evolution, recent advances, and future directions. Expert Rev Med Devices 2020; 17:111-122. [PMID: 31964194 DOI: 10.1080/17434440.2020.1719830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: MR neurography (MRN) of the brachial plexus has emerged in recent years as a safe and accurate modality for the identification of brachial plexopathies in pediatric and adult populations. While clinical differentiation of brachial plexopathy from cervical spine-related radiculopathy or nerve injury has long relied upon nonspecific physical exam and electrodiagnostic testing modalities, MRN now permits detailed interrogation of peripheral nerve anatomy and pathology, as well as assessment of surrounding soft tissues and musculature, thereby facilitating accurate diagnosis. The reader will learn about the current state of brachial plexus MRN, including recent advances and future directions, and gain knowledge about the adult and pediatric brachial plexopathies that can be characterized using these techniques.Areas Covered: The review details recent developments in brachial plexus MRN, including increasing availability of 3.0-T MR scanners at both private and academic diagnostic imaging centers, as well as the advent of multiple new vascular and fat signal suppression techniques. A literature search of PubMed and SCOPUS was used as the principal source of information gathered for this review.Expert Opinion: Refinement of fat-suppression, 3D techniques and diffusion MR imaging modalities has improved the accuracy of MRN, rendering it as a useful adjunct to clinical findings during the evaluation of suspected brachial plexus lesions.
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Affiliation(s)
- Alexander T Mazal
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ali Faramarzalian
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jonathan D Samet
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin Gill
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jonathan Cheng
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA.,Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
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16
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Heinen C, Dömer P, Schmidt T, Kewitz B, Janssen-Bienhold U, Kretschmer T. Fascicular Ratio Pilot Study: High-Resolution Neurosonography-A Possible Tool for Quantitative Assessment of Traumatic Peripheral Nerve Lesions Before and After Nerve Surgery. Neurosurgery 2020; 85:415-422. [PMID: 30107513 DOI: 10.1093/neuros/nyy355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 07/11/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clinical and electrophysiological assessments prevail in evaluation of traumatic nerve lesions and their regeneration following nerve surgery in humans. Recently, high-resolution neurosonography (HRNS) and magnetic resonance neurography have gained significant importance in peripheral nerve imaging. The use of the grey-scale-based "fascicular ratio" (FR) was established using both modalities allowing for quantitative assessment. OBJECTIVE To find out whether FR using HRNS can assess nerve trauma and structural reorganization in correlation to postoperative clinical development. METHODS Retrospectively, 16 patients with operated traumatic peripheral nerve lesions were included. The control group consisted of 6 healthy volunteers. All imaging was performed with a 15 to 6 MHz ultrasound probe (SonoSite X-Porte; Fujifilm, Tokyo, Japan). FR was calculated using Fiji () on 8-bit-images ("MaxEntropy" using "Auto-Threshold" plug-in). RESULTS Thirteen of 16 patients required autologous nerve grafting and 3 of 16 extra-intraneural neurolysis. There was no statistical difference between the FR of nonaffected patients' nerve portion with 43.48% and controls with FR 48.12%. The neuromatous nerve portion in grafted patients differed significantly with 85.05%. Postoperatively, FR values returned to normal with a mean of 39.33%. In the neurolyzed patients, FR in the affected portion was 78.54%. After neurolysis, FR returned to healthy values (50.79%). Ten of 16 patients showed clinical reinnervation. CONCLUSION To our best knowledge, this is the first description of FR using HRNS for quantitative assessment of nerve damage and postoperative structural reorganization. Our results show a significant difference in healthy vs lesioned nerves and a change in recovering nerve portions towards a more "physiological" ratio. Further evaluation in larger patient groups is required.
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Affiliation(s)
- Christian Heinen
- Department of Neurosurgery, Evangelisches Krankenhaus, Campus Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Patrick Dömer
- Department of Neurosciences, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Thomas Schmidt
- Department of Neurosurgery, Evangelisches Krankenhaus, Campus Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Bettina Kewitz
- Department of Neurosciences, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Ulrike Janssen-Bienhold
- Department of Neurosciences, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Thomas Kretschmer
- Department of Neurosurgery, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
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17
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Dannebrock FA, Zardo EDA, Ziegler MS, Severo CMD, Abramczuk J, Vialle E, Radaelli G, Schwanke CHA, Soder RB. EVALUATION OF THE LUMBAR SAFETY TRIANGLE THROUGH MAGNETIC RESONANCE IMAGING. COLUNA/COLUMNA 2019. [DOI: 10.1590/s1808-185120191804196935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate the lumbar triangular safety zone, its boundaries and its relationship with the dorsal root ganglion through Magnetic Resonance Imaging (MRI). Methods: The boundaries, shape and dimensions of 303 triangular safety zones were analyzed in Tesla 3.0 Magnetic Resonance Imaging (MRI) coronal sections from L2 to L5, including the dorsal root ganglion. Results: The sample consisted of 101 patients with a mean age of 32 years. The height of the triangular safety zone was formed by the lateral edge of the dura mater, the width by the upper plateau of the lower vertebra and the hypotenuse by the corresponding nerve root. The mean dimensions and the area varied according to the level studied. The dorsal root ganglion invaded the dimensions of the triangle in all the images studied. Conclusion: Based on the data and the analyses performed, we concluded that knowledge of the boundaries of the triangular safety zone through MRI increases the safety of minimally invasive procedures in the lumbar spine. Level of evidence I; Diagnostic studies – Investigation of a diagnostic test.
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Affiliation(s)
| | | | | | | | - Joel Abramczuk
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
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18
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Oudeman J, Verhamme C, Engbersen MP, Caan MWA, Maas M, Froeling M, Nederveen AJ, Strijkers GJ. Diffusion tensor MRI of the healthy brachial plexus. PLoS One 2018; 13:e0196975. [PMID: 29742154 PMCID: PMC5942843 DOI: 10.1371/journal.pone.0196975] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/24/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction Diffusion Tensor MRI (DT-MRI) is a promising tool for the evaluation of brachial plexus pathology. Therefore, we introduce and evaluate a fast DT-MRI protocol (8min33s scanning with 5–10 min postprocessing time) for the brachial plexus. Materials and methods Thirty healthy volunteers within three age-groups (18–35, 36–55, and > 56) received DT-MRI of the brachial-plexus twice. Means of fractional-anisotropy (FA), mean-diffusivity (MD), axial-diffusivity (AD), and radial-diffusivity (RD) for the individual roots and trunks were evaluated. A stepwise forward approach was applied to test for correlations with age, sex, body-mass-index (BMI), bodysurface, height, and bodyweight. Within-subject, intra-rater, and inter-rater repeatability were assessed using Bland-Altman analysis, coefficient of variation (CV), intraclass-correlation (ICC), and minimal detectable difference (MDD). Results No differences between sides and root levels were found. MD, AD, and RD correlated (P < 0.05) with bodyweight. Within-subject quantification proved repeatable with CVs for FA, MD, AD, and RD of 16%, 12%, 11%, and 14%, respectively. Discussion The DT-MRI protocol was fast and repeatable. Found correlations should be considered in future studies of brachial plexus pathology.
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Affiliation(s)
- Jos Oudeman
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail:
| | - Camiel Verhamme
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Mattan W. A. Caan
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Mario Maas
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center, Utrecht, the Netherlands
| | - Aart J. Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
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19
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Zare M, Faeghi F, Hosseini A, Ardekani MS, Heidari MH, Zarei E. Comparison Between Three-Dimensional Diffusion-Weighted PSIF Technique and Routine Imaging Sequences in Evaluation of Peripheral Nerves in Healthy People. Basic Clin Neurosci 2018; 9:65-71. [PMID: 29942442 PMCID: PMC6015634 DOI: 10.29252/nirp.bcn.9.1.65] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: The present study aims to evaluate the Three-Dimensional Diffusion-Weighted reversed fast imaging with steady state free precession (3D DW-PSIF) sequence with respect to imaging of the peripheral nerves; the tibial, medial, and lateral plantar nerves in the lower extremity, ulnar and median nerve in the upper extremity, sciatic nerve, brachial plexus, and lumbosacral plexus, and also to compare its usefulness with the current two-dimensional sequences on a 1.5 T MR scanner. Methods: A total of 25 healthy subjects underwent MR imaging of peripheral nerves, 5 subjects in each area. In each imaging sequence, including T2W SPAIR and 3D DW-PSIF, images were evaluated for ability to identify the nerves in the related area using a 3-score scale (0–2). Then, by summing up the conspicuity scores, a total certainty score was recorded for each sequence. Results: With combining the results of all studies, the conspicuity mean (SD) score was 1.57(0.67) on the 3D DW-PSIF images, and 0.74(0.76) on the T2-weighted images (P<0.001). Regarding the lumbosacral plexus, the corresponding certainty mean (SD) scores were 1.80(0.40) and 1.07(0.74) (P<0.001) and with regard to the brachial plexus, they were 1.23(0.83) and 0.75(0.84), (P<0.001). Regarding the ankle/hind foot they were 1.87(0.35) and 0.40(0.50) (P<0.001) and in the wrist/proximal hand, 1.70(0.48) and 0.50(0.52) (P<0.001). Regarding the sciatic nerve, they were 1.80(0.44) and 0.20(0.44) (P=0.003). Conclusion: 3D DW PSIF provides better manifestation of nerves compared to routine imaging sequences particularly fat saturated T2W images. This novel imaging technique can be used in MR neurography examination protocol for exact localization of the nerve and evaluation of the nerve pathology.
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Affiliation(s)
- Mahsa Zare
- Department of Radiology Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariborz Faeghi
- Department of Radiology Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ashrafsadat Hosseini
- Department of Radiology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Sobhan Ardekani
- Department of Radiology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Hossein Heidari
- Department of Basic Sciences, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Zarei
- Department of Physical Education, School of Education & Psychology, Shiraz University, Shiraz, Iran
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20
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Kumar I, Verma A, Ojha R, Aggarwal P, Shukla RC, Srivastava A. Magnetic resonance neurographic confirmation of extensive Plexiform neurofibroma in neurofibromatosis-1 presenting as ambiguous genitalia. Indian J Radiol Imaging 2016; 26:332-336. [PMID: 27857458 PMCID: PMC5036330 DOI: 10.4103/0971-3026.190423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Genitourinary involvement of neurofibromatosis is uncommon and genital neurofibromatosis is even rarer. Involvement of clitoris by neurofibroma can lead to clitoromegaly masquerading as a male penis. We report such a case of ambiguous genitalia in a 7-year-old female child presenting with clitoromegaly since birth, in which magnetic resonance imaging (MRI) revealed the presence of extensive neurofibromatosis in the clitoris and lumbosacral regions. We emphasize the central role of MRI in evaluation of hormonal and non-hormonal causes of ambiguous genitalia. We further discuss the merits of including MR neurography in the imaging protocol for comprehensive delineation of neurofibromatosis.
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Affiliation(s)
- Ishan Kumar
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashish Verma
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ritu Ojha
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Priyanka Aggarwal
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ram C Shukla
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Arvind Srivastava
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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21
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Bao H, Wang S, Wang G, Yang L, Hasan MU, Yao B, Wu C, Zhang X, Chen W, Chan Q, Wu L, Chhabra A. Diffusion-weighted MR neurography of median and ulnar nerves in the wrist and palm. Eur Radiol 2016; 27:2359-2366. [PMID: 27631109 DOI: 10.1007/s00330-016-4591-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/21/2016] [Accepted: 08/29/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate the feasibility of diffusion-weighted magnetic resonance neurography (DW-MRN) in the visualisation of extremity nerves in the wrist and palm. METHODS Thirty-two volunteers and 21 patients underwent imaging of the wrist and palm on a 3-T MR scanner. In all subjects, two radiologists evaluated the image quality on DW-MRN using a four-point grading scale. Kappa statistics were obtained for inter-observer performance. In volunteers, the chi-squared test was used to assess the differences in nerve visualisation on DW-MRN and axial fat-suppressed proton density weighted imaging (FS-PDWI). RESULTS In volunteers, the mean image quality scores for the median nerve (MN) and ulnar nerve (UN) were 3.71 ± 0.46 and 3.23 ± 0.67 for observer 1, and 3.70 ± 0.46 and 3.22 ± 0.71 for observer 2, respectively. The inter-observer agreement was excellent (k = 0.843) and good (k = 0.788), respectively. DW-MRN provided significantly improved visualisations of the second and the third common palmar digital nerves and three branches of UN compared with FS-PDWI (P < 0.05). In patients, the mean image quality scores for the two observers were 3.24 ± 0.62 and 3.10 ± 0.83, inter-observer performance was excellent (k = 0.842). CONCLUSIONS DW-MRN is feasible for improved visualisation of extremity nerves and their lesions in the wrist and palm with adequate image quality, thereby providing a supplementary method to conventional MR imaging. KEY POINTS • DW-MRN provides adequate image quality for wrist and palm neurography • DW-MRN performs similarly to FS-PDWI in nerve visualisation at the wrist • DW-MRN provides improved visualisation of small nerves in the palm • DW-MRN serves as a supplementary method to evaluate peripheral neuropathies.
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Affiliation(s)
- Hongjing Bao
- Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Shandong University, 324 Jingwu Rd, Jinan, 250021, Shandong, People's Republic of China
| | - Shanshan Wang
- Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Shandong University, 324 Jingwu Rd, Jinan, 250021, Shandong, People's Republic of China
| | - Guangbin Wang
- Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Shandong University, 324 Jingwu Rd, Jinan, 250021, Shandong, People's Republic of China.
| | - Li Yang
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Mansoor-Ul Hasan
- Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Shandong University, 324 Jingwu Rd, Jinan, 250021, Shandong, People's Republic of China
| | - Bin Yao
- Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Shandong University, 324 Jingwu Rd, Jinan, 250021, Shandong, People's Republic of China
| | - Chao Wu
- Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Shandong University, 324 Jingwu Rd, Jinan, 250021, Shandong, People's Republic of China
| | - Xu Zhang
- Department of Radiology, Shandong Chest Hospital, Jinan, 250021, Shandong, People's Republic of China
| | - Weibo Chen
- Philips Healthcare, Shanghai, People's Republic of China
| | - Queenie Chan
- Philips Healthcare, Shanghai, People's Republic of China
| | - Lebin Wu
- Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Shandong University, 324 Jingwu Rd, Jinan, 250021, Shandong, People's Republic of China
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22
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Robbins NM, Shah V, Benedetti N, Talbott JF, Chin CT, Douglas VC. Magnetic resonance neurography in the diagnosis of neuropathies of the lumbosacral plexus: a pictorial review. Clin Imaging 2016; 40:1118-1130. [PMID: 27454861 DOI: 10.1016/j.clinimag.2016.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/17/2016] [Accepted: 07/07/2016] [Indexed: 11/20/2022]
Abstract
Magnetic resonance neurography (MRN) is an important tool to detect abnormalities of peripheral nerves. This pictorial review demonstrates the MRN features of a variety of neuropathies affecting the lumbosacral plexus (LSP) and lower extremity nerves, drawn from over 1200 MRNs from our institution and supplemented by the literature. Abnormalities can be due to spinal compression, extraspinal compression, malignancy, musculoskeletal disease, iatrogenesis, inflammation, infection, and idiopathic disorders. We discuss indications and limitations of MRN in diagnosing LSP neuropathies. As MRN becomes more widely used, physicians must become familiar with the differential diagnosis of abnormalities detectable with MRN of the LSP.
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Affiliation(s)
- Nathaniel M Robbins
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Vinil Shah
- Department of Radiology and Biomedical Engineering, University of California San Francisco, San Francisco, California, USA
| | - Nancy Benedetti
- Department of Radiology and Biomedical Engineering, University of California San Francisco, San Francisco, California, USA
| | - Jason F Talbott
- Department of Radiology and Biomedical Engineering, University of California San Francisco, San Francisco, California, USA
| | - Cynthia T Chin
- Department of Radiology and Biomedical Engineering, University of California San Francisco, San Francisco, California, USA
| | - Vanja C Douglas
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
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23
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Oudeman J, Coolen BF, Mazzoli V, Maas M, Verhamme C, Brink WM, Webb AG, Strijkers GJ, Nederveen AJ. Diffusion-prepared neurography of the brachial plexus with a large field-of-view at 3T. J Magn Reson Imaging 2015; 43:644-54. [DOI: 10.1002/jmri.25025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 07/22/2015] [Indexed: 12/20/2022] Open
Affiliation(s)
- Jos Oudeman
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
| | - Bram F. Coolen
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
| | - Valentina Mazzoli
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
- Biomedical NMR; Department of Biomedical Engineering; Eindhoven University of Technology; Nijmegen The Netherlands
- Orthopaedic Research Lab; Radboud University Medical Center; Nijmegen The Netherlands
| | - Mario Maas
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
| | - Camiel Verhamme
- Department of Neurology; Academic Medical Center; Amsterdam The Netherlands
| | - Wyger M. Brink
- Department of Radiology; Leiden University Medical Center; Leiden The Netherlands
| | - Andrew G. Webb
- Department of Radiology; Leiden University Medical Center; Leiden The Netherlands
| | - Gustav J. Strijkers
- Biomedical NMR; Department of Biomedical Engineering; Eindhoven University of Technology; Nijmegen The Netherlands
- Biomedical Engineering and Physics; Academic Medical Center; Amsterdam The Netherlands
| | - Aart J. Nederveen
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
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24
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Grisold W, Grisold A. Cancer around the brain. Neurooncol Pract 2014; 1:13-21. [PMID: 26034610 DOI: 10.1093/nop/npt002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 12/11/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neuro-oncologists are familiar with primary brain tumors, intracerebral metastases meningeal carcinomatosis and extracerebral intracranial tumors as meningeoma. For these conditions, and also some other rare tumor entities several treatment options exist. Cancer can also involve structures around the brain as the dura, the base of the skull, the cavities of the skull and tissue around the bony skull, the skin, the tissue of the neck. and either compress, invade or spread in the central or peripheral nervous system. METHODS A systematic literature research was conducted determining symptoms and signs, tumor sites of nerve invasion, tumor types, diagnostic techniques, mechanisms of nerve invasion, and important differential diagnosis. Additional cases from own experience were added for illustration. RESULTS The mechanisms of tumor invasion of cranial nerves is heterogenous and not only involves several types of invasion, but also spread along the cranial nerves in antero- and retrograde fashion and even spread into different nerve territories via anastomosis. In addition the concept of angiosomas may have an influence on the spread of metastases. CONCLUSION In addition to the well described tumor spread in meningeal carcinomatosis and base of the skull metastases, dural spread, lesions of the bony skull, the cavities of the skull and skin of the face and tissue of the neck region need to be considered, and have an impact on therapeutic decisions.
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Affiliation(s)
- Wolfgang Grisold
- Department Neurology , KFJ Hospital Vienna , Vienna, Austria (W.G.); Department of Neurology , University Hospital of Vienna , Vienna, Austria (A.G.)
| | - Anna Grisold
- Department Neurology , KFJ Hospital Vienna , Vienna, Austria (W.G.); Department of Neurology , University Hospital of Vienna , Vienna, Austria (A.G.)
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