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Park JY, Lee MJ, Kim HJ, Nam JW. Evaluation of peripheral nerve injury according to the severity of damage using 18F-FDG PET/MRI in a rat Model of sciatic nerve injury. Neurol Res 2024; 46:356-366. [PMID: 38402903 DOI: 10.1080/01616412.2024.2321774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES We ascertained that the PET scan may be a valuable imaging modality for the noninvasive, objective diagnosis of neuropathic pain caused by peripheral nerve injury through the previous study. This study aimed to assess peripheral nerve damage according to severity using18F-FDG PET/MRI of the rat sciatic nerve. METHODS Eighteen rats were divided into three groups: 30-second (G1), 2-minute (G2), and 5-minute (G3) crushing injuries. The severity of nerve damage was measured in the third week after the crushing injury using three methods: the paw withdrawal threshold test (RevWT), standardized uptake values on PET (SUVR), and intensity analysis on immunohistochemistry (IntR). RESULTS There were significant differences between G1 and G3 in both SUVR and IntR (p = 0.012 and 0.029, respectively), and no significant differences in RevWT among the three groups (p = 0.438). There was a significant difference in SUVR (p = 0.012), but no significant difference in IntR between G1 and G2 (p = 0.202). There was no significant difference between G2 and G3 in SUVR and IntR (p = 0.810 and 0.544, respectively). DISCUSSION Although PET did not show results consistent with those of immunohistochemistry in all respects, this study demonstrated that PET uptake tended to increase with severe nerve damage. If this research is supplemented by further experiments, PET/MRI can be used as an effective diagnostic modality.
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Affiliation(s)
- Jong Yeol Park
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Mi Jee Lee
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Hyung Jun Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Jung Woo Nam
- Department of Oral and Maxillofacial Surgery, Sanbon Dental Hospital, Wonkwang University, Gunpo-si, Republic of Korea
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Telleman JA, Sneag DB, Visser LH. The role of imaging in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:19-42. [PMID: 38697740 DOI: 10.1016/b978-0-323-90108-6.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Electrodiagnostic testing (EDX) has been the diagnostic tool of choice in peripheral nerve disease for many years, but in recent years, peripheral nerve imaging has been used ever more frequently in daily clinical practice. Nerve ultrasound and magnetic resonance (MR) neurography are able to visualize nerve structures reliably. These techniques can aid in localizing nerve pathology and can reveal significant anatomical abnormalities underlying nerve pathology that may have been otherwise undetected by EDX. As such, nerve ultrasound and MR neurography can significantly improve diagnostic accuracy and can have a significant effect on treatment strategy. In this chapter, the basic principles and recent developments of these techniques will be discussed, as well as their potential application in several types of peripheral nerve disease, such as carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), radial neuropathy, brachial and lumbosacral plexopathy, neuralgic amyotrophy (NA), fibular, tibial, sciatic, femoral neuropathy, meralgia paresthetica, peripheral nerve trauma, tumors, and inflammatory neuropathies.
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Affiliation(s)
- Johan A Telleman
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Leo H Visser
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
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Gasparotti R, Salvalaggio A, Corbo D, Agazzi G, Cacciavillani M, Lozza A, Fenu S, De Vigili G, Tagliapietra M, Fabrizi GM, Pareyson D, Obici L, Briani C. Magnetic resonance neurography and diffusion tensor imaging of the sciatic nerve in hereditary transthyretin amyloidosis polyneuropathy. J Neurol 2023; 270:4827-4840. [PMID: 37329346 PMCID: PMC10511361 DOI: 10.1007/s00415-023-11813-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023]
Abstract
The therapeutic advance in hereditary transthyretin amyloidosis (ATTRv amyloidosis) requires quantitative biomarkers of nerve involvement in order to foster early diagnosis and monitor therapy response. We aimed at quantitatively assessing Magnetic Resonance Neurography (MRN) and Diffusion Tensor Imaging (DTI) properties of the sciatic nerve in subjects with ATTRv-amyloidosis-polyneuropathy (ATTRv-PN) and pre-symptomatic carriers (ATTRv-C). Twenty subjects with pathogenic variants of the TTR gene (mean age 62.20 ± 12.04 years), 13 ATTRv-PN, and 7 ATTRv-C were evaluated and compared with 20 healthy subjects (mean age 60.1 ± 8.27 years). MRN and DTI sequences were performed at the right thigh from the gluteal region to the popliteal fossa. Cross-sectional-area (CSA), normalized signal intensity (NSI), and DTI metrics, including fractional anisotropy (FA), mean (MD), axial (AD), and radial diffusivity (RD) of the right sciatic nerve were measured. Increased CSA, NSI, RD, and reduced FA of sciatic nerve differentiated ATTRv-PN from ATTRv-C and healthy subjects at all levels (p < 0.01). NSI differentiated ATTRv-C from controls at all levels (p < 0.05), RD at proximal and mid-thigh (1.04 ± 0.1 vs 0.86 ± 0.11 p < 0.01), FA at mid-thigh (0.51 ± 0.02 vs 0.58 ± 0.04 p < 0.01). According to receiver operating characteristic (ROC) curve analysis, cutoff values differentiating ATTRv-C from controls (and therefore identifying subclinical sciatic involvement) were defined for FA, RD, and NSI. Significant correlations between MRI measures, clinical involvement and neurophysiology were found. In conclusion, the combination of quantitative MRN and DTI of the sciatic nerve can reliably differentiate ATTRv-PN, ATTRv-C, and healthy controls. More important, MRN and DTI were able to non-invasively identify early subclinical microstructural changes in pre-symptomatic carriers, thus representing a potential tool for early diagnosis and disease monitoring.
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Affiliation(s)
- Roberto Gasparotti
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili Hospital, P.Le Spedali Civili 1, 25123, Brescia, Italy.
| | - Alessandro Salvalaggio
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
- Padova Neuroscience Center (PNC), University of Padova, Padua, Italy
| | - Daniele Corbo
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili Hospital, P.Le Spedali Civili 1, 25123, Brescia, Italy
| | - Giorgio Agazzi
- Neuroradiology Unit, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | | | - Alessandro Lozza
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Fenu
- Rare Neurological Diseases Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Grazia De Vigili
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matteo Tagliapietra
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gian Maria Fabrizi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Davide Pareyson
- Rare Neurological Diseases Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Obici
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Briani
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
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Qin Y, Liu J, Zhang X, Fan X, Li G, Chang Y, Li L. To explore the pathogenesis of Bell's palsy using diffusion tensor image. Sci Rep 2023; 13:15298. [PMID: 37714930 PMCID: PMC10504306 DOI: 10.1038/s41598-023-42570-8] [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: 06/12/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023] Open
Abstract
To explore the pathogenesis of Bell's palsy using the diffusion tensor image on 3.0 T MR. The healthy people and the patients with Bell's palsy underwent intraparotid facial nerve scanning by using the DTI and T1 structural sequence at 3.0 T MR. The raw DTI data were performed affine transformation and nonlinear registration in the common MNI152_T1 space and resampled to the 0.4 mm3 voxel size. A group of 4 spherical seed regions were placed on the intratemporal facial nerves in the common space, bilaterally and symmetrically. The DTI data in the common space were used to track the intratemporal facial nerve fibers by using TrackVis and its Diffusion Toolkit. Each tractography was used to construct the maximum probability map (MPM) according to the majority rule. The fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were calculated and extracted on the basis of MPM. For healthy people, there was no significant difference in FA, MD, RD and AD of bilateral facial nerves. For patients with Bell's palsy, there was no significant difference in AD, there was significant difference in FA, MD and RD between the affected nerve and the healthy nerve (P < 0.02). This study showed that the myelin sheath injury of the intratemporal facial nerve is the main cause of Bell's palsy. Most neural axons are not damaged. The results may explain the pathogenesis of the Bell's palsy, which is self-limited for most cases.
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Affiliation(s)
- Yi Qin
- Radiology Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China
| | - Jihua Liu
- Radiology Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China.
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China.
| | - Xuening Zhang
- Radiology Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, He Xi District, Tianjin, 300211, China
| | - Xiaonong Fan
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China
| | - Guiping Li
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China
| | - Yinghui Chang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China
| | - Li Li
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China
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Kim KH, Lee MH, Park SY, Kim HJ, Chee CG, Yoon MA, Chung HW, Lee SH. Ulnar neuropathy at the elbow: associations of pre-operative DTI parameters with clinical outcomes after cubital tunnel decompression. Eur Radiol 2023; 33:6351-6358. [PMID: 37014404 DOI: 10.1007/s00330-023-09562-8] [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: 10/03/2022] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES To evaluate whether DTI parameters of the ulnar nerve at the elbow are associated with clinical outcomes in patients receiving cubital tunnel decompression (CTD) surgery for ulnar neuropathy. METHODS This retrospective study included 21 patients with cubital tunnel syndrome who received CTD surgery between January 2019 and November 2020. All patients underwent pre-operative elbow MRI, including DTI. Region-of-interest analysis was performed on the ulnar nerve at three levels around the elbow: above (level 1), cubital tunnel (level 2), and below (level 3). Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were calculated on three sections at each level. Clinical data on symptom improvement in respect to pain and tingling sensation after CTD were recorded. Logistic regression analysis was used to compare DTI parameters of the nerve at three levels and the entire nerve course between patients with and without symptom improvement after CTD. RESULTS After CTD, 16 patients showed improvement in symptoms, but five did not. ROC analysis of DTI parameters showed that AUCs of FA, AD, and MD were higher at level 1 than at levels 2 and 3, with FA showing the highest AUC (level 1: FA, 0.7104 [95% CI, 0.5206-0.9002] vs AD, 0.6521 [95% CI, 0.4900-0.8142] vs MD, 0.6153 [95% CI, 0.4187-0.8119]). CONCLUSION In patients who underwent CTD surgery for ulnar neuropathy at the elbow, the DTI parameters of FA, AD, and MD above the cubital tunnel level were associated with clinical outcomes, with FA showing the strongest associations. KEY POINTS • After CTD surgery for ulnar neuropathy at the elbow, persistent symptoms may be observed, depending on symptom severity. • DTI parameters of the ulnar nerve at the elbow showed differences in their capacity for discriminating between patients with and without symptom improvement following CTD surgery, with this capacity depending on the nerve level at the elbow. • FA, AD, and MD measured above the cubital tunnel on pre-operative DTI may be associated with surgical outcomes, with FA showing the strongest association (AUC at level 1, 0.7104 [95% CI, 0.5206-0.9002]).
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Affiliation(s)
- Kyung Ho Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
- Department of Radiology, BNS Neurosurgery, 68, Yangpyeong-ro, Yeongdeungpo-gu, Seoul, South Korea
| | - Min Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Sun-Young Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Choong Guen Chee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Min A Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sang Hoon Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Martín-Noguerol T, Barousse R, Wessell DE, Rossi I, Luna A. Clinical applications of skeletal muscle diffusion tensor imaging. Skeletal Radiol 2023; 52:1639-1649. [PMID: 37083977 DOI: 10.1007/s00256-023-04350-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023]
Abstract
Diffusion tensor imaging (DTI) may allow the determination of new threshold values, based on water anisotropy, to differentiate between healthy muscle and various pathological processes. Additionally, it may quantify treatment monitoring or training effects. Most current studies have evaluated the potential of DTI of skeletal muscle to assess sports-related injuries or therapy, and training monitoring. Another critical area of application of this technique is the characterization and monitoring of primary and secondary myopathies. In this manuscript, we review the application of DTI in the evaluation of skeletal muscle in these and other novel clinical scenarios, with emphasis on the use of quantitative imaging-derived biomarkers. Finally, the main limitations of the introduction of DTI in the clinical setting and potential areas of future use are discussed.
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Affiliation(s)
| | | | | | | | - Antonio Luna
- MRI Unit, Radiology Department, HT Médica, Jaén, Spain
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Wang C, Fu L, Liang L, Zhou J. Application of magnetic resonance neuroimaging in determining the relationship between tumors and peripheral nerves. Am J Transl Res 2023; 15:4678-4686. [PMID: 37560227 PMCID: PMC10408530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/26/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is commonly used to analyze the relationship between tumors and nerves before surgery. However, the application value of diffusion tensor imaging (DTI), diffusion weighted imaging (DWI), and post-processing techniques needs further elucidation. PURPOSE To assess the value of DTI, DWI, and various post-processing techniques in determining the relationship between tumors and nerves. MATERIAL AND METHODS The participants were 42 patients diagnosed with peripheral nerve-related tumors and 20 healthy controls. DTI and DWI scans were performed before surgery, and then DTI unidirectional maximum intensity projection (MIP) post-processing and DWI subtraction of unidirectionally encoded images for suppression of heavily isotropic objects (DWISUSHI) postprocessing techniques were used to observe the relationship between the mass and the target nerves. The mean apparent diffusion coefficient (ADC) of nerves was compared among the target neural origin group, non-target neural origin group, and healthy control group using the paired Wilcoxon rank-sum test. RESULTS The diagnostic coincidence rates of preoperative DTI and DWI findings with postoperative pathology were 88.1% and 100%, respectively. DTI images were of poor quality when compared to DWISUSHI (P < 0.05). The mean ADC value of the target neural origin group was greater than that of the non-target neural origin group and the healthy control group (P < 0.05). CONCLUSION Both DTI and DWISUSHI can stereoscopically display the relationship between peripheral nerves and tumors, but the latter contributes to better quality of the reconstructed images.
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Affiliation(s)
| | | | - Liang Liang
- Department of Radiology, Li Huili Hospital of Ningbo Medical CenterNingbo 315041, Zhejiang, P. R. China
| | - Jinlong Zhou
- Department of Radiology, Li Huili Hospital of Ningbo Medical CenterNingbo 315041, Zhejiang, P. R. China
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Abstract
ABSTRACT Magnetic resonance neurography of the brachial plexus (BP) is challenging owing to its complex anatomy and technical obstacles around this anatomic region. Magnetic resonance techniques to improve image quality center around increasing nerve-to-background contrast ratio and mitigating imaging artifacts. General considerations include unilateral imaging of the BP at 3.0 T, appropriate selection and placement of surface coils, and optimization of pulse sequences. Technical considerations to improve nerve conspicuity include fat, vascular, and respiratory artifact suppression techniques; metal artifact reduction techniques; and 3-dimensional sequences. Specific optimization of these techniques for BP magnetic resonance neurography greatly improves image quality and diagnostic confidence to help guide nonoperative and operative management.
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Chen Y, Pan Z, Meng F, Yu X, Xu Q, Huang L, Liang Q, Wu Y, Lin X. Magnetic resonance imaging assessment of the therapeutic effect of combined electroacupuncture and stem cells in acute peripheral nerve injury. Front Cell Neurosci 2022; 16:1065557. [PMID: 36605615 PMCID: PMC9807880 DOI: 10.3389/fncel.2022.1065557] [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: 10/09/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives: This study aimed to evaluate the therapeutic effect of a combination of Bone Mesenchymal stem cells (BMSCs) transplantation and Electroacupuncture (EA) for acute sciatic nerve injury in rats using magnetic resonance. Methods: Ninety-two male adult healthy Sprague-Dawley rats were randomly divided into the EA+BMSCs group, EA group, MSCs group, and PBS group (control). Electroacupuncture was performed on a rat receiving EA treatment at Huantiao (GB30) and Zusanli (ST36). T2 values and diffusion tensor imaging (DTI) derived from multiparametric magnetic resonance imaging (MRI), histological assessments, and immunohistochemistry was used to monitor nerve regeneration. Walking track analysis was used to assess nerve functional recovery. Repeated-measures one-way analysis of variance was used to evaluate the significance of T2, DTI, and SFI values among the four groups. One-way analysis of variance was used for comparing the histological characteristics. Bonferroni test was used for multiple pairwise comparisons at each time point. Results: In terms of FA, the EA+BMSCs and EA groups had faster recovery than PBS (control) in all time points after surgery, and the EA+BMSCs group recovered better than the BMSCs group at 3 weeks (P ≤ 0.008). FA values were higher in the EA group than in the BMSCs group at 4 weeks (P ≤ 0.008). In terms of RD, the EA+BMSCs group recovered better than the BMSCs group at 2 and 4 weeks (P ≤ 0.008). Immunofluorescence staining for axon guidance molecule netrin-1 revealed that it was significantly higher in the EA+BMSCs subgroup and EA subgroup than it was in the control (PBS) subgroup at 1-3 weeks (P < 0.001). Immunofluorescence staining for S100 showed the continuity of nerve fibers recovered more quickly in the EA+BMSCs subgroup than in the BMSCs subgroup. Conclusion: Our research revealed that a combination of MSCs and EA can provide both topological and biomolecular guidance to promote axonal extension, myelin regeneration, and functional recovery after PNI. EA not only promotes nerve repair on its own, but also enhanced the beneficial effects of stem cell treatment and the secretion of netrin 1, a guidance regeneration factor, and promotes the orderly growth of nerve fibers. These PNI repairs could be monitored non-invasively and in situ by MRI. The FA and RD values derived from MRI could be sensitive biomarkers to reflect the PNI repair process.
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Affiliation(s)
- Yueyao Chen
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital (The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine), Shenzhen, China
| | - Zhongxian Pan
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital (The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine), Shenzhen, China
| | - Fanqi Meng
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital (The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine), Shenzhen, China
| | - Xuewen Yu
- Department of Pathology, Shenzhen Traditional Chinese Medicine Hospital (The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine), Shenzhen, China
| | - Qian Xu
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital (The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine), Shenzhen, China
| | - Leyu Huang
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital (The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine), Shenzhen, China
| | - Qiumei Liang
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital (The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine), Shenzhen, China
| | | | - Xiaofeng Lin
- Department of Nuclear Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China,*Correspondence: Xiaofeng Lin
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Graesser EA, Dy CJ, Brogan DM. Future Considerations in the Diagnosis and Treatment of Compressive Neuropathies of the Upper Extremity. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022. [PMID: 37521547 PMCID: PMC10382897 DOI: 10.1016/j.jhsg.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Compressive neuropathies of the upper extremity are among the most common conditions seen by hand surgeons. The diagnoses of carpal tunnel syndrome and cubital tunnel syndrome have traditionally been made by a combination of history, physical examination, and electrodiagnostic testing. However, findings can be nonspecific and electrodiagnostic testing is invasive for the patient. The diagnosis of compressive neuropathies continues to evolve as technology advances, and newer diagnostic modalities predominantly focus on preoperative diagnostic imaging with ultrasound and magnetic resonance imaging/neurography. With the advent of cheaper, faster, and less invasive imaging, the future may bring a paradigm shift away from electrophysiology as the gold standard for the preoperative diagnosis of compressive neuropathies. Intraoperative imaging of nerve health is an emerging concept that warrants further investigation, whereas postoperative imaging of nerve recovery with ultrasound and magnetic resonance imaging currently has a limited role because of nonspecific findings and potential for misinterpretation. Advances in surgical treatment of compressive neuropathies appear to center around the use of imaging for less invasive neurolysis techniques and other adjunctive treatments with nerve decompression. The management of failed peripheral nerve decompressions and recurrent compressive neuropathies remains challenging.
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Marin A, Savescu M, Marin G, Dricu A, Parasca S, Giuglea C. Evaluation of muscle atrophy after sciatic nerve defect repair – experimental model. ROMANIAN JOURNAL OF MILITARY MEDICINE 2022. [DOI: 10.55453/rjmm.2022.125.3.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Peripheral nerve injuries are one of the most important causes for disability generating considerable costs around the world. Appropriate assessment of the extent of peripheral nerve lesions and the choice of the right therapeutic protocol remain some of the biggest challenges. Non-invasive neuroimaging approaches are suitable in managing peripheral nerve repairs, providing in the same time accuracy details in structural neural detection, with minimal discomfort at a low cost. Medical imaging technology development has led to progress in examination of peripheral nervous system, using a series of tools and methods, such as: ultrasonography (US), positron emission tomography (PET), magnetic resonance imaging (MRI) and magnetic diffusion tensor imaging (DTI). In this study, we evaluated the regeneration process in Wistar rats after sciatic nerve defects repair with 4 different techniques (i.e. nerve graft, rat aorta used as a nerve conduit, rat aorta filled with platelet rich plasma (PRP) and rat aorta filled with stem cells) by using MRI investigation alongside the clinical evaluation. Our results showed that among the 4 batches, the PRP batch had the best results in muscle atrophy condition (both on MRI scan and on gastrocnemius index); on the second place the stem cell batch, then the nerve graft batch and finally the aortic conduit batch. MRI proved to be a reliable non-invasive monitoring method and showed good result in correlation with the footprint test (sciatic functional index) and the gastrocnemius index
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Wu P, Huang C, Shi B, Jin A. Comparison of region-of-interest delineation methods for diffusion tensor imaging in patients with cervical spondylotic radiculopathy. BMC Musculoskelet Disord 2022; 23:677. [PMID: 35840941 PMCID: PMC9284815 DOI: 10.1186/s12891-022-05639-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 07/06/2022] [Indexed: 11/20/2022] Open
Abstract
Background Diffusion tensor imaging is a promising technique for determining the responsible lesion of cervical radiculopathy, but the selection and delineation of the region of interest (ROI) affect the results. This study explored the impact of different ROI sketching methods on the repeatability and consistency of DTI measurement values in patients with cervical spondylotic radiculopathy (CSR). Methods This retrospective study included CSR patients who underwent DTI imaging. The images were analyzed independently by two radiologists. Four delineation methods were used: freehand method, maximum roundness, quadrilateral method, and multi-point averaging method. They re-examined the images 6 weeks later. The intra-class correlation coefficient (ICC) was used to investigate the consistency between the two measurements and the reproducibility between two radiologists. Results Forty-two CSR patients were included in this study. The distribution of the compressed nerve roots was five C4, eight C5, sixteen C6, eleven C7, and two C8. No differences were found among the four methods in fractional anisotropy (FA) or apparent diffusion coefficient (ADC), irrespective of radiologists (all P>0.05). Similar results were observed between the first and second measurements (all P>0.05), but some significant differences were observed for radiologist 2 for the four-small rounds method (P=0.033). The freehand and single largest circle methods were the two methods with the highest ICC between the two measurements and the two radiologists (all ICC >0.90). Conclusion The freehand and single largest circle methods were the most consistent methods for delineating DTI ROI in patients with CSR.
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Affiliation(s)
- Penghuan Wu
- Shaoguan First People's Hospital, Affiliated Shaoguan First People's Hospital, Southern Medical University, Guangdong, China
| | - Chengyan Huang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Benchao Shi
- Department of Spinal Surgery, Orthopedics Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Anmin Jin
- Department of Spinal Surgery, Orthopedics Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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13
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Vo NQ, Hoang NT, Nguyen DD, Nguyen THD, Le TB, Le NTN, Nguyen TT. Quantitative parameters of diffusion tensor imaging in the evaluation of carpal tunnel syndrome. Quant Imaging Med Surg 2022; 12:3379-3390. [PMID: 35655836 PMCID: PMC9131322 DOI: 10.21037/qims-21-910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/16/2022] [Indexed: 11/30/2023]
Abstract
BACKGROUND To explore the value of diffusion tensor imaging (DTI)-derived metrics in quantitative evaluation of carpal tunnel syndrome (CTS). METHODS This prospective cross-sectional study included 39 wrists from 24 symptomatic CTS patients, who underwent clinical, electrophysiological, and magnetic resonance imaging (MRI) evaluations. In addition, 10 wrists of 6 healthy participants were included as controls. Clinical and nerve conduction study (NCS) findings were evaluated and graded according to the Boston Carpal Tunnel Questionnaire (BCTQ) and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM), respectively. We performed MRI using a 1.5 Tesla scanner. Mean diffusivity (MD), fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) of the median nerve at the distal radioulnar joint (DRUJ) (d), the inlet of the carpal tunnel (CT) at the pisiform level (i), the middle of the CT (m) and the outlet of the CT at the level of the hook of hamate (o), cross-sectional area at the inlet of the CT (iCSA), and the difference between MD and FA of the DRUJ and the outlet of CT (Delta MD and Delta FA) were measured. RESULTS The CTS patients had significantly lower FA [for example, oFA: mean difference 0.09, 95% confidence interval (CI): 0.05 to 0.12] and significantly higher MD than healthy participants (for example, iMD: mean difference 0.3, 95% CI: 0.03 to 0.57). There was a negative correlation between iCSA with iFA and between mFA and oFA (-0.5 CONCLUSIONS The DTI-derived quantitative metrics add potential value to the evaluation of CTS. Alterations in the FA of the median nerve along the CT are the most significant features of CTS and reflect the degree of median nerve compression and clinical deficit. With a cutoff value of 0.45, FA at the carpal outlet has a sensitivity and specificity of 87.5% and 85.7% in the diagnosis of CTS, respectively.
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Affiliation(s)
- Nhu Quynh Vo
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Ngoc Thanh Hoang
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Duy Duan Nguyen
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thi Hieu Dung Nguyen
- Department of Physiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Trong Binh Le
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Nghi Thanh Nhan Le
- Department of Surgery, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thanh Thao Nguyen
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
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14
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Tiryaki S, Celtik U, Eraslan C, Divarci E, Tekin A, Ozok G, Ergun O, Celik A, Calli C, Avanoglu A, Ulman I. Diffusion tensor imaging in anorectal malformations: a pilot study for the evaluation of lumbosacral plexus. Pediatr Surg Int 2022; 38:609-616. [PMID: 35129658 DOI: 10.1007/s00383-022-05077-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Neurogenic bladder with anorectal malformations (ARM) is a well-known yet understudied topic. Diffusion tensor imaging (DTI) is a special usage of MRI that can evaluate peripheric nerves. The aim of this study is to evaluate the lumbosacral plexuses of patients with ARM using DTI. PATIENTS AND METHODS Patients with ARM willing to participate were included. Patient files were reviewed, a questionnaire was made, and DTI was performed. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were computed for the right and left lumbosacral plexuses. RESULTS There were 18 patients and 12 controls. Groups were similar in terms of sex (p = 0.232) and age (p = 0.853). There was a significant difference only for ADC of the left plexus. There was visible asymmetry in tractographies and DTI parameters of two patients with severely deformed pelvises (image 1) but also in another patient with a normal sacrum. In addition, despite asymmetry, FA and ADC were similar to controls also in these patients. CONCLUSION This is the first study presenting quantitative data about the lumbosacral plexus in ARM. We think the most interesting finding of this study was observing the normal values even in the patients with severely malformed sacrum which is yet to be validated with further studies.
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Affiliation(s)
- Sibel Tiryaki
- Division of Pediatric Urology, Department of Pediatric Surgery, Ege University, 35100, Izmir, Turkey.
| | - Ulgen Celtik
- Department of Pediatric Surgery, Ege University, Izmir, Turkey
| | - Cenk Eraslan
- Division of Neuroradiology, Department of Radiology, Ege University, Izmir, Turkey
| | - Emre Divarci
- Department of Pediatric Surgery, Ege University, Izmir, Turkey
| | - Ali Tekin
- Division of Pediatric Urology, Department of Pediatric Surgery, Ege University, 35100, Izmir, Turkey
| | - Geylani Ozok
- Department of Pediatric Surgery, Ege University, Izmir, Turkey
| | - Orkan Ergun
- Department of Pediatric Surgery, Ege University, Izmir, Turkey
| | - Ahmet Celik
- Department of Pediatric Surgery, Ege University, Izmir, Turkey
| | - Cem Calli
- Division of Neuroradiology, Department of Radiology, Ege University, Izmir, Turkey
| | - Ali Avanoglu
- Division of Pediatric Urology, Department of Pediatric Surgery, Ege University, 35100, Izmir, Turkey
| | - Ibrahim Ulman
- Division of Pediatric Urology, Department of Pediatric Surgery, Ege University, 35100, Izmir, Turkey
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15
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Xiao R, Chen J, Zeng C, Feng X, Li T, Das SK, Li B, Zhang C, Yang H. Development of magnetic resonance imaging of brachial plexus neuralgia. Neurol Sci 2022; 43:1685-1693. [DOI: 10.1007/s10072-022-05915-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
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16
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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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17
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Aggarwal A, Das CJ, Khanna N, Sharma R, Srivastava DN, Goyal V, Netaji A. Role of diffusion tensor imaging in the evaluation of ulnar nerve involvement in leprosy. Br J Radiol 2022; 95:20210290. [PMID: 34558292 PMCID: PMC8722232 DOI: 10.1259/bjr.20210290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Early detection of peripheral neuropathy is extremely important as leprosy is one of the treatable causes of peripheral neuropathy. The study was undertaken to assess the role of diffusion tensor imaging (DTI) in ulnar neuropathy in leprosy patients. METHODS This was a case-control study including 38 patients (72 nerves) and 5 controls (10 nerves) done between January 2017 and June 2019. Skin biopsy proven cases of leprosy, having symptoms of ulnar neuropathy (proven on nerve conduction study) were included. MRI was performed on a 3 T MR system. Mean cross-sectional area, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of ulnar nerve at cubital tunnel were calculated. Additional ancillary findings and appearance of base sequences were evaluated. RESULTS Ulnar nerve showed thickening with altered T2W signal in all the affected nerves, having an average cross-sectional area of 0.26 cm2. Low FA with mean of 0.397 ± 0.19 and high ADC with mean of 1.28 ± 0.427 x 10 -3 mm2/s of ulnar nerve in retrocondylar groove was obtained. In the control group, mean cross-sectional area was 0.71cm2 with mean FA and ADC of 0.53 ± 0.088 and 1.03 ± 0.24 x 10 -3 mm2/s respectively. Statistically no significant difference was seen in diseased and control group. Cut-off to detect neuropathy for FA and ADC is 0.4835 and 1.1020 × 10 -3 mm2/s respectively. CONCLUSION DTI though is challenging in peripheral nerves, however, is proving to be a powerful complementary tool for assessment of peripheral neuropathy. Our study validates its utility in infective neuropathies. ADVANCES IN KNOWLEDGE 1. DTI is a potential complementary tool for detection of peripheral neuropathies and can be incorporated in standard MR neurography protocol.2. In leprosy-related ulnar neuropathy, altered signal intensity with thickening or abscess of the nerve is appreciated along with locoregional nodes and secondary denervation changes along with reduction of FA and rise in ADC value.3. Best cut-offs obtained in our study for FA and ADC are 0.4835 and 1.1020 × 10 -3 mm2/s respectively.
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Affiliation(s)
| | | | - Neena Khanna
- Department of Dermatology, AIIMS, New Delhi, India
| | - Raju Sharma
- Department of Radiology, AIIMS, New Delhi, India
| | | | - Vinay Goyal
- Department of Neurology, AIIMS, New Delhi, India
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18
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Moneo J, Kramer JLK, Nightingale TE, Berger MJ. Can Magnetic Resonance Imaging Reveal Lower Motor Neuron Damage after Traumatic Spinal Cord Injury? A Scoping Review. Neurotrauma Rep 2021; 2:541-547. [PMID: 34901947 PMCID: PMC8655802 DOI: 10.1089/neur.2021.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Restoring muscle function to patients with spinal cord injuries (SCIs) will invariably require a functioning lower motor neuron (LMN). As techniques such as nerve transfer surgery emerge, characterizing the extent of LMN damage associated with SCIs becomes clinically important. Current methods of LMN diagnosis have inherent limitations that could potentially be overcome by the development of magnetic resonance imaging (MRI) biomarkers: specific features on MRI that are indicative of LMN integrity. To identify research on MRI biomarkers of LMN damage in the acute phase after SCI, we searched PubMed, EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials for articles published from inception to April 27, 2021. Overall, 2 of 58 unique articles screened met our inclusion criteria, both of which were small studies. We therefore identify MRI biomarkers of LMN damage overlying SCI as a notable gap in the literature. Because of the lack of existing literature on this specific problem, we further our discussion by examining concepts explored in research characterizing MRI biomarkers of spinal cord and neuronal damage in different contexts that may provide value in future work to identify a biomarker for LMN damage in SCI. We conclude that MRI biomarkers of LMN damage in SCI is an underexplored, but promising, area of research as emerging, function-restoring therapies requiring this information continue to advance.
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Affiliation(s)
- Jethro Moneo
- MD Program, Faculty of Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,School of Kinesiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Michael J Berger
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,School of Kinesiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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19
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Abstract
Neuropathies are a common problem encountered by neurologist in the hospitalized setting. Nerve injury may occur secondary to compression, stretch, and direct trauma, among other causes. Common focal neuropathies include the ulnar, median, and radial nerve in the upper extremities and sciatic, peroneal, and femoral nerve in the lower extremities. Surgical and obstetric risk factors are especially important considerations in evaluation of patients with focal neuropathies. Treatment is either conservative therapy or surgery depending on the mechanism of injury and extent of recovery.
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Affiliation(s)
- Mark Terrelonge
- University of California San Francisco, 400 Parnassus Avenue, 8th Floor, San Francisco, CA 94143, USA.
| | - Laura Rosow
- University of California San Francisco, 400 Parnassus Avenue, 8th Floor, San Francisco, CA 94143, USA
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20
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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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21
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Braga Silva J, Chammas M, Chammas PE, Andrade R, Hochhegger B, Leal BLM. Evaluation of peripheral nerve injury by magnetic resonance neurography: A systematic review. HAND SURGERY & REHABILITATION 2021; 41:7-13. [PMID: 34543765 DOI: 10.1016/j.hansur.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/28/2021] [Accepted: 09/07/2021] [Indexed: 12/01/2022]
Abstract
In view of the limitations of current methods for assessing peripheral nerve injury, there is a need for technical innovations to improve diagnosis, surgical approach and postoperative monitoring. The objective of this study was to conduct a systematic review to analyze the applicability of magnetic resonance neurography in peripheral nerve injuries. The present systematic review focused on the use of magnetic resonance neurography. The literature was searched in the PUBMED, Cochrane Library and Virtual Health Library databases using the PICO method. One hundred sixty-two articles were retrieved with the terms "magnetic resonance imaging" and "peripheral nerve injury", with a filter for the last 10 years (2010-2020). Nineteen were eligible for the review. Most were reviews, with few systematic reviews of randomized controlled trials. Although not included in the recommended protocol, MRI is increasingly used due to its numerous advantages: it is non-invasive, providing objective visualization of neural and perineural tissues, fascicular representation as a result of high resolution, and objective visualization of serial interval images of successful treatment. This is one of the first systematic reviews of the literature regarding the use of magnetic resonance imaging neurography to assess peripheral nerve injury, highlighting the need to implement new imaging techniques in this field of medical practice.
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Affiliation(s)
- Jefferson Braga Silva
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Av. Ipiranga 6681, Partenon, Porto Alegre RS, 90619-900, Brazil; Service of Hand Surgery and Reconstructive Microsurgery, São Lucas Hospital, Centro Clinico PUCRS, Av. Ipiranga 6690, Suite 216, Porto Alegre, RS, 90610-000, Brazil.
| | - Michel Chammas
- Service of hand surgery and peripheral nerve surgery, SOS Main, Hospital Lapeyronie, CHU Montpellier, 371 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Pierre-Emmanuel Chammas
- Service of hand surgery and peripheral nerve surgery, SOS Main, Hospital Lapeyronie, CHU Montpellier, 371 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Rubens Andrade
- Radiology Service, São Lucas Hospital, Brain Institute, São Lucas Hospital, Centro Clinico PUCRS, Av. Ipiranga 6690, Porto Alegre, RS, 90610-000, Brazil
| | - Bruno Hochhegger
- Radiology Service, São Lucas Hospital, Brain Institute, São Lucas Hospital, Centro Clinico PUCRS, Av. Ipiranga 6690, Porto Alegre, RS, 90610-000, Brazil
| | - Bruna Leiria Meréje Leal
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Av. Ipiranga 6681, Partenon, Porto Alegre RS, 90619-900, Brazil
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22
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Chhabra A, Ratakonda R, Zaottini F, Picasso R, Martinoli C. Hand and Wrist Neuropathies: High-resolution Ultrasonography and MR Neurography. Semin Musculoskelet Radiol 2021; 25:366-378. [PMID: 34450661 DOI: 10.1055/s-0041-1730406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
High-resolution ultrasonography (US) and magnetic resonance neurography (MRN) have followed parallel paths for peripheral nerve imaging with little comparison of the two modalities. They seem equally effective to study a variety of neuropathies affecting large and small nerves in the wrist and hand. This article outlines the technical considerations of US and MRN and discusses normal and abnormal imaging appearances of hand and wrist nerves from etiologies such as entrapment, injury, tumor, and proximal and diffuse neuropathy, with specific case illustrations.
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Affiliation(s)
- Avneesh Chhabra
- Radiology and Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Raghu Ratakonda
- Radiology and Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Federico Zaottini
- Radiology Unit, Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Riccardo Picasso
- Radiology Unit, Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carlo Martinoli
- Radiology Unit, Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Abstract
Peripheral nerve imaging is a helpful and sometimes essential adjunct to clinical history, physical examination, and electrodiagnostic studies. Advances in imaging technology have allowed the visualization of nerve structures and their surrounding tissues. The clinical applications of ultrasound and magnetic resonance imaging (MRI) in the evaluation of peripheral nerve disorders are growing exponentially. This article reviews basics of ultrasound and MRI as they relate to nerve imaging, reviews advantages and limitations of each imaging modality, reviews the applications of ultrasound and MRI in disorders of peripheral nerve, and discusses emerging advances in the field.
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Affiliation(s)
- Natalia L Gonzalez
- Department of Neurology, Neuromuscular Division, Duke University, Duke University Hospital, 3403 DUMC, Duke South Clinic 1L, Durham, NC 27710, USA.
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University, Duke University Hospital, 3403 DUMC, Duke South Clinic 1L, Durham, NC 27710, USA
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24
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Ibrahim I, Škoch A, Herynek V, Jírů F, Tintěra J. Magnetic resonance tractography of the lumbosacral plexus: Step-by-step. Medicine (Baltimore) 2021; 100:e24646. [PMID: 33578590 PMCID: PMC10545402 DOI: 10.1097/md.0000000000024646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/22/2020] [Accepted: 01/13/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT MR tractography of the lumbosacral plexus (LSP) is challenging due to the difficulty of acquiring high quality data and accurately estimating the neuronal tracts. We proposed an algorithm for an accurate visualization and assessment of the major LSP bundles using the segmentation of the cauda equina as seed points for the initial starting area for the fiber tracking algorithm.Twenty-six healthy volunteers underwent MRI examinations on a 3T MR scanner using the phased array coils with optimized measurement protocols for diffusion-weighted images and coronal T2 weighted 3D short-term inversion recovery sampling perfection with application optimized contrast using varying flip angle evaluation sequences used for LSP fiber reconstruction and MR neurography (MRN).The fiber bundles reconstruction was optimized in terms of eliminating the muscle fibers contamination using the segmentation of cauda equina, the effects of the normalized quantitative anisotropy (NQA) and angular threshold on reconstruction of the LSP. In this study, the NQA parameter has been used for fiber tracking instead of fractional anisotropy (FA) and the regions of interest positioning was precisely adjusted bilaterally and symmetrically in each individual subject.The diffusion data were processed in individual L3-S2 nerve fibers using the generalized Q-sampling imaging algorithm. Data (mean FA, mean diffusivity, axial diffusivity and radial diffusivity, and normalized quantitative anisotropy) were statistically analyzed using the linear mixed-effects model. The MR neurography was performed in MedINRIA and post-processed using the maximum intensity projection method to demonstrate LSP tracts in multiple planes.FA values significantly decreased towards the sacral region (P < .001); by contrast, mean diffusivity, axial diffusivity, radial diffusivity and NQA values significantly increased towards the sacral region (P < .001).Fiber tractography of the LSP was feasible in all examined subjects and closely corresponded with the nerves visible in the maximum intensity projection images of MR neurography. Usage of NQA instead of FA in the proposed algorithm enabled better separation of muscle and nerve fibers.The presented algorithm yields a high quality reconstruction of the LSP bundles that may be helpful both in research and clinical practice.
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Affiliation(s)
- Ibrahim Ibrahim
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, MR Unit
| | - Antonín Škoch
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, MR Unit
| | - Vít Herynek
- Center for Advanced Preclinical Imaging, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Filip Jírů
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, MR Unit
| | - Jaroslav Tintěra
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, MR Unit
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Imaging manifestations on sequential magnetic resonance imaging in pharyngolaryngeal involvement by varicella zoster virus. J Neurovirol 2021; 27:186-190. [PMID: 33534132 DOI: 10.1007/s13365-021-00953-5] [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: 12/16/2020] [Revised: 01/03/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
Clarifying temporal changes in magnetic resonance imaging (MRI) offers a good chance to understand the pathology of neural lesions; however, such information is scarce in varicella zoster virus (VZV) neuropathies for the glossopharyngeal and vagus nerves. Here, we present the changes in sequential MR images of such a pathology over a period of 12 months from symptom onset.A 27-year-old woman with difficulty in swallowing and hoarseness due to a palatal palsy and arytenoid fixation on the left presented 2 days after onset. MRI revealed a lesion which largely filled the left jugular foramen on T2-weighted images (T2-WI) with high diffusion-weighted imaging (DWI) signals, which has never been previously described, on the 3rd day after onset. The DWI signals were highest on day 3, then deteriorated over 2 months until the signal was only detectable at the intracranial level, but not in the jugular foramen. The glossopharyngeal nerve had returned to normal by 2 months.The time course of the glossopharyngeal and vagus nerve swelling detected on T2-WI suggests that nerve swelling reduces over several months, even though the paralytic symptoms persist. Furthermore, the high DWI signal suggests that nerve swelling was caused by edematous swelling of the nerve fibers, rather than fiber disruption with water displacement in the extracellular space. These findings may provide good clues to speculate on the dynamically changing pathology of VZV neuropathies of the glossopharyngeal and vagus nerves.
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Diagnostic Accuracy of the Magnetic Resonance Imaging in Adult Post-Ganglionic Brachial Plexus Traumatic Injuries: A Systematic Review and Meta-Analysis. Brain Sci 2021; 11:brainsci11020173. [PMID: 33573175 PMCID: PMC7911314 DOI: 10.3390/brainsci11020173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Traumatic brachial plexus injuries are rare but serious consequences of major traumas. Pre-ganglionic lesions are considered irreparable, while post-ganglionic injuries can be potentially treated if an early diagnosis is available. Pre-surgical diagnosis is important to distinguish low-grade from high-grade lesions and to identify their location. The aim of the review is to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in the identification of adult post-ganglionic lesions due to traumatic brachial plexus injuries, compared to intraoperative findings. Methods: Research on the main scientific electronic databases was conducted. Studies of adults with traumatic post-ganglionic brachial plexus injuries were included. The index test was preoperative MRI and the reference standard was surgical exploration. Pooled sensitivity and specificity were calculated. Results: Four studies were included for the systematic review, of which three articles met the inclusion criteria for the meta-analysis. Pooled sensitivity and pooled specificity values resulted high. The sensitivity value is associated with a high heterogeneity index of the selected literature. Conclusion: MRI can be considered, despite the limits, the gold standard exam in morphological evaluation of brachial plexus injuries, particularly in the diagnosis of post-ganglionic traumatic injuries.
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Zheng C, Yang Z, Chen S, Zhang F, Rao Z, Zhao C, Quan D, Bai Y, Shen J. Nanofibrous nerve guidance conduits decorated with decellularized matrix hydrogel facilitate peripheral nerve injury repair. Am J Cancer Res 2021; 11:2917-2931. [PMID: 33456580 PMCID: PMC7806490 DOI: 10.7150/thno.50825] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
Rationale: Peripheral nerve injury (PNI) is a great challenge for regenerative medicine. Nerve autograft is the gold standard for clinical PNI repair. Due to its significant drawbacks, artificial nerve guidance conduits (NGCs) have drawn much attention as replacement therapies. We developed a combinatorial NGC consisting of longitudinally aligned electrospun nanofibers and porcine decellularized nerve matrix hydrogel (pDNM gel). The in vivo capacity for facilitating nerve tissue regeneration and functional recovery was evaluated in a rat sciatic nerve defect model. Methods: Poly (L-lactic acid) (PLLA) was electrospun into randomly oriented (PLLA-random) and longitudinally aligned (PLLA-aligned) nanofibers. PLLA-aligned were further coated with pDNM gel at concentrations of 0.25% (PLLA-aligned/0.25% pDNM gel) and 1% (PLLA-aligned/1% pDNM gel). Axonal extension and Schwann cells migration were evaluated by immunofluorescence staining of dorsal root ganglia cultured on the scaffolds. To fabricate implantable NGCs, the nanofibrous scaffolds were rolled and covered with an electrospun protection tube. The fabricated NGCs were then implanted into a 5 mm sciatic nerve defect model in adult male Sprague-Dawley rats. Nerves treated with NGCs were compared to contralateral uninjured nerves (control group), injured but untreated nerves (unstitched group), and autografted nerves. Nerve regeneration was monitored by an established set of assays, including T2 values and diffusion tensor imaging (DTI) derived from multiparametric magnetic resonance imaging (MRI), histological assessments, and immunostaining. Nerve functional recovery was evaluated by walking track analysis. Results: PLLA-aligned/0.25% pDNM gel scaffold exhibited the best performance in facilitating directed axonal extension and Schwann cells migration in vitro due to the combined effects of the topological cues provided by the aligned nanofibers and the biochemical cues retained in the pDNM gel. Consistent results were obtained in animal experiments with the fabricated NGCs. Both the T2 and fractional anisotropy values of the PLLA-aligned/0.25% pDNM gel group were the closest to those of the autografted group, and returned to normal much faster than those of the other NGCs groups. Histological assessment indicated that the implanted PLLA-aligned/0.25% pDNM gel NGC resulted in the largest number of axons and the most extensive myelination among all fabricated NGCs. Further, the PLLA-aligned/0.25% pDNM gel group exhibited the highest sciatic nerve function index, which was comparable to that of the autografted group, at 8 weeks post-surgery. Conclusions: NGCs composed of aligned PLLA nanofibers decorated with 0.25% pDNM gel provided both topological and biochemical guidance for directing and promoting axonal extension, nerve fiber myelination, and functional recovery. Moreover, T2-mapping and DTI metrics were found to be useful non-invasive monitoring techniques for PNI treatment.
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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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Manoharan D, Sudhakaran D, Goyal A, Srivastava DN, Ansari MT. Clinico-radiological review of peripheral entrapment neuropathies - Part 2 Lower limb. Eur J Radiol 2020; 135:109482. [PMID: 33360825 DOI: 10.1016/j.ejrad.2020.109482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 06/15/2020] [Accepted: 12/14/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE This review discusses the relevant anatomy, etiopathogenesis, current notions in clinical and imaging features as well as management outline of lower limb entrapment neuropathies. METHODS The review is based on critical analysis of the current literature as well as our experience in dealing with entrapment neuropathies of the lower limb. RESULTS The complex anatomical network of nerves supplying the lower extremities are prone to entrapment by a heterogenous group of etiologies. This leads to diverse clinical manifestations making them difficult to diagnose with traditional methods such as clinical examination and electrodiagnostic studies. Moreover, some of these may mimic other common conditions such as disc pain or fibromyalgia leading to delay in diagnosis and increasing morbidity. Addition of imaging improves the diagnostic accuracy and also help in correct treatment of these entities. Magnetic resonance imaging is very useful for deeply situated nerves in pelvis and thigh while ultrasound is well validated for superficial entrapment neuropathies. CONCLUSION The rapidly changing concepts in these conditions accompanied by the advances in imaging has made it essential for a clinical radiologist to be well-informed with the current best practices.
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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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Shafa G, Zuo KJ, Gordon T, Borschel GH. Advances in magnetic resonance imaging for evaluation of peripheral nerve injuries: Diffusion tensor imaging. J Plast Reconstr Aesthet Surg 2020; 74:1101-1160. [PMID: 33386268 DOI: 10.1016/j.bjps.2020.10.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/06/2020] [Accepted: 10/25/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Golsa Shafa
- Neurosciences and Mental Health, SickKids Research Institute, Canada
| | - Kevin J Zuo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Canada
| | - Tessa Gordon
- Neurosciences and Mental Health, SickKids Research Institute, Canada; Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Canada
| | - Gregory H Borschel
- Neurosciences and Mental Health, SickKids Research Institute, Canada; Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Canada.
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Schreiber S, Vielhaber S, Schreiber F, Cartwright MS. Peripheral nerve imaging in amyotrophic lateral sclerosis. Clin Neurophysiol 2020; 131:2315-2326. [DOI: 10.1016/j.clinph.2020.03.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/20/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
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Yang Z, Zheng C, Zhang F, Lin B, Cao M, Tian X, Zhang J, Zhang X, Shen J. Magnetic resonance imaging of enhanced nerve repair with mesenchymal stem cells combined with microenvironment immunomodulation in neurotmesis. Muscle Nerve 2020; 61:815-825. [PMID: 32170960 DOI: 10.1002/mus.26862] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/04/2020] [Accepted: 03/11/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The immuno-microenvironment of injured nerves adversely affects mesenchymal stem cell (MSC) therapy for neurotmesis. Magnetic resonance imaging (MRI) can be used noninvasively to monitor nerve degeneration and regeneration. The aim of this study was to investigate nerve repair after MSC transplantation combined with microenvironment immunomodulation in neurotmesis by using multiparametric MRI. METHODS Rats with sciatic nerve transection and surgical coaptation were treated with MSCs combined with immunomodulation or MSCs alone. Serial multiparametric MRI examinations were performed over an 8-week period after surgery. RESULTS Nerves treated with MSCs combined with immunomodulation showed better functional recovery, rapid recovery of nerve T2, fractional anisotropy and radial diffusivity values, and more rapid restoration of the fiber tracks than nerves treated with MSCs alone. DISCUSSION Transplantation of MSCs in combination with immunomodulation can exert a synergistic repair effect on neurotmesis, which can be monitored by multiparametric MRI.
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Affiliation(s)
- Zehong Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chushan Zheng
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fang Zhang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Binglin Lin
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Minghui Cao
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xuwei Tian
- Department of Radiology, The First People's Hospital of Kashgar, Kashgar, China
| | - Jingzhong Zhang
- The Key Laboratory of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Xiao Zhang
- CAS Key Laboratory of Regenerative Biology, Joint School of Life Sciences, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Jun Shen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Update in the evaluation of peripheral nerves by MRI, from morphological to functional neurography. RADIOLOGIA 2020; 62:90-101. [PMID: 31611009 DOI: 10.1016/j.rx.2019.06.005] [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] [Received: 01/24/2019] [Revised: 05/28/2019] [Accepted: 06/24/2019] [Indexed: 12/11/2022]
Abstract
Imaging studies of peripheral nerves have increased considerably in the last ten years. In addition to the classical and still valid study by ultrasound, new neurographic techniques developed from conventional morphological sequences (including 3D isotropic studies with fat suppression) are making it possible to assess different peripheral nerves and plexuses, including small sensory and/or motor branches, with great precision. Diffusion-weighted sequences and diffusion tensor imaging have opened a new horizon in neurographic studies. This new approach provides morphological and functional information about the internal structure and pathophysiology of the peripheral nerves and diseases that involve them. This update reviews the different MR neurography techniques available for the study of the peripheral nerves, with special emphasis on new sequences based on diffusion.
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Update in the evaluation of peripheral nerves by MRI, from morphological to functional neurography. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2019.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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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Wu F, Wang W, Zhao Y, Liu B, Wang Y, Yang Y, Ren Y, Liu H. MR neurography of lumbosacral nerve roots: Diagnostic value in chronic inflammatory demyelinating polyradiculoneuropathy and correlation with electrophysiological parameters. Eur J Radiol 2020; 124:108816. [PMID: 31923808 DOI: 10.1016/j.ejrad.2020.108816] [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] [Received: 08/23/2019] [Revised: 12/12/2019] [Accepted: 12/26/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE MR neurography(MRN) is an advanced imaging technique to visualize peripheral nerves. Our aim was to determine the value of morphological features of lumbosacral nerve roots on MRN in diagnosing chronic inflammatory demyelinating polyradiculoneuropathy(CIDP) and analyze their correlations with electrophysiological parameters. METHODS MRN of lumbosacral plexus was performed in 21 CIDP patients and 21 healthy volunteers. The cross-sectional areas(CSAs) and signal intensities(SI) of L3 to S1 nerve roots were measured and compared between two groups. Receiver operating characteristic(ROC) curves were plotted to assess the diagnostic accuracy. All patients also underwent nerve conduction studies. Correlations between CSAs and SI of lumbosacral nerve roots and electrophysiological parameters were analyzed. RESULTS Compared with control group, CIDP patients showed significantly increased CSAs and SI from L3 to S1 nerve root (P < 0.001 and P < 0.05 respectively for all nerve roots). The CSAmean and SImean were 28.04 ± 8.55mm2, 1.314 ± 0.199 for patient group and 14.91 ± 2.36mm2,1.155 ± 0.094 for control group. ROC analysis revealed the best diagnostic accuracy for the CSAmean with an area under the curve of 0.968 and optimal cut-off value of 19.20 mm2. CSAs of L5 or S1 nerve root correlated positively with central latency and negatively with conduction velocity of tibial nerve. SI of L5 also had a positive correlation with latency of sural nerve. CONCLUSIONS Evaluation of lumbosacral nerve roots on MRN in a quantitative manner may serve as an important tool to support the diagnosis of CIDP.
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Affiliation(s)
- Fei Wu
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, China.
| | - Weiwei Wang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, China.
| | - Yanyin Zhao
- Department of Neurology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, China.
| | - Bingyou Liu
- Department of Neurology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, China.
| | - Yin Wang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, China.
| | - Yang Yang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, China.
| | - Yan Ren
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, China.
| | - Hanqiu Liu
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, China.
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Upadhyaya V, Upadhyaya DN, Bansal R, Pandey T, Pandey AK. MR neurography in Parsonage-Turner syndrome. Indian J Radiol Imaging 2019; 29:264-270. [PMID: 31741594 PMCID: PMC6857269 DOI: 10.4103/ijri.ijri_269_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/01/2019] [Accepted: 09/04/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Parsonage Turner Syndrome is a well known clinical entity. Several excellent articles have succinctly described Magnetic Resonance Imaging (MRI) findings in PTS. However, these articles have inferred neural involvement in PTS based on the patterns of denervation of muscles in the shoulder region. The aim of this study is to directly visualize the distribution and extent of abnormality in MR Neurography (MRN) of the brachial plexus in known cases of brachial plexus neuritis or Parsonage-Turner Syndrome (PTS). Methods: 15 patients who were diagnosed with PTS based on clinical and electrophysiological findings participated in the study. MRN of the brachial plexus was done in a 1.5T system using a combination of T1W (T1-weighted), T2W (T2-weighted) fat-saturated, STIR (Short Tau Inversion Recovery), 3D STIR SPACE (Sampling Perfection with Application Optimized Contrasts) and 3D T2W SPACE sequences. Findings were recorded and assessed. Results: The age range of our patients was 7-65 years (mean 37.87 years). Most of the patients had unilateral symptoms. All patients had weakness in shoulder abduction. Other common associated complaints included pain in the shoulder/neck/arm and preceding fever. MRN revealed the percentage of involvement of roots, trunks, cords and terminal branches was 53.3%, 46.7%, 40% and 13.3% respectively. Evidence of muscle denervation in the form of edema, fatty infiltration and atrophy was noted in 8 (53.3%) patients. Conclusion: Most of the patients in this study had unilateral involvement on MRN. The roots were the commonest site of involvement followed by the trunks, cords and terminal branches. C5 was the most commonly involved root.
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Affiliation(s)
- Vaishali Upadhyaya
- Department of Radiology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Nirala Nagar, Uttar Pradesh, India
| | - Divya Narain Upadhyaya
- Department of Plastic Surgery, King George's Medical University, Shah Meena Road, Chowk, Lucknow, Uttar Pradesh, India
| | - Richa Bansal
- Department of Radiology, Max Superspecialty Hospital, Saket, New Delhi, India
| | - Tarun Pandey
- Department of Neurosurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Nirala Nagar, Uttar Pradesh, India
| | - Ashok Kumar Pandey
- Department of Neurology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Nirala Nagar, Uttar Pradesh, India
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Choi JS, Seo HG, Oh BM, Choi H, Cheon GJ, Lee SU, Lee SH. 18 F-FDG uptake in denervated muscles of patients with peripheral nerve injury. Ann Clin Transl Neurol 2019; 6:2175-2185. [PMID: 31588693 PMCID: PMC6856607 DOI: 10.1002/acn3.50899] [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: 05/26/2019] [Revised: 08/08/2019] [Accepted: 09/01/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We aimed to investigate the clinical significance of increased uptake in 18 F-fluorodeoxyglucose positron emission tomography in patients with peripheral nerve lesions. METHODS We selected patients with unilateral peripheral nerve lesions confirmed with electromyography who had undergone 18 F-fluorodeoxyglucose positron emission tomography covering the lesions. In the denervated muscles and their contralateral corresponding pairs, a mean (SUVmean) and maximum standardized uptake value (SUVmax) were obtained from 18 F-fluorodeoxyglucose positron emission tomography images. We analyzed the difference in these values between the denervated and normal muscles. The lesion-to-normal ratio of the SUVmean (LNRmean) between each muscle pair was also obtained. Subgroup analysis was performed to find whether these three parameters were related to severity, abundance of abnormal spontaneous activity, and etiology. RESULTS Twenty-three patients with 38 denervated muscles were included. Compared to their normal counterparts, the denervated muscles showed significantly higher SUVmax (1.33 ± 0.49 vs. 1.10 ± 0.37, n = 38, P < 0.001) and SUVmean (0.91 ± 0.31 vs. 0.77 ± 0.28, n = 38, P < 0.001). The muscles with severe neuropathy showed significantly higher LNRmean than those with mild neuropathy (1.30 ± 0.36, n = 19 vs. 1.11 ± 0.24, n = 19; P = 0.046), and the muscles with traumatic neuropathy showed significantly higher LNRmean than those with nontraumatic neuropathy (1.32 ± 0.28, n = 13 vs. 1.14 ± 0.33, n = 23; P = 0.015). INTERPRETATION Denervated muscles with peripheral nerve injury showed higher uptake than normal muscles in 18 F-fluorodeoxyglucose positron emission tomography, and this was associated with severity and etiology.
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Affiliation(s)
- Ji Soo Choi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
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Luzhansky ID, Sudlow LC, Brogan DM, Wood MD, Berezin MY. Imaging in the repair of peripheral nerve injury. Nanomedicine (Lond) 2019; 14:2659-2677. [PMID: 31612779 PMCID: PMC6886568 DOI: 10.2217/nnm-2019-0115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022] Open
Abstract
Surgical intervention followed by physical therapy remains the major way to repair damaged nerves and restore function. Imaging constitutes promising, yet underutilized, approaches to improve surgical and postoperative techniques. Dedicated methods for imaging nerve regeneration will potentially provide surgical guidance, enable recovery monitoring and postrepair intervention, elucidate failure mechanisms and optimize preclinical procedures. Herein, we present an outline of promising innovations in imaging-based tracking of in vivo peripheral nerve regeneration. We emphasize optical imaging because of its cost, versatility, relatively low toxicity and sensitivity. We discuss the use of targeted probes and contrast agents (small molecules and nanoparticles) to facilitate nerve regeneration imaging and the engineering of grafts that could be used to track nerve repair. We also discuss how new imaging methods might overcome the most significant challenges in nerve injury treatment.
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Affiliation(s)
- Igor D Luzhansky
- Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
- The Institute of Materials Science & Engineering, Washington University, St Louis, MO 63130, USA
| | - Leland C Sudlow
- Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - David M Brogan
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Matthew D Wood
- Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Mikhail Y Berezin
- Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
- The Institute of Materials Science & Engineering, Washington University, St Louis, MO 63130, USA
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A study protocol on nerve mobilization induced diffusion tensor imaging values in posterior tibial nerve in healthy controls and in patients with diabetic neuropathy-multigroup pretest posttest design. Contemp Clin Trials Commun 2019; 16:100451. [PMID: 31650071 PMCID: PMC6804550 DOI: 10.1016/j.conctc.2019.100451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/27/2019] [Accepted: 09/14/2019] [Indexed: 12/15/2022] Open
Abstract
Background Diabetic neuropathy is the commonest chronic disabling complication of diabetes which may lead to amputation and compromising patient’s quality of life. It is characterized by pain, sensation loss associated with neural edema. Diffusion tensor imaging parameter i.e. fraction anisotropy determines the free water proton diffusion in the healthy nerve. Since the diabetes leads to altered mechanosensitivity of the posterior tibial nerve thereby, might interferes with the water molecules movement. Therefore the present clinical trial will provide the evidence of improving the diffusion tensor imaging in the diabetic neuropathy directly by targeting the nerve through nerve mobilization treatment. Methods Participants with Type II Diabetes Mellitus induced peripheral neuropathy will be selected randomly on the basis of eligibility criteria and informed consent will be taken. Participants will be recruited into three groups. Group A (experimental group A) will receive neural mobilization technique, Group B (experimental group B) will receive conventional therapy and Group C (control group) will receive sham treatment for 3 weeks. MRI technique, Visual analogue scale and neuropathy specific quality of life questionnaire will be used as assessment tools. Assessment will be taken at baseline and post intervention. Conclusion this clinical trial will provide the evidence of efficacy of nerve mobilization in determining the diffusion tensor imaging (DTI) changes in the posterior tibial nerve in patients with diabetic neuropathy. This trial will also be the first one in itself to look at the treatment induced DTI changes in the peripheral nerve. Trial Registration Clinical Trial Registry of India (CTRI/2019/06/019552).
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Sneag DB, Queler S. Technological Advancements in Magnetic Resonance Neurography. Curr Neurol Neurosci Rep 2019; 19:75. [DOI: 10.1007/s11910-019-0996-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Lee YL, Chen ST, Yang JT, Weng HH, Wang HL, Tsai YH. Diffusivity parameters of diffusion tensor imaging and apparent diffusion coefficient as imaging markers for predicting the treatment response of patients with trigeminal neuralgia. J Neurosurg 2019; 132:1993-1999. [PMID: 31100729 DOI: 10.3171/2019.2.jns183008] [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] [Received: 10/22/2018] [Accepted: 02/19/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is facial pain that is usually caused by neurovascular compression syndrome and is characterized by suddenly intense and paroxysmal pain. Radiofrequency lesioning (RFL) is one of the major treatments for TN, but the treatment response for RFL is sometimes inconsistent, and the recurrence of TN is not uncommon. This study aimed to estimate the outcome predictors of TN treated with RFL by using the parameters of diffusion tensor imaging (DTI). METHODS Fifty-one patients with TN who were treated with RFL were enrolled in the study. MRI was performed in all patients within 1 week before surgery. The visual analog scale was used to evaluate symptom severity at three time points: before, 1 week after, and 3 months after RFL. The involved cisternal segment of the trigeminal nerves was manually selected, and the histograms of each of the diffusivity metrics-including the apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD)-were measured. The differences in the means, as well as the kurtosis and skewness of each of the diffusivity metrics between the nonrecurrent and recurrent groups, were then analyzed using the Mann-Whitney U-test. RESULTS There were significantly lower kurtosis values (a broader peak of the distributional curves) for both FA and ADC in the recurrent group (p = 0.0004 and 0.015, respectively), compared to the nonrecurrent group. The kurtoses of AD and RD, as well as the mean and skewness of all other diffusivity metrics, did not show significant differences between the two groups. CONCLUSIONS The pretreatment diffusivity metrics of DTI and ADC may be feasible imaging biomarkers for predicting the outcome of TN after RFL. A clarification of the kurtosis value of FA and ADC is helpful for determining the prognosis of patients after RFL.
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Affiliation(s)
- Yu-Li Lee
- Departments of1Diagnostic Radiology and
| | | | - Jen-Tsung Yang
- 2Neurosurgery, Chang Gung Memorial Hospital, Chiayi branch, Chiayi; and
| | | | | | - Yuan-Hsiung Tsai
- Departments of1Diagnostic Radiology and.,3College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Du CZ, Li S, Xu L, Zhou QS, Zhu ZZ, Sun X, Qiu Y. Spinal Gorham-Stout syndrome: radiological changes and spinal deformities. Quant Imaging Med Surg 2019; 9:565-578. [PMID: 31143648 DOI: 10.21037/qims.2019.03.17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Gorham-Stout syndrome (GSS) involving the spine is a rare clinical entity, and there is a paucity of comprehensive study on its radiological features. We aimed to present the radiological changes and spinal deformities in patients with spinal GSS. Methods From January 2005 to December 2017, 11 consecutive GSS patients with spinal deformity were identified. Their medical records and imaging features were retrospectively reviewed. Computed tomography (CT) and magnetic resonance imaging (MRI) were used for a precise evaluation of spinal involvement. Posteroanterior and lateral standing radiographs were used to evaluate the spinal deformity. Results CT showed multi-level generalized osteolytic lesions, with ill-defined fluid attenuation adjacent to the osseous changes. MRI demonstrated hyperintense signals on both T1- and T2-weighted images, while the unaffected segments showed normal signal intensity. Seven patients (63.6%) had a dominant feature of kyphosis, and 4 (36.4%) had scoliosis when spinal GSS was diagnosed. Kyphosis variably spanned from C7 to L1, averaged 94° (range, 53° to 158°), and was associated with sagittal imbalance in 4 cases. In our series, the apex of kyphosis and scoliosis coincided within the most seriously osteolytic segment. All patients received medication for GSS. Two adolescents taking Boston braces showed a relatively stable deformity. Four patients received long posterior spinal fusion, but two had fusion failure. Conclusions CT and MRI investigations are important in the initial diagnosis and continued management for spinal GSS. A typical spinal deformity secondary to GSS presents as kyphosis or kyphoscoliosis, which is usually highly variable but highly concordant with osteolysis in terms of span and apex.
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Affiliation(s)
- Chang-Zhi Du
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Song Li
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Liang Xu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Qing-Shuang Zhou
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Ze-Zhang Zhu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Xu Sun
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Yong Qiu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
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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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Koszewicz M, Szydlo M, Gosk J, Wieczorek M, Budrewicz S. Use of collision tests to identify physiological differences between the median and ulnar nerves. Muscle Nerve 2019; 59:470-474. [PMID: 30681158 DOI: 10.1002/mus.26428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/11/2019] [Accepted: 01/20/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Median and ulnar nerves are used in comparative electrophysiological studies. We analyzed the conduction values in these hand nerves in healthy volunteers to find any physiological differences between them. METHODS We performed standard conduction studies and conduction velocity distribution (CVD) tests with estimation of 3 quartiles in 31 healthy right-handed volunteers (17 women, 14 men) with a mean age of 44.8 ± 15.5 years. RESULTS The conduction velocities in all quartiles of CVD tests were statistically faster in the ulnar nerve (P < 0.00001), with no differences in the spread of conduction values and no differences between sides. In the ulnar nerve, CVD velocities in all quartiles were faster in the female group (P < 0.05). DISCUSSION The ulnar nerve has more fibers conducting with high velocities than does the median nerve. Electrophysiological comparisons between hand nerves must be performed carefully. Muscle Nerve 59:470-474, 2019.
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Affiliation(s)
- Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Mariusz Szydlo
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Jerzy Gosk
- Department of Trauma and Hand Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Malgorzata Wieczorek
- Faculty of Earth Sciences and Environmental Management, University of Wrocław, Wroclaw, Poland
| | - Slawomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
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Identification of abnormalities in the lumbar nerve tract using diffusion-weighted magnetic resonance neurography. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:849-854. [DOI: 10.1007/s00586-018-05867-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 01/13/2023]
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Quantitative MR neurography of brachial plexus lesions based on diffusivity measurements. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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The Multidisciplinary Approach to the Diagnosis and Management of Nonobstetric Traumatic Brachial Plexus Injuries. AJR Am J Roentgenol 2018; 211:1319-1331. [DOI: 10.2214/ajr.18.19887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Zhang L, Zhang L, Xue F, Yue K, Peng H, Wu Y, Sha O, Yang L, Ding Y. Brain morphological alteration and cognitive dysfunction in multiple system atrophy. Quant Imaging Med Surg 2018; 8:1030-1038. [PMID: 30598880 DOI: 10.21037/qims.2018.11.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Multiple system atrophy (MSA) is a progressive neurodegenerative disease in adults, manifesting various clinical symptoms including autonomic nerve dysfunction, Parkinson's syndrome, cerebellar ataxia, and pyramidal sign. The clinical diagnosis and classification of MSA are mainly dependent on motion and non-motion symptoms, such as autonomic nerve dysfunction. In addition, an increasing amount of clinical and pathological evidence has shown that about half of the MSA patients exhibit distinct types and levels of cognitive dysfunction. However, cognitive dysfunction has not been included in the current diagnosis criteria of MSA. In most cases, it was even used as an exclusion criterion of MSA. Based on the neuroimaging, neuropathology and neuropsychology, this review summarized the morphological changes of the brain in the patients with MSA, and discussed possible brain regions that could be associated with cognitive impairment. The article may provide a theoretical basis for incorporating cognitive dysfunction into the criteria of MSA diagnosis.
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Affiliation(s)
- Lihong Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Li Zhang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Fang Xue
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Kathy Yue
- School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Haixin Peng
- Department of Food Science and Nutrition, Sichuan Agricultural University, Chengdu 611130, China
| | - Ya'nan Wu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Ou Sha
- Department of Anatomy, Histology and Developmental Biology, School of Basic Medical Sciences, Shenzhen University Health Science Centre, Shenzhen 518060, China
| | - Lan Yang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Yan Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Zhang L, Xiao T, Yu Q, Li Y, Shen F, Li W. Clinical Value and Diagnostic Accuracy of 3.0T Multi-Parameter Magnetic Resonance Imaging in Traumatic Brachial Plexus Injury. Med Sci Monit 2018; 24:7199-7205. [PMID: 30297687 PMCID: PMC6192456 DOI: 10.12659/msm.907019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The aim of this study was to evaluate the clinical value and diagnostic accuracy of 3.0T multi-parameter magnetic resonance imaging (MRI) in traumatic brachial plexus injury. Material/Methods Twenty-five healthy volunteers and 28 patients with clinically confirmed traumatic brachial plexus injury were enrolled in this study. Bilateral brachial plexus imaging was performed using conventional sequences (T1WI, T2WI), short time inversion recovery (STIR), balanced fast field echo (balance-FFE), and diffusion weighted imaging with background suppression (DWIBS). The MRI diagnosis was compared with intraoperative electromyography and surgery. Results Brachial plexus injuries were classified based on the anatomic locations. There were 16 patients with pre-ganglionic injury and 12 patients with post-ganglionic injury. The pre-ganglionic injury included ruptured nerve roots, stiff nerve roots, traumatic meningeal cysts, black line sign, spinal cord edema, and thickened nerve root sleeve. The post-ganglionic injury included thickened nerve roots, disappearance of normal nerve root structure or disrupted continuity of the nerve, stiff nerve roots, pseudo-neuroma, and abnormalities in the adjacent soft tissues. Comparing the results from MRI and surgery, the sensitivity, specificity, and accuracy of MRI examination were 93.55%, 71.43%, and 89.47% respectively for preganglionic injury, and 91.30%, 60.00%, and 85.71% respectively for postganglionic injury. Conclusions The combination of STIR, balance-FFE, and DWIBS sequences can display brachial plexus pre-ganglionic and post-ganglionic injury clearly, effectively, and accurately.
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Affiliation(s)
- Lihong Zhang
- The Medical Imaging Center, The Third People's Hospital of Liaocheng, Liaocheng, Shangdong, China (mainland)
| | - Taixing Xiao
- The Medical Imaging Center, The Third People's Hospital of Liaocheng, Liaocheng, Shangdong, China (mainland)
| | - Qiufeng Yu
- The Magnetic Resonance Imaging Department, The Third People's Hospital of Liaocheng, Liaocheng, Shangdong, China (mainland)
| | - Yong Li
- The Medical Imaging Center, The Third People's Hospital of Liaocheng, Liaocheng, Shangdong, China (mainland)
| | - Feng Shen
- Department of Radiology, Liaocheng People's Hospital, Liaocheng, Shangdong, China (mainland)
| | - Wenming Li
- Technical Squadron of Criminal Investigation Brigade of Dongchang Fu Public Security Bureau, Liaocheng, Shangdong, China (mainland)
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