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Endo Y, Nwawka OK, Sneag DB. Iatrogenic "overshoot" nerve injuries: imaging features. Skeletal Radiol 2024; 53:1173-1181. [PMID: 38165469 DOI: 10.1007/s00256-023-04550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Describe features of iatrogenic "overshoot" nerve injuries on ultrasound and MRI, which occur when an instrument passes through the bone and injures the nerve after it penetrates the opposite cortex. MATERIALS AND METHODS After a keyword search of the radiology database at a tertiary care orthopedic hospital from January 2016 to December 2022, those fulfilling the inclusion criteria of (1) instrumentation through the bone during surgery, (2) acute neuropathy immediately after surgery, (3) nerve injury confirmed on electrodiagnostics, and (4) imaging consistent with overshoot nerve injury were included. Imaging studies were retrospectively evaluated to determine primary and secondary signs of an overshoot nerve injury. RESULTS Six patients (3 females, mean age 26.7 (range 10-49) years) had nerve injury fitting the mechanism of injury: 3 injuries to the radial nerve during fixation of distal humerus fractures, 1 tibial nerve and 1 superficial peroneal nerve injury during fixation of tibial fractures, and 1 posterior interosseous nerve injury during biceps tendon repair. Ultrasounds were performed in all while 4 also had MRI. Secondary signs included (1) cortical defect adjacent to injured nerve (n=2); (2) scar extending from bone to injured nerve (n=2); (3) screw tip pointing to injured nerve (n=1, 4) tract in bone on MRI from previous instrumentation pointing to injured nerve (n=2). CONCLUSION In addition to primary signs such as laceration or neuroma, secondary signs of "overshoot" nerve injury include cortical defect, scar extending to nerve, screw tip pointing to nerve, and linear tract in the bone on MRI.
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Affiliation(s)
- Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
| | - Ogonna K Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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Park JE, Sneag DB, Choi YS, Oh SH, Choi S. Fascicular Involvement of the Median Nerve Trunk in the Upper Arm: Manifestation as Anterior Interosseous Nerve Syndrome With Unique Imaging Features. Korean J Radiol 2024; 25:449-458. [PMID: 38685735 PMCID: PMC11058432 DOI: 10.3348/kjr.2023.1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/26/2024] [Accepted: 02/10/2024] [Indexed: 05/02/2024] Open
Abstract
Selective fascicular involvement of the median nerve trunk above the elbow leading to anterior interosseous nerve (AIN) syndrome is a rare form of peripheral neuropathy. This condition has recently garnered increased attention within the medical community owing to advancements in imaging techniques and a growing number of reported cases. In this article, we explore the topographical anatomy of the median nerve trunk and the clinical features associated with AIN palsy. Our focus extends to unique manifestations captured through MRI and ultrasonography (US) studies, highlighting noteworthy findings, such as nerve fascicle swelling, incomplete constrictions, hourglass-like constrictions, and torsions, particularly in the posterior/posteromedial region of the median nerve. Surgical observations have further enhanced the understanding of this complex neuropathic condition. High-resolution MRI not only reveals denervation changes in the AIN and median nerve territories but also illuminates these alterations without the presence of compressing structures. The pivotal roles of high-resolution MRI and US in diagnosing this condition and guiding the formulation of an optimal treatment strategy are emphasized.
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Affiliation(s)
- Jae Eun Park
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, USA
| | - Yun Sun Choi
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea.
| | - Sung Hoon Oh
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - SeongJu Choi
- Department of Orthopedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
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Lin Y, Sahr M, Lan R, Nguyen J, Tan ET, Sneag DB. MRI findings correlate with difficult dissection during proximal hamstring repair and with postoperative sciatica. Skeletal Radiol 2024:10.1007/s00256-024-04668-6. [PMID: 38581584 DOI: 10.1007/s00256-024-04668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE This study examines the correlation between MRI findings and difficult dissection during proximal primary hamstring repair and postoperative sciatica. MATERIALS AND METHODS A total of 32 cases of surgically repaired hamstring tendon tears that underwent preoperative and postoperative MRI were divided into sciatica (n = 12) and control (n = 20) groups based on the presence or absence of postoperative sciatica. Cases were scored by two blinded musculoskeletal radiologists for imaging features associated with difficult surgical dissection and the development of subsequent sciatica. Intra- and interrater agreements, as well as correlation of MRI findings with symptoms (odds ratio, OR), were calculated. RESULTS On preoperative MRI, diffuse hamstring muscle edema pattern suggestive of active denervation (OR 9.4-13.6), and greater sciatic perineural scar circumference (OR 1.9-2) and length (OR 1.2-1.3) were significantly correlated with both difficult dissection and postoperative sciatica. Preoperatively, a greater number of tendons torn (OR 3.3), greater tear cross-sectional area (CSA, OR 1.03), and increased nerve T2-weighted signal (OR 3.2) and greater perineural scar thickness (OR 1.7) were also associated with difficult dissection, but not postoperative sciatica. On postoperative MRI, hamstring denervation, sciatic nerve tethering to the hamstring tendon, and development of perineural scar and greater perineural scar extent were all significantly correlated with postoperative sciatica. CONCLUSION Preoperative hamstring MRI demonstrates findings predictive of difficult sciatic nerve dissection; careful MRI evaluation of the nerve and for the presence and extent of perineural scar is important for preoperative planning. Preoperative and postoperative MRI both depict findings that correlate with postoperative sciatica.
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Affiliation(s)
- Yenpo Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Meghan Sahr
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, 10021, USA.
| | - Ranqing Lan
- Biostatistics Core Facility, Hospital for Special Surgery, New York, NY, USA
| | - Joe Nguyen
- Biostatistics Core Facility, Hospital for Special Surgery, New York, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, 10021, USA
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Thejeel B, Lin J, Queler S, Nimura C, Lin Y, Valle AGD, Sneag DB. Magnetic resonance imaging of femoral nerve injury in the setting of anterior approach total hip arthroplasty. Clin Imaging 2024; 108:110112. [PMID: 38457906 DOI: 10.1016/j.clinimag.2024.110112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/01/2024] [Accepted: 02/24/2024] [Indexed: 03/10/2024]
Abstract
PURPOSE To illustrate MRI findings in patients with femoral neuropathy following anterior approach total hip arthroplasty (THA). METHODS This was a retrospective review of patients who underwent MRI for femoral neuropathy following anterior approach THA between January 1, 2010, and July 1, 2022. Included patients had no preexisting neurologic condition. Clinical and diagnostic data were collected. MRIs were reviewed in consensus by 2 musculoskeletal radiologists. RESULTS A total of 115 patient records were reviewed, 17 of which were included in the final analysis (mean age 64 years; 11 females). Study subjects presented with weakness with hip flexion and knee extension and pain and numbness in the femoral nerve distribution. In 7 subjects, the femoral nerve appeared normal. In 5 subjects, the femoral nerve was hyperintense on fluid-sensitive fat-suppressed imaging. In 4 patients, mass effect on the femoral nerve by either ill-defined soft tissue edema (n = 2), seroma (n = 1), or heterotopic ossification (n = 1) was detected. Only 1 patient had a nerve transection. Patients were imaged at a median time of 8 months (range: 1 day to 11 years) following arthroplasty placement. Clinical follow-up was available in 8 patients, of whom half had complete symptomatic resolution and half had partial improvement at a mean follow-up time of 39.3 months (SD 51.1). Of these 8, 1 underwent revision arthroplasty, 1 had removal of hardware, and another had excision of heterotopic ossification. CONCLUSION MRI provides a means to directly evaluate the femoral nerve following anterior approach THA in both the immediate and chronic postoperative periods.
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Affiliation(s)
- Bashiar Thejeel
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, NY 10021, United States of America.
| | - Ji Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, NY 10021, United States of America.
| | - Sophie Queler
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, NY 10021, United States of America.
| | - Clare Nimura
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, NY 10021, United States of America.
| | - Yenpo Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, NY 10021, United States of America; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, No.5, Fuxing Street, Taoyuan 33305, Taiwan.
| | - Alejandro Gonzalez Della Valle
- Department of Orthopedic Surgery, Division of Hip and Knee Replacement, Hospital for Special Surgery, 535 E. 70(th) Street, New York, NY 10021, United States of America.
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, NY 10021, United States of America.
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Sneag DB, Queler SC, Campbell G, Colucci PG, Lin J, Lin Y, Wen Y, Li Q, Tan ET. Optimized 3D brachial plexus MR neurography using deep learning reconstruction. Skeletal Radiol 2024; 53:779-789. [PMID: 37914895 DOI: 10.1007/s00256-023-04484-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To evaluate whether 'fast,' unilateral, brachial plexus, 3D magnetic resonance neurography (MRN) acquisitions with deep learning reconstruction (DLR) provide similar image quality to longer, 'standard' scans without DLR. MATERIALS AND METHODS An IRB-approved prospective cohort of 30 subjects (13F; mean age = 50.3 ± 17.8y) underwent clinical brachial plexus 3.0 T MRN with 3D oblique-coronal STIR-T2-weighted-FSE. 'Standard' and 'fast' scans (time reduction = 23-48%, mean = 33%) were reconstructed without and with DLR. Evaluation of signal-to-noise ratio (SNR) and edge sharpness was performed for 4 image stacks: 'standard non-DLR,' 'standard DLR,' 'fast non-DLR,' and 'fast DLR.' Three raters qualitatively evaluated 'standard non-DLR' and 'fast DLR' for i) bulk motion (4-point scale), ii) nerve conspicuity of proximal and distal suprascapular and axillary nerves (5-point scale), and iii) nerve signal intensity, size, architecture, and presence of a mass (binary). ANOVA or Wilcoxon signed rank test compared differences. Gwet's agreement coefficient (AC2) assessed inter-rater agreement. RESULTS Quantitative SNR and edge sharpness were superior for DLR versus non-DLR (SNR by + 4.57 to + 6.56 [p < 0.001] for 'standard' and + 4.26 to + 4.37 [p < 0.001] for 'fast;' sharpness by + 0.23 to + 0.52/pixel for 'standard' [p < 0.018] and + 0.21 to + 0.25/pixel for 'fast' [p < 0.003]) and similar between 'standard non-DLR' and 'fast DLR' (SNR: p = 0.436-1, sharpness: p = 0.067-1). Qualitatively, 'standard non-DLR' and 'fast DLR' had similar motion artifact, as well as nerve conspicuity, signal intensity, size and morphology, with high inter-rater agreement (AC2: 'standard' = 0.70-0.98, 'fast DLR' = 0.69-0.97). CONCLUSION DLR applied to faster, 3D MRN acquisitions provides similar image quality to standard scans. A faster, DL-enabled protocol may replace currently optimized non-DL protocols.
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Affiliation(s)
- D B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70Th St., New York, NY, 10021, USA.
- Weill Medical College of Cornell, New York, NY, USA.
| | - S C Queler
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70Th St., New York, NY, 10021, USA
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - G Campbell
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70Th St., New York, NY, 10021, USA
| | - P G Colucci
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70Th St., New York, NY, 10021, USA
| | - J Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70Th St., New York, NY, 10021, USA
| | - Y Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70Th St., New York, NY, 10021, USA
| | - Y Wen
- GE Healthcare, Waukesha, WI, USA
| | - Q Li
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70Th St., New York, NY, 10021, USA
| | - E T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70Th St., New York, NY, 10021, USA
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Abel F, Lebl DR, Gorgy G, Dalton D, Chazen JL, Lim E, Li Q, Sneag DB, Tan ET. Deep-learning reconstructed lumbar spine 3D MRI for surgical planning: pedicle screw placement and geometric measurements compared to CT. Eur Spine J 2024:10.1007/s00586-023-08123-3. [PMID: 38472429 DOI: 10.1007/s00586-023-08123-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/06/2023] [Accepted: 12/26/2023] [Indexed: 03/14/2024]
Abstract
PURPOSE To test equivalency of deep-learning 3D lumbar spine MRI with "CT-like" contrast to CT for virtual pedicle screw planning and geometric measurements in robotic-navigated spinal surgery. METHODS Between December 2021 and June 2022, 16 patients referred for spinal fusion and decompression surgery with pre-operative CT and 3D MRI were retrospectively assessed. Pedicle screws were virtually placed on lumbar (L1-L5) and sacral (S1) vertebrae by three spine surgeons, and metrics (lateral deviation, axial/sagittal angles) were collected. Vertebral body length/width (VL/VW) and pedicle height/width (PH/PW) were measured at L1-L5 by three radiologists. Analysis included equivalency testing using the 95% confidence interval (CI), a margin of ± 1 mm (± 2.08° for angles), and intra-class correlation coefficients (ICCs). RESULTS Across all vertebral levels, both combined and separately, equivalency between CT and MRI was proven for all pedicle screw metrics and geometric measurements, except for VL at L1 (mean difference: - 0.64 mm; [95%CI - 1.05, - 0.24]), L2 (- 0.65 mm; [95%CI - 1.11, - 0.20]), and L4 (- 0.78 mm; [95%CI - 1.11, - 0.46]). Inter- and intra-rater ICC for screw metrics across all vertebral levels combined ranged from 0.68 to 0.91 and 0.89-0.98 for CT, and from 0.62 to 0.92 and 0.81-0.97 for MRI, respectively. Inter- and intra-rater ICC for geometric measurements ranged from 0.60 to 0.95 and 0.84-0.97 for CT, and 0.61-0.95 and 0.93-0.98 for MRI, respectively. CONCLUSION Deep-learning 3D MRI facilitates equivalent virtual pedicle screw placements and geometric assessments for most lumbar vertebrae, with the exception of vertebral body length at L1, L2, and L4, compared to CT for pre-operative planning in patients considered for robotic-navigated spine surgery.
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Affiliation(s)
- Frederik Abel
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - George Gorgy
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - David Dalton
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - J Levi Chazen
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Elisha Lim
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Qian Li
- Biostatistics Core, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
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Lin Y, Tan ET, Campbell G, Colucci PG, Singh S, Lan R, Wen Y, Sneag DB. Improved 3D DESS MR neurography of the lumbosacral plexus with deep learning and geometric image combination reconstruction. Skeletal Radiol 2024:10.1007/s00256-024-04613-7. [PMID: 38386108 DOI: 10.1007/s00256-024-04613-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE To evaluate the impact of deep learning (DL) reconstruction in enhancing image quality and nerve conspicuity in LSP MRN using DESS sequences. Additionally, a geometric image combination (GIC) method to improve DESS signals' combination was proposed. MATERIALS AND METHODS Adult patients undergoing 3.0 Tesla LSP MRN with DESS were prospectively enrolled. The 3D DESS echoes were separately reconstructed with and without DL and DL-GIC combined reconstructions. In a subset of patients, 3D T2-weighted short tau inversion recovery (STIR-T2w) sequences were also acquired. Three radiologists rated 4 image stacks ('DESS S2', 'DESS S2 DL', 'DESS GIC DL' and 'STIR-T2w DL') for bulk motion, vascular suppression, nerve fascicular architecture, and overall nerve conspicuity. Relative SNR, nerve-to-muscle, -fat, and -vessel contrast ratios were measured. Statistical analysis included ANOVA and Wilcoxon signed-rank tests. p < 0.05 was considered statistically significant. RESULTS Forty patients (22 females; mean age = 48.6 ± 18.5 years) were enrolled. Quantitatively, 'DESS GIC DL' demonstrated superior relative SNR (p < 0.001), while 'DESS S2 DL' exhibited superior nerve-to-background contrast ratio (p value range: 0.002 to < 0.001). Qualitatively, DESS provided superior vascular suppression and depiction of sciatic nerve fascicular architecture but more bulk motion as compared to 'STIR-T2w DL'. 'DESS GIC DL' demonstrated better nerve visualization for several smaller, distal nerve segments than 'DESS S2 DL' and 'STIR-T2w DL'. CONCLUSION Application of a DL reconstruction with geometric image combination in DESS MRN improves nerve conspicuity of the LSP, especially for its smaller branch nerves.
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Affiliation(s)
- Yenpo Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Gracyn Campbell
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Philip G Colucci
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Sumedha Singh
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Ranqing Lan
- Biostatistics Core, Hospital for Special Surgery, New York, NY, USA
| | - Yan Wen
- GE Healthcare, Waukesha, WI, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
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Campbell GJ, Sneag DB, Queler SC, Lin Y, Li Q, Tan ET. Quantitative double echo steady state T2 mapping of upper extremity peripheral nerves and muscles. Front Neurol 2024; 15:1359033. [PMID: 38426170 PMCID: PMC10902120 DOI: 10.3389/fneur.2024.1359033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction T2 mapping can characterize peripheral neuropathy and muscle denervation due to axonal damage. Three-dimensional double echo steady-state (DESS) can simultaneously provide 3D qualitative information and T2 maps with equivalent spatial resolution. However, insufficient signal-to-noise ratio may bias DESS-T2 values. Deep learning reconstruction (DLR) techniques can reduce noise, and hence may improve quantitation of high-resolution DESS-T2. This study aims to (i) evaluate the effect of DLR methods on DESS-T2 values, and (ii) to evaluate the feasibility of using DESS-T2 maps to differentiate abnormal from normal nerves and muscles in the upper extremities, with abnormality as determined by electromyography. Methods and results Analysis of images from 25 subjects found that DLR decreased DESS-T2 values in abnormal muscles (DLR = 37.71 ± 9.11 msec, standard reconstruction = 38.56 ± 9.44 msec, p = 0.005) and normal muscles (DLR: 27.18 ± 6.34 msec, standard reconstruction: 27.58 ± 6.34 msec, p < 0.001) consistent with a noise reduction bias. Mean DESS-T2, both with and without DLR, was higher in abnormal nerves (abnormal = 75.99 ± 38.21 msec, normal = 35.10 ± 9.78 msec, p < 0.001) and muscles (abnormal = 37.71 ± 9.11 msec, normal = 27.18 ± 6.34 msec, p < 0.001). A higher DESS-T2 in muscle was associated with electromyography motor unit recruitment (p < 0.001). Discussion These results suggest that quantitative DESS-T2 is improved by DLR and can differentiate the nerves and muscles involved in peripheral neuropathies from those uninvolved.
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Affiliation(s)
- Gracyn J. Campbell
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Darryl B. Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Sophie C. Queler
- College of Medicine, Downstate Health Sciences University, Brooklyn, NY, United States
| | - Yenpo Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Qian Li
- Biostatistics Core, Hospital for Special Surgery, New York, NY, United States
| | - Ek T. Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
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Altorfer FCS, Burkhard MD, Kelly MJ, Avrumova F, Sneag DB, Chazen JL, Tan ET, Lebl DR. Robot-Assisted Lumbar Pedicle Screw Placement Based on 3D Magnetic Resonance Imaging. Global Spine J 2024:21925682241232328. [PMID: 38324511 DOI: 10.1177/21925682241232328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
STUDY DESIGN Human Cadaveric Study. OBJECTIVE This study aims to explore the feasibility of using preoperative magnetic resonance imaging (MRI), zero-time-echo (ZTE) and spoiled gradient echo (SPGR), as source data for robotic-assisted spine surgery and assess the accuracy of pedicle screws. METHODS Zero-time-echo and SPGR MRI scans were conducted on a human cadaver. These images were manually post-processed, producing a computed tomography (CT)-like contrast. The Mazor X robot was used for lumbar pedicle screw-place navigating of MRI. The cadaver underwent a postoperative CT scan to determine the actual position of the navigated screws. RESULTS Ten lumbar pedicle screws were robotically navigated of MRI (4 ZTE; 6 SPGR). All MR-navigated screws were graded A on the Gertzbein-Robbins scale. Comparing preoperative robotic planning to postoperative CT scan trajectories: The screws showed a median deviation of overall 0.25 mm (0.0; 1.3), in the axial plane 0.27 mm (0.0; 1.3), and in the sagittal plane 0.24 mm (0.0; 0.7). CONCLUSION This study demonstrates the first successful registration of MRI sequences, ZTE and SPGR, in robotic spine surgery here used for intraoperative navigation of lumbar pedicle screws achieving sufficient accuracy, showcasing potential progress toward radiation-free spine surgery.
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Affiliation(s)
| | - Marco D Burkhard
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Michael J Kelly
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Fedan Avrumova
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - J Levi Chazen
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
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Altorfer FCS, Tan ET, Sneag DB. Editorial for "Clinical Value and Reliability of Quantitative Assessments of Lumbosacral Nerve Root Using Diffusion Tensor and Diffusion Weighted MR Imaging: A Systematic Review". J Magn Reson Imaging 2024. [PMID: 38190425 DOI: 10.1002/jmri.29215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
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Telleman JA, Sneag DB, Visser LH. The role of imaging in focal neuropathies. Handb Clin Neurol 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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Abel F, Tan ET, Lunenburg M, van Leeuwen C, van Hooren T, van Uden M, Arteaga C, Vincent J, Robb F, Sneag DB. Flexible array coil for cervical and extraspinal (FACE) MRI at 3.0 Tesla. Phys Med Biol 2023; 68:215011. [PMID: 37816375 DOI: 10.1088/1361-6560/ad0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/10/2023] [Indexed: 10/12/2023]
Abstract
Objective.High-resolution MRI of the cervical spine (c-spine) and extraspinal neck region requires close-fitting receiver coils to maximize the signal-to-noise ratio (SNR). Conventional, rigid C-spine receiver coils do not adequately contour to the neck to accommodate varying body shapes, resulting in suboptimal SNR. Recent innovations in flexible surface coil array designs may provide three-dimensional (3D) bendability and conformability to optimize SNR, while improving capabilities for higher acceleration factors.Approach.This work describes the design, implementation, and preliminaryin vivotesting of a novel, conformal 23-channel receive-only flexible array for cervical and extraspinal (FACE) MRI at 3-Tesla (T), with use of high-impedance elements to enhance the coil's flexibility. Coil performance was tested by assessing SNR and geometry factors (g-factors) in a phantom compared to a conventional 21-channel head-neck-unit (HNU).In vivoimaging was performed in healthy human volunteers and patients using high-resolution c-spine and neck MRI protocols at 3T, including MR neurography (MRN).Main results.Mean SNR with the FACE was 141%-161% higher at left, right, and posterior off-isocenter positions and 4% higher at the isocenter of the phantom compared to the HNU. Parallel imaging performance was comparable for an acceleration factor (R) = 2 × 2 between the two coils, but improved forR= 3 × 3 with meang-factors ranging from 1.46-2.15 with the FACE compared to 2.36-3.62 obtained with the HNU. Preliminary human volunteer and patient testing confirmed that equivalent or superior image quality could be obtained for evaluation of osseous and soft tissue structures of the cervical region with the FACE.Significance.A conformal and highly flexible cervical array with high-impedance coil elements can potentially enable higher-resolution imaging for cervical imaging.
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Affiliation(s)
- Frederik Abel
- Hospital for Special Surgery, 535 East 70th Street, NY 10021, United States of America
| | - Ek T Tan
- Hospital for Special Surgery, 535 East 70th Street, NY 10021, United States of America
| | - Martijn Lunenburg
- Tesla Dynamic Coils, Schimminck 12, 5301 Zaltbommel, The Netherlands
| | - Carel van Leeuwen
- Tesla Dynamic Coils, Schimminck 12, 5301 Zaltbommel, The Netherlands
| | - Thijs van Hooren
- Tesla Dynamic Coils, Schimminck 12, 5301 Zaltbommel, The Netherlands
| | - Mark van Uden
- Tesla Dynamic Coils, Schimminck 12, 5301 Zaltbommel, The Netherlands
| | - Catalina Arteaga
- Tesla Dynamic Coils, Schimminck 12, 5301 Zaltbommel, The Netherlands
| | - Jana Vincent
- GE HealthCare, 1515 Danner Dr, 44202 Aurora, OH, United States of America
| | - Fraser Robb
- GE HealthCare, 1515 Danner Dr, 44202 Aurora, OH, United States of America
| | - Darryl B Sneag
- Hospital for Special Surgery, 535 East 70th Street, NY 10021, United States of America
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13
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Abel F, Fiore J, Belanger M, Sneag DB, Lebl DR, Tan ET. Lumbar dorsal root ganglion displacement between supine and prone positions evaluated with 3D MRI. Magn Reson Imaging 2023; 104:29-38. [PMID: 37769881 DOI: 10.1016/j.mri.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE Pre-operative lumbar spine MRI is usually acquired with the patient supine, whereas lumbar spine surgery is most commonly performed prone. For MRI to be used reliably and safely for intra-operative navigation for foraminal and extraforaminal decompression, the magnitude of dorsal root ganglion (DRG) displacement between supine and prone positions needs to be understood. METHODS A prospective study of a degenerative lumbar spine cohort of 18 subjects indicated for lumbar spine surgery. Three-dimensional T2-weighted fast spin echo and T1-weighted spoiled gradient echo sequences were acquired at 3 T. Displacement and cross-sectional area (CSA) of the bilateral DRGs at 5 motion levels (L1-2 to L5-S1) were determined via 3D segmentation by 2 independent evaluators. Wilcoxon rank-sum tests without correction for multiple comparison were performed against hypothesized 1-mm absolute displacement and corresponding 24% CSA change. RESULTS DRG mean absolute displacement was <1 mm (p > 0.99, mean = 0.707 mm, 95% confidence interval (CI) = 0.659 to 0.755 mm), with the largest directional displacement in the dorsal-to-ventral direction from supine to prone (mean = 0.141 mm, 95% CI = 0.082 to 0.200 mm). Directional displacements caudal-to-cephalad were 0.087 mm (95% CI = 0.022 to 0.151 mm), and left-right were -0.030 mm (95%CI = -0.059 to -0.001 mm). Mean CSA change was within 24% (p > 0.99, mean = -8.30%, 95% CI = -10.5 to -6.09%). Mean absolute displacement was largest for the L1 (mean = 0.811 mm) and L2 (mean = 0.829 mm) DRGs. CONCLUSIONS Minimal, non-statistically significant soft tissue displacement and morphological area differences were demonstrated between supine and prone positions during 3D lumbar spine MRI.
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Affiliation(s)
- Frederik Abel
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA; Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jake Fiore
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Marianne Belanger
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
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Morena J, Tan ET, Campbell GJ, Bhatti P, Li Q, Geannette CS, Lin Y, Milani CJ, Sneag DB. MR Neurography and Quantitative Muscle MRI of Parsonage Turner Syndrome Involving the Long Thoracic Nerve. J Magn Reson Imaging 2023. [PMID: 37702553 DOI: 10.1002/jmri.29007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Parsonage-Turner syndrome (PTS) is characterized by severe, acute upper extremity pain and subsequent paresis and most commonly involves the long thoracic nerve (LTN). While MR neurography (MRN) can detect LTN hourglass-like constrictions (HGCs), quantitative muscle MRI (qMRI) can quantify serratus anterior muscle (SAM) neurogenic changes. PURPOSE/HYPOTHESIS 1) To characterize qMRI findings in LTN-involved PTS. 2) To investigate associations between qMRI and clinical assessments of HGCs/electromyography (EMG). STUDY TYPE Prospective. POPULATION 30 PTS subjects (25 M/5 F, mean/range age = 39/15-67 years) with LTN involvement who underwent bilateral chest wall qMRI and unilateral brachial plexus MRN. FIELD STRENGTH/SEQUENCES 3.0 Tesla/multiecho spin-echo T2-mapping, diffusion-weighted echo-planar-imaging, multiecho gradient echo. ASSESSMENT qMRI was performed to obtain T2, muscle diameter fat fraction (FF), and cross-sectional area of the SAM. Clinical reports of MRN and EMG were obtained; from MRN, the number of HGCs; from EMG, SAM measurements of motor unit recruitment levels, fibrillations, and positive sharp waves. qMRI/MRN were performed within 90 days of EMG. EMG was performed on average 185 days from symptom onset (all ≥2 weeks from symptom onset) and 5 days preceding MRI. STATISTICAL TESTS Paired t-tests were used to compare qMRI measures in the affected SAM versus the contralateral, unaffected side (P < 0.05 deemed statistically significant). Kendall's tau was used to determine associations between qMRI against HGCs and EMG. RESULTS Relative to the unaffected SAM, the affected SAM had increased T2 (50.42 ± 6.62 vs. 39.09 ± 4.23 msec) and FF (8.45 ± 9.69 vs. 4.03% ± 1.97%), and decreased muscle diameter (74.26 ± 21.54 vs. 88.73 ± 17.61 μm) and cross-sectional area (9.21 ± 3.75 vs. 16.77 ± 6.40 mm2 ). There were weak to negligible associations (tau = -0.229 to <0.001, P = 0.054-1.00) between individual qMRI biomarkers and clinical assessments of HGCs and EMG. DATA CONCLUSION qMRI changes in the SAM were observed in subjects with PTS involving the LTN. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Jonathan Morena
- Department of Neurology, Hospital for Special Surgery, New York City, New York, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Gracyn J Campbell
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Pravjit Bhatti
- Georgetown University School of Medicine, Washington, D.C., USA
| | - Qian Li
- Department of Biostatistics, Hospital for Special Surgery, New York City, New York, USA
| | - Christian S Geannette
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Yenpo Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Carlo J Milani
- Department of Physiatry, Hospital for Special Surgery, New York City, New York, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
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Motovilova E, Ching T, Vincent J, Shin J, Tan ET, Taracila V, Robb F, Hashimoto M, Sneag DB, Winkler SA. Dual-Channel Stretchable, Self-Tuning, Liquid Metal Coils and Their Fabrication Techniques. Sensors (Basel) 2023; 23:7588. [PMID: 37688046 PMCID: PMC10490642 DOI: 10.3390/s23177588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023]
Abstract
Flexible and stretchable radiofrequency coils for magnetic resonance imaging represent an emerging and rapidly growing field. The main advantage of such coil designs is their conformal nature, enabling a closer anatomical fit, patient comfort, and freedom of movement. Previously, we demonstrated a proof-of-concept single element stretchable coil design with a self-tuning smart geometry. In this work, we evaluate the feasibility of scaling this coil concept to a multi-element coil array and the associated engineering and manufacturing challenges. To this goal, we study a dual-channel coil array using full-wave simulations, bench testing, in vitro, and in vivo imaging in a 3 T scanner. We use three fabrication techniques to manufacture dual-channel receive coil arrays: (1) single-layer casting, (2) double-layer casting, and (3) direct-ink-writing. All fabricated arrays perform equally well on the bench and produce similar sensitivity maps. The direct-ink-writing method is found to be the most advantageous fabrication technique for fabrication speed, accuracy, repeatability, and total coil array thickness (0.6 mm). Bench tests show excellent frequency stability of 128 ± 0.6 MHz (0% to 30% stretch). Compared to a commercial knee coil array, the stretchable coil array is more conformal to anatomy and provides 50% improved signal-to-noise ratio in the region of interest.
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Affiliation(s)
- Elizaveta Motovilova
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY 10021, USA
| | - Terry Ching
- Pillar of Engineering Product Development, Singapore University of Technology and Design, Singapore 487372, Singapore
- Digital Manufacturing and Design (DManD) Centre, Singapore University of Technology and Design, Singapore 487372, Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore 117583, Singapore
| | | | - James Shin
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY 10021, USA
| | | | | | - Michinao Hashimoto
- Pillar of Engineering Product Development, Singapore University of Technology and Design, Singapore 487372, Singapore
- Digital Manufacturing and Design (DManD) Centre, Singapore University of Technology and Design, Singapore 487372, Singapore
| | - Darryl B. Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY 10021, USA
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16
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Nimura CA, Milani C, Tan ET, Sneag DB. Parsonage-Turner syndrome following monkeypox infection and vaccination. Skeletal Radiol 2023; 52:1781-1784. [PMID: 36752829 PMCID: PMC9907186 DOI: 10.1007/s00256-023-04298-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/23/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
Beginning in May 2022, monkeypox infection and vaccination rates dramatically increased due to a worldwide outbreak. This case highlights magnetic resonance (MR) neurography findings in an individual who developed Parsonage-Turner syndrome (PTS) 5 days after monkeypox symptom onset and 12 days after receiving the JYNNEOS vaccination. MR neurography of the patient's left suprascapular nerve demonstrated intrinsic hourglass-like constrictions, a characteristic finding of peripheral nerves involved in PTS. Other viral infections and vaccinations are well-documented triggers of PTS, an underrecognized peripheral neuropathy that is thought to be immune-mediated and results in severe upper extremity pain and weakness. The close temporal relationship between monkeypox infection and vaccination, and PTS onset, in this case, suggests a causal relationship and marks the first known report of peripheral neuropathy associated with monkeypox.
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Affiliation(s)
- Clare A Nimura
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
| | - Carlo Milani
- Department of Spine and Sports Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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17
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Sneag DB, Urban C, Li TY, Colucci PG, Pedrick EG, Nimura CA, Feinberg JH, Milani CJ, Tan ET. Hourglass-like constrictions on MRI are common in electromyography-confirmed cases of neuralgic amyotrophy (Parsonage-Turner syndrome): A tertiary referral center experience. Muscle Nerve 2023:10.1002/mus.27961. [PMID: 37610034 PMCID: PMC10884353 DOI: 10.1002/mus.27961] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION/AIMS Hourglass-like constrictions (HGCs) of involved nerves in neuralgic amyotrophy (NA) (Parsonage-Turner syndrome) have been increasingly recognized with magnetic resonance neurography (MRN). This study sought to determine the sensitivity of HGCs, detected by MRN, among electromyography (EMG)-confirmed NA cases. METHODS This study retrospectively reviewed records of patients with the clinical diagnosis of NA, and with EMG confirmation, who underwent 3-Tesla MRN within 90 days of EMG at a single tertiary referral center between 2011 and 2021. "Severe NA" positive cases were defined by a clinical diagnosis and specific EMG criteria: fibrillation potentials or positive sharp waves, along with motor unit recruitment (MUR) grades of "discrete" or "none." On MRN, one or more HGCs, defined as focally decreased nerve caliber or diffusely beaded appearance, was considered "imaging-positive." Post hoc inter-rater reliability for HGCs was measured by comparing the original MRN report against subsequent blinded interpretation by a second radiologist. RESULTS A total of 123 NA patients with 3-Tesla MRN performed within 90 days of EMG were identified. HGCs were observed in 90.2% of all NA patients. In "severe NA" cases, based on the above EMG criteria, HGC detection resulted in a sensitivity of 91.9%. Nerve-by-nerve analysis (183 nerve-muscle pairs, nerves assessed by MRN, muscles assessed by EMG) showed a sensitivity of 91.0%. The second radiologist largely agreed with the original HGC evaluation, (94.3% by subjects, 91.8% by nerves), with no significant difference between evaluations (subjects: χ2 = 2.27, P = .132, nerves: χ2 = 0.98, P = .323). DISCUSSION MRN detection of HGCs is common in NA.
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Affiliation(s)
- Darryl B. Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
| | - Casey Urban
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY, USA 10021
| | - Tim Y. Li
- Weill Cornell Medical College, New York, NY, USA 10021
| | - Philip G. Colucci
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
| | - Emily G. Pedrick
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
| | - Clare A. Nimura
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
| | - Joseph H. Feinberg
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA 10021
| | - Carlo J. Milani
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA 10021
| | - Ek T. Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
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18
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Sneag DB, Abel F, Potter HG, Fritz J, Koff MF, Chung CB, Pedoia V, Tan ET. MRI Advancements in Musculoskeletal Clinical and Research Practice. Radiology 2023; 308:e230531. [PMID: 37581501 PMCID: PMC10477516 DOI: 10.1148/radiol.230531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 08/16/2023]
Abstract
Over the past decades, MRI has become increasingly important for diagnosing and longitudinally monitoring musculoskeletal disorders, with ongoing hardware and software improvements aiming to optimize image quality and speed. However, surging demand for musculoskeletal MRI and increased interest to provide more personalized care will necessitate a stronger emphasis on efficiency and specificity. Ongoing hardware developments include more powerful gradients, improvements in wide-bore magnet designs to maintain field homogeneity, and high-channel phased-array coils. There is also interest in low-field-strength magnets with inherently lower magnetic footprints and operational costs to accommodate global demand in middle- and low-income countries. Previous approaches to decrease acquisition times by means of conventional acceleration techniques (eg, parallel imaging or compressed sensing) are now largely overshadowed by deep learning reconstruction algorithms. It is expected that greater emphasis will be placed on improving synthetic MRI and MR fingerprinting approaches to shorten overall acquisition times while also addressing the demand of personalized care by simultaneously capturing microstructural information to provide greater detail of disease severity. Authors also anticipate increased research emphasis on metal artifact reduction techniques, bone imaging, and MR neurography to meet clinical needs.
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Affiliation(s)
- Darryl B. Sneag
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Frederik Abel
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Hollis G. Potter
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Jan Fritz
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Matthew F. Koff
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Christine B. Chung
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Valentina Pedoia
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Ek T. Tan
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
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19
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Abel F, Tan ET, Chazen JL, Lebl DR, Sneag DB. MRI after Lumbar Spine Decompression and Fusion Surgery: Technical Considerations, Expected Findings, and Complications. Radiology 2023; 308:e222732. [PMID: 37404146 DOI: 10.1148/radiol.222732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Postoperative MRI of the lumbar spine is a mainstay for detailed anatomic assessment and evaluation of complications related to decompression and fusion surgery. Key factors for reliable interpretation include clinical presentation of the patient, operative approach, and time elapsed since surgery. Yet, recent spinal surgery techniques with varying anatomic corridors to approach the intervertebral disc space and implanted materials have expanded the range of normal (expected) and abnormal (unexpected) postoperative changes. Modifications of lumbar spine MRI protocols in the presence of metallic implants, including strategies for metal artifact reduction, provide important diagnostic information. This focused review discusses essential principles for the acquisition and interpretation of MRI after lumbar spinal decompression and fusion surgery, highlights expected postoperative changes, and describes early and delayed postoperative complications with examples.
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Affiliation(s)
- Frederik Abel
- From the Department of Radiology and Imaging (F.A., E.T.T., J.L.C., D.B.S.) and Department of Spine Surgery (F.A., D.R.L.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Ek T Tan
- From the Department of Radiology and Imaging (F.A., E.T.T., J.L.C., D.B.S.) and Department of Spine Surgery (F.A., D.R.L.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - J Levi Chazen
- From the Department of Radiology and Imaging (F.A., E.T.T., J.L.C., D.B.S.) and Department of Spine Surgery (F.A., D.R.L.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Darren R Lebl
- From the Department of Radiology and Imaging (F.A., E.T.T., J.L.C., D.B.S.) and Department of Spine Surgery (F.A., D.R.L.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Darryl B Sneag
- From the Department of Radiology and Imaging (F.A., E.T.T., J.L.C., D.B.S.) and Department of Spine Surgery (F.A., D.R.L.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
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20
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Affiliation(s)
- Yenpo Lin
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 (Y.L., D.B.S.); and Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan (Y.L.)
| | - Darryl B Sneag
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 (Y.L., D.B.S.); and Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan (Y.L.)
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Jardon M, Tan ET, Chazen JL, Sahr M, Wen Y, Schneider B, Sneag DB. Deep-learning-reconstructed high-resolution 3D cervical spine MRI for foraminal stenosis evaluation. Skeletal Radiol 2023; 52:725-732. [PMID: 36269331 DOI: 10.1007/s00256-022-04211-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/23/2022] [Accepted: 10/13/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare standard-of-care two-dimensional MRI acquisitions of the cervical spine with those from a single three-dimensional MRI acquisition, reconstructed using a deep-learning-based reconstruction algorithm. We hypothesized that the improved image quality provided by deep-learning-based reconstruction would result in improved inter-rater agreement for cervical spine foraminal stenosis compared to conventional two-dimensional acquisitions. MATERIALS AND METHODS Forty-one patients underwent routine cervical spine MRI with a conventional protocol comprising two-dimensional T2-weighted fast spin echo scans (2 axial planes, 1 sagittal plane), and an isotropic-resolution three-dimensional T2-weighted fast spin echo scan reconstructed over a 4-h time window with a deep-learning-based reconstruction algorithm. Three radiologists retrospectively assessed images for the degree to which motion artifact limited clinical assessment, and foraminal and central stenosis at each level. Inter-rater agreement was analyzed with weighted Fleiss's kappa (k) and comparisons between two-dimensional and three-dimensional sequences were performed with Wilcoxon signed-rank test. RESULTS Inter-rater agreement for foraminal stenosis was "substantial" for two-dimensional sequences (k = 0.76) and "excellent" for the three-dimensional sequence (k = 0.81). Agreement was "excellent" for both sequences (k = 0.85 and 0.83) for central stenosis. The three-dimensional sequence had less perceptible motion artifact (p ≤ 0.001-0.036). Mean total scan time was 10.8 min for the two-dimensional sequences, and 7.3 min for the three-dimensional sequence. CONCLUSION Three-dimensional MRI reconstructed with a deep-learning-based algorithm provided "excellent" inter-observer agreement for foraminal and central stenosis, which was at least equivalent to standard-of-care two-dimensional imaging. Three-dimensional MRI with deep-learning-based reconstruction was less prone to motion artifact, with overall scan time savings.
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Affiliation(s)
- Meghan Jardon
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - J Levi Chazen
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Meghan Sahr
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Yan Wen
- GE Healthcare, Waukesha, WI, USA
| | - Brandon Schneider
- Biostatistics Core, Research Administration, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
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22
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Thejeel B, Tan ET, Colucci PG, Gonzalez Della Valle A, Sneag DB. Early perioperative magnetic resonance findings in patients with foot drop following total hip Arthroplasty: A descriptive case-series. Eur J Radiol 2023; 161:110727. [PMID: 36753810 DOI: 10.1016/j.ejrad.2023.110727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/09/2022] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aims to characterize iatrogenic sciatic nerve injury patterns in the early, perioperative period following posterior-approach total hip arthroplasty (THA) with magnetic resonance imaging (MRI). METHODS This was an IRB-approved retrospective analysis of patients acquired from a longitudinal, single site radiology database of patients who underwent MRI for "foot drop" within 4 weeks following posterior-approach THA surgery, over a 20-year period. RESULTS MRI exams from 51 patients (mean age 62 years; 32 females) who met inclusion criteria were evaluated. Mean time to MRI was 2.4 days. Of 51 patients, 43 underwent primary THA, 6 revision THA and 2 explantation with antibiotic spacer placement. Ten exams revealed a normal appearance of the sciatic nerve. Nineteen showed compression of the sciatic nerve by edema or a fluid collection, without intrinsic nerve abnormality. Fifteen demonstrated perineural tethering or scar/granulation tissue encasement of the nerve, and in half of these cases the sciatic nerve was enlarged and/or hyperintense on fluid-sensitive sequences. Six patients had sciatic nerve compression secondary to quadratus femoris retraction. Six patients had complete resolution of the foot drop at a mean follow-up of 37.3 months following surgery, and in these cases the sciatic nerve appeared normal on the initial postoperative MRI. Remaining patients all had persistent weakness and paresthesias in the sciatic nerve distribution at a mean follow-up duration of 34.3 months. CONCLUSION This retrospective case series demonstrates various sciatic nerve injury patterns in the early perioperative period on MRI and proposes a targeted MRI protocol to evaluate the sciatic nerve post THA surgery.
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Affiliation(s)
- Bashiar Thejeel
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, New York 10021, United States.
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, New York 10021, United States.
| | - Philip G Colucci
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, New York 10021, United States.
| | - Alejandro Gonzalez Della Valle
- Department of Orthopedic Surgery, Division of Hip and Knee Replacement, Hospital for Special Surgery, 535 E. 70(th) Street, New York, New York 10021, United States.
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, New York 10021, United States.
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23
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Abel F, Tan ET, Sneag DB, Lebl DR, Chazen JL. Postoperative Lumbar Fusion Bone Morphogenic Protein-Related Epidural Cyst Formation. AJNR Am J Neuroradiol 2023; 44:351-355. [PMID: 36797032 PMCID: PMC10187819 DOI: 10.3174/ajnr.a7799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/27/2023] [Indexed: 02/18/2023]
Abstract
Bone morphogenetic protein is broadly used in spinal surgery to enhance fusion rates. Several complications have been associated with the use of bone morphogenetic protein, including postoperative radiculitis and pronounced bone resorption/osteolysis. Bone morphogenetic protein-related epidural cyst formation may represent another complication that has not been described aside from limited case reports. In this case series, we retrospectively reviewed imaging and clinical findings of 16 patients with epidural cysts on postoperative MR imaging following lumbar fusion. In 8 patients, mass effect on the thecal sac or lumbar nerve roots was noted. Of these, 6 patients developed new postoperative lumbosacral radiculopathy. During the study period, most patients were managed conservatively, and 1 patient required revision surgery with cyst resection. Concurrent imaging findings included reactive endplate edema and vertebral bone resorption/osteolysis. Epidural cysts had characteristic findings on MR imaging in this case series and may represent an important postoperative complication in patients following bone morphogenetic protein-augmented lumbar fusion.
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Affiliation(s)
- F Abel
- From the Departments of Radiology and Imaging (F.A., E.T.T., D.B.S., J.L.C.)
- Spine Surgery (F.A., D.R.L.), Hospital for Special Surgery, New York, New York
| | - E T Tan
- From the Departments of Radiology and Imaging (F.A., E.T.T., D.B.S., J.L.C.)
| | - D B Sneag
- From the Departments of Radiology and Imaging (F.A., E.T.T., D.B.S., J.L.C.)
| | - D R Lebl
- Spine Surgery (F.A., D.R.L.), Hospital for Special Surgery, New York, New York
| | - J L Chazen
- From the Departments of Radiology and Imaging (F.A., E.T.T., D.B.S., J.L.C.)
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Motovilova E, Aronowitz E, Vincent J, Shin J, Tan ET, Robb F, Taracila V, Sneag DB, Dyke JP, Winkler SA. Silicone-based materials with tailored MR relaxation characteristics for use in reduced coil visibility and in tissue-mimicking phantom design. Med Phys 2023. [PMID: 36737839 DOI: 10.1002/mp.16255] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/24/2022] [Accepted: 01/15/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The development of materials with tailored signal intensity in MR imaging is critically important both for the reduction of signal from non-tissue hardware, as well as for the construction of tissue-mimicking phantoms. Silicone-based phantoms are becoming more popular due to their structural stability, stretchability, longer shelf life, and ease of handling, as well as for their application in dynamic imaging of physiology in motion. Moreover, silicone can be also used for the design of stretchable receive radio-frequency (RF) coils. PURPOSE Fabrication of materials with tailored signal intensity for MRI requires knowledge of precise T1 and T2 relaxation times of the materials used. In order to increase the range of possible relaxation times, silicone materials can be doped with gadolinium (Gd). In this work, we aim to systematically evaluate relaxation properties of Gd-doped silicone material at a broad range of Gd concentrations and at three clinically relevant magnetic field strengths (1.5 T, 3 T, and 7 T). We apply the findings for rendering silicone substrates of stretchable receive RF coils less visible in MRI. Moreover, we demonstrate early stage proof-of-concept applicability in tissue-mimicking phantom development. MATERIALS AND METHODS Ten samples of pure and Gd-doped Ecoflex silicone polymer samples were prepared with various Gd volume ratios ranging from 1:5000 to 1:10, and studied using 1.5 T and 3 T clinical and 7 T preclinical scanners. T1 and T2 relaxation times of each sample were derived by fitting the data to Bloch signal intensity equations. A receive coil made from Gd-doped Ecoflex silicone polymer was fabricated and evaluated in vitro at 3 T. RESULTS With the addition of a Gd-based contrast agent, it is possible to significantly change T2 relaxation times of Ecoflex silicone polymer (from 213 ms to 20 ms at 1.5 T; from 135 ms to 17 ms at 3 T; and from 111.4 ms to 17.2 ms at 7 T). T1 relaxation time is less affected by the introduction of the contrast agent (changes from 608 ms to 579 ms; from 802.5 ms to 713 ms at 3 T; from 1276 ms to 979 ms at 7 T). First results also indicate that liver, pancreas, and white matter tissues can potentially be closely mimicked using this phantom preparation technique. Gd-doping reduces the appearance of the silicone-based coil substrate during the MR scan by up to 81%. CONCLUSIONS Gd-based contrast agents can be effectively used to create Ecoflex silicone polymer-based phantoms with tailored T2 relaxation properties. The relative low cost, ease of preparation, stretchability, mechanical stability, and long shelf life of Ecoflex silicone polymer all make it a good candidate for "MR invisible" coil development and bears promise for tissue-mimicking phantom development applicability.
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Affiliation(s)
- Elizaveta Motovilova
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.,Department of Radiology, Hospital for Special Surgery, New York, New York, USA
| | - Eric Aronowitz
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | | | - James Shin
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Ek Tsoon Tan
- Department of Radiology, Hospital for Special Surgery, New York, New York, USA
| | | | | | - Darryl B Sneag
- Department of Radiology, Hospital for Special Surgery, New York, New York, USA
| | - Jonathan P Dyke
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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Pedrick EG, Sneag DB, Colucci PG, Duong M, Tan ET. Three-dimensional MR Neurography of the Brachial Plexus: Vascular Suppression with Low-dose Ferumoxytol. Radiology 2022; 307:e221087. [PMID: 36511805 DOI: 10.1148/radiol.221087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The efficacy of ferumoxytol, an ultrasmall superparamagnetic iron oxide particle for three-dimensional (3D) MR neurography, has yet to be evaluated. Purpose To evaluate the effects of low-dose ferumoxytol for vascular suppression and nerve visualization in 3D brachial plexus MR neurography as a pilot study. Materials and Methods Volunteers without anemia were prospectively enrolled in July 2021. Brachial plexus MR neurography was performed 30 minutes following infusion of 25% of the standard (510 mg of iron) therapeutic ferumoxytol dose with use of a 3D short-tau inversion recovery T2-weighted fast spin-echo sequence. The 3D fast spin-echo was acquired with and without the use of additional flow suppression techniques. Two musculoskeletal radiologists qualitatively evaluated examinations for the degree of vascular suppression (0-3, none to complete), nerve visualization (0-2, none to full), and motion artifact (0-4, none to severe). Nerve-to-fat, muscle, or vessel contrast ratios were calculated with use of manually drawn regions of interests. Comparisons of the proportion of scans with adequate image quality (vascular suppression, 3; nerve visualization, 1, 2; motion artifacts, 0, 1) were made with use of the McNemar test. Comparisons of quantitative contrast ratios were performed with use of Wilcoxon signed rank tests. P < .05 was deemed statistically significant. Results There were 12 volunteers (mean age, 25 years ± 3; six women) evaluated. The scans with adequate vascular suppression increased from 0% to 98% with and without ferumoxytol, respectively (P < .001). All individual nerve assessments of adequate nerve visualization increased from 4%-63% to 36%-100% without and with ferumoxytol, respectively (P < .001-.010), while motion artifacts were unchanged (from 33% to 52%, P = .212). Quantitatively, nerve-to-vessel contrast ratios increased from 0.6 without to 7.6 with ferumoxytol (P < .001). The addition of flow suppression did not change nerve-to-vessel contrast ratio quantitatively (from 7.5 to 8.4, P > .99) following ferumoxytol. Conclusion Low-dose ferumoxytol improved vascular suppression and nerve visualization in three-dimensional MR neurography of the brachial plexus compared to imaging without ferumoxytol. © RSNA, 2022.
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Affiliation(s)
- Emily G. Pedrick
- From the Department of Radiology and Imaging (E.G.P., D.B.S., P.G.C., E.T.T.) and Department of Pharmacy (M.D.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Darryl B. Sneag
- From the Department of Radiology and Imaging (E.G.P., D.B.S., P.G.C., E.T.T.) and Department of Pharmacy (M.D.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Philip G. Colucci
- From the Department of Radiology and Imaging (E.G.P., D.B.S., P.G.C., E.T.T.) and Department of Pharmacy (M.D.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Mylinh Duong
- From the Department of Radiology and Imaging (E.G.P., D.B.S., P.G.C., E.T.T.) and Department of Pharmacy (M.D.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Ek T. Tan
- From the Department of Radiology and Imaging (E.G.P., D.B.S., P.G.C., E.T.T.) and Department of Pharmacy (M.D.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
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Tan ET, Serrano KC, Bhatti P, Pishgar F, Vanderbeek AM, Milani CJ, Sneag DB. Quantitative MRI Differentiates Electromyography Severity Grades of Denervated Muscle in Neuropathy of the Brachial Plexus. J Magn Reson Imaging 2022; 56:1104-1115. [PMID: 35195321 PMCID: PMC9395546 DOI: 10.1002/jmri.28125] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Quantitative MRI (qMRI) metrics reflect microstructural skeletal muscle changes secondary to denervation and may correspond to conventional electromyography (EMG) assessments of motor unit recruitment (MUR) and denervation. HYPOTHESIS Differences in quantitative T2 , diffusion-based apparent fiber diameter (AFD), and fat fraction (FF) exist between EMG grades, in patients with clinically suspected neuropathy of the brachial plexus. STUDY TYPE Prospective. POPULATION A total of 30 subjects (age = 37.5 ± 17.5, 21M/9F) with suspected brachial plexopathy. FIELD STRENGTH/SEQUENCE 3-Tesla; qMRI using fast spin echo (T2 -mapping), multi-b-valued diffusion-weighted echo planar imaging (for AFD), and dual-echo Dixon gradient echo (FF-mapping) sequences. ASSESSMENT qMRI values were compared against EMG grades (MUR and denervation). qMRI values (T2 , AFD, and FF) were obtained for five regional shoulder muscles. A 4-point scale was used for MUR/denervation severity. STATISTICAL TESTS Linear mixed models and least-squares pairwise comparisons were used to evaluate qMRI differences between EMG grades. Predictive accuracy of EMG grades from qMRI was quantified by 10-fold cross-validated logistic models. A P value < 0.05 was considered statistically significant. RESULTS Mean (95% confidence interval) qMRI for "full" MUR were T2 = 39.40 msec (35.72-43.08 msec), AFD = 78.35 μm (72.52-84.19 μm), and FF = 4.54% (2.11-6.97%). Significant T2 increases (+8.36 to +14.67 msec) and significant AFD decreases (-11.04 to -21.58 μm) were observed with all abnormal MUR grades as compared to "full" MUR. Significant changes in both T2 and AFD were observed with increased denervation (+9.59 to +15.04 msec, -16.25 to -18.66 μm). There were significant differences in FF between some MUR grades (-1.45 to +2.96%), but no significant changes were observed with denervation (P = 0.089-0.662). qMRI prediction of abnormal MUR or denervation was strong (mean accuracy = 0.841 and 0.810, respectively) but moderate at predicting individual grades (accuracy = 0.492 and 0.508, respectively). DATA CONCLUSION Quantitative T2 and AFD differences were observed between EMG grades in assessing muscle denervation. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Ek T. Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
| | - Kenneth C. Serrano
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA 11794
| | - Pravjit Bhatti
- Georgetown University School of Medicine, Washington DC, USA, 20007
| | - Farhad Pishgar
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, 21205
| | - Alyssa M. Vanderbeek
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
- Biostatistics Core, Research Administration, Hospital for Special Surgery, New York, NY, USA 10021
| | - Carlo J. Milani
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA 10021
| | - Darryl B. Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA 10021
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Brogan DM, Osei DA, Colorado BS, Sneag DB, Van Voorhis A, Dy CJ. Team Approach: Management of Brachial Plexus Injuries. JBJS Rev 2022; 10:01874474-202204000-00005. [PMID: 35427254 DOI: 10.2106/jbjs.rvw.21.00222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Traumatic brachial plexus injuries are relatively rare but potentially devastating injuries with substantial functional, psychological, and economic consequences. » Prompt referral (ideally within 6 weeks of injury) to a center with a team of experts experienced in the diagnosis and management of these injuries is helpful to achieving optimal outcomes. » Preoperative and intraoperative decision-making to diagnose and plan reconstructive procedures is complex and must take into account a number of factors, including the time from injury, concomitant injuries, preservation of cervical nerve roots, and the availability of intraplexal and extraplexal donor nerves for nerve transfer. » A team approach is essential to ensure accurate localization of the pathology before surgery and to maximize rehabilitation after surgery, necessitating close contact between the surgical team, physiatrists, radiologists, and therapists.
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Affiliation(s)
- David M Brogan
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | | | - Berdale S Colorado
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | | | - Anna Van Voorhis
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri
| | - Christopher J Dy
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
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28
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Sun S, Tan ET, Mintz DN, Sahr M, Endo Y, Nguyen J, Lebel RM, Carrino JA, Sneag DB. Evaluation of deep learning reconstructed high-resolution 3D lumbar spine MRI. Eur Radiol 2022; 32:6167-6177. [PMID: 35322280 DOI: 10.1007/s00330-022-08708-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/24/2022] [Accepted: 03/05/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To compare interobserver agreement and image quality of 3D T2-weighted fast spin echo (T2w-FSE) L-spine MRI images processed with a deep learning reconstruction (DLRecon) against standard-of-care (SOC) reconstruction, as well as against 2D T2w-FSE images. The hypothesis was that DLRecon 3D T2w-FSE would afford improved image quality and similar interobserver agreement compared to both SOC 3D and 2D T2w-FSE. METHODS Under IRB approval, patients who underwent routine 3-T lumbar spine (L-spine) MRI from August 17 to September 17, 2020, with both isotropic 3D and 2D T2w-FSE sequences, were retrospectively included. A DLRecon algorithm, with denoising and sharpening properties was applied to SOC 3D k-space to generate 3D DLRecon images. Four musculoskeletal radiologists blinded to reconstruction status evaluated randomized images for motion artifact, image quality, central/foraminal stenosis, disc degeneration, annular fissure, disc herniation, and presence of facet joint cysts. Inter-rater agreement for each graded variable was evaluated using Conger's kappa (κ). RESULTS Thirty-five patients (mean age 58 ± 19, 26 female) were evaluated. 3D DLRecon demonstrated statistically significant higher median image quality score (2.0/2) when compared to SOC 3D (1.0/2, p < 0.001), 2D axial (1.0/2, p < 0.001), and 2D sagittal sequences (1.0/2, p value < 0.001). κ ranges (and 95% CI) for foraminal stenosis were 0.55-0.76 (0.32-0.86) for 3D DLRecon, 0.56-0.73 (0.35-0.84) for SOC 3D, and 0.58-0.71 (0.33-0.84) for 2D. Mean κ (and 95% CI) for central stenosis at L4-5 were 0.98 (0.96-0.99), 0.97 (0.95-0.99), and 0.98 (0.96-0.99) for 3D DLRecon, 3D SOC and 2D, respectively. CONCLUSIONS DLRecon 3D T2w-FSE L-spine MRI demonstrated higher image quality and similar interobserver agreement for graded variables of interest when compared to 3D SOC and 2D imaging. KEY POINTS • 3D DLRecon T2w-FSE isotropic lumbar spine MRI provides improved image quality when compared to 2D MRI, with similar interobserver agreement for clinical evaluation of pathology. • 3D DLRecon images demonstrated better image quality score (2.0/2) when compared to standard-of-care (SOC) 3D (1.0/2), p value < 0.001; 2D axial (1.0/2), p value < 0.001; and 2D sagittal sequences (1.0/2), p value < 0.001. • Interobserver agreement for major variables of interest was similar among all sequences and reconstruction types. For foraminal stenosis, κ ranged from 0.55 to 0.76 (95% CI 0.32-0.86) for 3D DLRecon, 0.56-0.73 (95% CI 0.35-0.84) for standard-of-care (SOC) 3D, and 0.58-0.71 (95% CI 0.33-0.84) for 2D.
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Affiliation(s)
- Simon Sun
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Douglas N Mintz
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Meghan Sahr
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Joseph Nguyen
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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Krishnan KR, Sneag DB, Feinberg JH, Lee SK, Wolfe SW. Localization of Brachial Plexopathies Using a Novel Diagnostic Program. HSS J 2022; 18:78-82. [PMID: 35087336 PMCID: PMC8753543 DOI: 10.1177/15563316211001358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 02/03/2023]
Abstract
Background: Assessing the extent and specific location of brachial plexus injuries can be difficult given the variety of mechanisms of injury and anatomic complexity of the plexus. We developed a program to accurately assess the location of a patient's neurologic injury based on electromyographic data. Purpose: We sought to test our hypothesis that the location of traumatic brachial plexopathies could be accurately assessed with a novel program that processed electromyogram (EMG) and mechanism of injury data. Methods: This retrospective diagnostic cohort study was carried out with a novel diagnostic algorithm developed with the Python programming language. The program accepts user input of muscles demonstrating decreased motor unit recruitment, positive sharp waves, or fibrillation potentials. The testing data set was derived from a registry of brachial plexus injuries treated at our center. The primary outcome was the percent concordance of the algorithm's diagnosis with the surgical diagnosis. Results: Ninety-five cases met the inclusion criteria. Median time from injury onset to EMG examination was 4 months; median time from EMG examination to surgery was 1.2 months. The program diagnosis matched the surgical diagnosis in 92 out of 95 (97%) of cases, including cases with multilevel injuries and additional peripheral nerve injuries. Conclusion: This program accurately localized brachial plexopathies in nearly all cases, including those involving polytrauma or complex patterns of injury. This algorithm may be valuable as an aid to complete electrodiagnostic examinations, a diagnostic adjunct when planning treatment of severe plexus palsies, or an educational tool.
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Affiliation(s)
- Karthik R. Krishnan
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY, USA,Weill Cornell Medicine, New York, NY, USA,Karthik Krishnan, MS, Weill Cornell Medicine, New York, NY 10021, USA.
| | - Darryl B. Sneag
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY, USA,Weill Cornell Medicine, New York, NY, USA,Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Joseph H. Feinberg
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY, USA
| | - Steve K. Lee
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY, USA,Weill Cornell Medicine, New York, NY, USA
| | - Scott W. Wolfe
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY, USA,Weill Cornell Medicine, New York, NY, USA
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30
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Sneag DB, Geannette C, Queler S, Shin S, Winfree C, Hausman M, Bryce C, Simpson D. Long-Segment Nonfocal Peripheral Neuropathies After COVID-19 Infection: A Case Report of Magnetic Resonance Neurography Findings. HSS J 2022; 18:156-160. [PMID: 35087345 PMCID: PMC8753541 DOI: 10.1177/15563316211009207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/19/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Darryl B. Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
- Darryl B. Sneag, MD, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY 10021-4898, USA.
| | - Christian Geannette
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Sophie Queler
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Susan Shin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher Winfree
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Hausman
- Upper Extremity Surgery, Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Clare Bryce
- Department of Pathology, Mount Sinai Hospital, New York, NY, USA
| | - David Simpson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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31
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Tan ET, Zochowski KC, Sneag DB. Diffusion MRI fiber diameter for muscle denervation assessment. Quant Imaging Med Surg 2022; 12:80-94. [PMID: 34993062 PMCID: PMC8666740 DOI: 10.21037/qims-21-313] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND To develop and evaluate a diffusion MRI-based apparent muscle fiber diameter (AFD) method in patients with muscle denervation. It was hypothesized that AFD differences between denervated, non-denervated and control muscles would be greater than those from standard diffusion metrics. METHODS A spin-echo diffusion acquisition with multi-b-valued diffusion sampling was used. An orientation-invariant dictionary approach utilized a cylinder-based forward model and multi-compartment model for obtaining restricted and free fractions. Simulations were performed to determine precision, bias, and optimize dictionary parameters. In all, 18 exams of patients with muscle denervation and 8 exams of healthy subjects were performed at 3T. Six regions of interests (ROIs) within separate shoulder muscles were selected, yielding three groups consisting 47 control (healthy), 36 non-denervated (patients), and 68 denervated (patients) muscle ROIs. Two-sample t-tests (α=0.05) between groups were performed with Holm-Bonferroni correction. T2- and fat fraction (FF)-mapping were acquired for comparison. RESULTS Mean AFD was 89.7±13.6 µm in control, 71.6±15.3 µm in non-denervated, and 60.7±15.9 µm in denervated muscles and were significantly different (P<0.001) in paired comparisons and in 10/12 individual muscle region comparisons. Correlation between AFD and FF (-0.331, P<0.001) was low, but correlation between FA and FF was negligible (0.197, P=0.016). Correlation was low between AFD and T2 (-0.395, P<0.001) and between FA and T2 (0.359, P<0.001). CONCLUSIONS Diffusion MRI-based AFD complements T2- and FF-mapping techniques to non-invasively assess muscle denervation.
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Affiliation(s)
| | - Kelly C. Zochowski
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Darryl B. Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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32
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Queler SC, Towbin AJ, Milani C, Whang J, Sneag DB. Parsonage-Turner Syndrome Following COVID-19 Vaccination: MR Neurography. Radiology 2022; 302:84-87. [PMID: 34402669 PMCID: PMC8488809 DOI: 10.1148/radiol.2021211374] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/19/2021] [Accepted: 07/29/2021] [Indexed: 12/25/2022]
Abstract
Vaccination is one of the several known triggers of Parsonage-Turner syndrome (PTS). This case series describes two individuals with clinical presentations of PTS whose symptoms began 13 hours and 18 days following receipt of the Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273 COVID-19 vaccine, respectively. The diagnosis of PTS was confirmed by using both electrodiagnostic testing and 3.0-T MR neurography. Although research is needed to understand the association between PTS and COVID-19 vaccination, MR neurography may be used to help confirm suspected cases of PTS as COVID-19 vaccines continue to be distributed worldwide.
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Affiliation(s)
- Sophie C. Queler
- From the Department of Radiology and Imaging (S.C.Q., D.B.S.) and
Department of Spine and Sports Medicine (C.M.), Hospital for Special Surgery,
535 E 70th St, New York, NY 10021; Department of Radiology, Cincinnati
Children's Hospital Medical Center, University of Cincinnati College of
Medicine, Cincinnati, Ohio (A.J.T.); and Blue Star Radiology Associates,
Frisco, Tex (J.W.)
| | - Alexander J. Towbin
- From the Department of Radiology and Imaging (S.C.Q., D.B.S.) and
Department of Spine and Sports Medicine (C.M.), Hospital for Special Surgery,
535 E 70th St, New York, NY 10021; Department of Radiology, Cincinnati
Children's Hospital Medical Center, University of Cincinnati College of
Medicine, Cincinnati, Ohio (A.J.T.); and Blue Star Radiology Associates,
Frisco, Tex (J.W.)
| | - Carlo Milani
- From the Department of Radiology and Imaging (S.C.Q., D.B.S.) and
Department of Spine and Sports Medicine (C.M.), Hospital for Special Surgery,
535 E 70th St, New York, NY 10021; Department of Radiology, Cincinnati
Children's Hospital Medical Center, University of Cincinnati College of
Medicine, Cincinnati, Ohio (A.J.T.); and Blue Star Radiology Associates,
Frisco, Tex (J.W.)
| | - Jeremy Whang
- From the Department of Radiology and Imaging (S.C.Q., D.B.S.) and
Department of Spine and Sports Medicine (C.M.), Hospital for Special Surgery,
535 E 70th St, New York, NY 10021; Department of Radiology, Cincinnati
Children's Hospital Medical Center, University of Cincinnati College of
Medicine, Cincinnati, Ohio (A.J.T.); and Blue Star Radiology Associates,
Frisco, Tex (J.W.)
| | - Darryl B. Sneag
- From the Department of Radiology and Imaging (S.C.Q., D.B.S.) and
Department of Spine and Sports Medicine (C.M.), Hospital for Special Surgery,
535 E 70th St, New York, NY 10021; Department of Radiology, Cincinnati
Children's Hospital Medical Center, University of Cincinnati College of
Medicine, Cincinnati, Ohio (A.J.T.); and Blue Star Radiology Associates,
Frisco, Tex (J.W.)
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LeBrun DG, Sneag DB, Feinberg JH, McCarthy MM, Gulotta LV, Lee SK, Wolfe SW. Surgical Treatment of Iatrogenic Nerve Injury Following Arthroscopic Capsulolabral Repair. J Hand Surg Am 2021; 46:1121.e1-1121.e11. [PMID: 33902974 DOI: 10.1016/j.jhsa.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 01/10/2021] [Accepted: 03/11/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Case reports of nerve injuries following arthroscopic capsulolabral repair emphasize the proximity of major nerves to the glenoid. This study describes preoperative localization using nerve-sensitive magnetic resonance imaging in a small cohort of patients with iatrogenic nerve injuries following arthroscopic capsulolabral repair and the outcomes of nerve repair in these patients. METHODS Cases of iatrogenic nerve injury following arthroscopic capsulolabral repair referred to 2 surgeons from January 2017 to December 2019 were identified. Clinical charts, electrodiagnostic testing, magnetic resonance imaging studies, and operative reports were reviewed. RESULTS Four cases of iatrogenic nerve injury were identified. The time to presentation to our institution ranged from 2 weeks to 8 years. The axillary nerves in 3 cases were tethered by a suture at the inferior glenoid, whereas 1 case had a suture tied around the radial and median nerves inferior to the glenohumeral joint capsule. One case underwent excision and nerve transfer, 1 underwent excision and nerve repair, and 2 underwent suture removal and neurolysis. Open and arthroscopic approaches, including a recently described approach to the axillary nerve in the "blind zone," were used. Three cases demonstrated good recovery of all affected motor and sensory functions after surgery. At the 10-month follow-up, 1 case had persistent weakness, but there was evidence of axonal regeneration on electrodiagnostic testing. CONCLUSIONS Arthroscopic capsulolabral repair places regional nerves, particularly the axillary nerve, at risk owing to their proximity to the joint capsule and inferior glenoid. Patients with neuropathic pain in the distribution of affected nerves with corresponding sensorimotor loss following arthroscopic capsulolabral surgery should undergo focused magnetic resonance imaging with nerve-sensitive sequences and electrodiagnostic testing to localize the injury. The use of multiple surgical windows to the axillary nerve in the "blind zone" enables full visualization for neurolysis, suture removal, and nerve repair or transfer. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Drake G LeBrun
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | | | - Moira M McCarthy
- Department of Orthopedic Surgery, Sports Medicine, Hospital for Special Surgery, New York, NY
| | - Lawrence V Gulotta
- Department of Orthopedic Surgery, Sports Medicine, Hospital for Special Surgery, New York, NY
| | - Steve K Lee
- Department of Orthopedic Surgery, Hand and Upper Extremity, Hospital for Special Surgery, New York, NY
| | - Scott W Wolfe
- Department of Orthopedic Surgery, Hand and Upper Extremity, Hospital for Special Surgery, New York, NY
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34
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Daniels SP, Ross AB, Sneag DB, Gardon SN, Li G, Hanna A, Tuite MJ. Intravenous contrast does not improve detection of nerve lesions or active muscle denervation changes in MR neurography of the common peroneal nerve. Skeletal Radiol 2021; 50:2483-2494. [PMID: 34021773 DOI: 10.1007/s00256-021-03812-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effect of intravenous (IV) contrast on sensitivity, specificity, and accuracy of magnetic resonance (MR) neurography of the knee with attention to the common peroneal nerve (CPN) in identifying nerve lesions and active muscle denervation changes. MATERIALS AND METHODS A retrospective search for contrast-enhanced MR neurography cases evaluating the CPN at the knee was performed. Patients with electrodiagnostic testing (EDX) within 3 months of imaging were included and those with relevant prior surgery were excluded. Two radiologists independently reviewed non-contrast sequences and then 4 weeks later evaluated non-contrast and contrast sequences. McNemar's tests were performed to detect a difference between non-contrast only and combined non-contrast and contrast sequences in identifying nerve lesions and active muscle denervation changes using EDX as the reference standard. RESULTS Forty-four exams in 42 patients (2 bilateral) were included. Twenty-eight cases had common peroneal neuropathy and 29, 21, and 9 cases had active denervation changes in the anterior, lateral, and posterior compartment/proximal muscles respectively on EDX. Sensitivity, specificity, and accuracy of non-contrast versus combined non-contrast and contrast sequences for common peroneal neuropathy were 50.0%, 56.2%, and 52.3% versus 50.0%, 56.2%, and 52.3% for reader 1 and 57.1%, 50.0%, and 54.5% versus 64.3%, 56.2%, and 61.4% for reader 2. Sensitivity, specificity, and accuracy of non-contrast and combined non-contrast and contrast sequences in identifying active denervation changes for anterior, lateral, and posterior compartment muscles were not significantly different. McNemar's tests were all negative. CONCLUSION IV contrast does not improve the ability of MR neurography to detect CPN lesions or active muscle denervation changes.
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Affiliation(s)
- Steven P Daniels
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY, 10016, USA.
| | - Andrew B Ross
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th St., New York, NY, 10021, USA
| | - Stephanie N Gardon
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA
| | - Geng Li
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA
| | - Amgad Hanna
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA
| | - Michael J Tuite
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA
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35
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Queler SC, Tan ET, Geannette C, Prince M, Sneag DB. Ferumoxytol-enhanced vascular suppression in magnetic resonance neurography. Skeletal Radiol 2021; 50:2255-2266. [PMID: 33961070 DOI: 10.1007/s00256-021-03804-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate ferumoxytol-enhanced vascular suppression for visualizing branch nerves of the brachial plexus in magnetic resonance (MR) neurography. MATERIALS AND METHODS Signal simulations were performed to determine ferumoxytol's effect on nerve-, fat-, and blood-to-muscle contrast and to optimize pulse sequence parameters. Prospective, in vivo assessment included 10 subjects with chronic anemia who underwent a total of 19 (9 bilateral) pre- and post-infusion brachial plexus exams using three-dimensional (3D), T2-weighted short-tau inversion recovery (T2-STIR) sequences at 3.0 T. Two musculoskeletal radiologists qualitatively rated sequences for the degree of vascular suppression and brachial plexus branch nerve conspicuity. Nerve-to-muscle, -fat, and -vessel contrast ratios were measured. RESULTS Quantitative nerve/muscle and nerve/small vessel contrast ratios (CRs) increased with ferumoxytol (p < 0.05). Qualitative vascular suppression and suprascapular nerve visualization improved following ferumoxytol administration for both raters (p < .05). Pre- and post-ferumoxytol exams demonstrated moderate to near-perfect inter-rater agreement for nerve visualization and diagnostic confidence for the suprascapular and axillary nerves but poor to no agreement for the long thoracic nerve. CONCLUSION Ferumoxytol in T2-weighted brachial plexus MR neurography provides robust vascular suppression and aids visualization of the suprascapular nerve in volunteers without neuropathy.
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Affiliation(s)
- Sophie C Queler
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Christian Geannette
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Martin Prince
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, 535 E. 70th St., New York, NY, 10021, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
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36
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Zochowski KC, Tan ET, Argentieri EC, Lin B, Burge AJ, Queler SC, Lebel RM, Sneag DB. Improvement of peripheral nerve visualization using a deep learning-based MR reconstruction algorithm. Magn Reson Imaging 2021; 85:186-192. [PMID: 34715288 DOI: 10.1016/j.mri.2021.10.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess a new deep learning-based MR reconstruction method, "DLRecon," for clinical evaluation of peripheral nerves. METHODS Sixty peripheral nerves were prospectively evaluated in 29 patients (mean age: 49 ± 16 years, 17 female) undergoing standard-of-care (SOC) MR neurography for clinically suspected neuropathy. SOC-MRIs and DLRecon-MRIs were obtained through conventional and DLRecon reconstruction methods, respectively. Two radiologists randomly evaluated blinded images for outer epineurium conspicuity, fascicular architecture visualization, pulsation artifact, ghosting artifact, and bulk motion. RESULTS DLRecon-MRIs were likely to score better than SOC-MRIs for outer epineurium conspicuity (OR = 1.9, p = 0.007) and visualization of fascicular architecture (OR = 1.8, p < 0.001) and were likely to score worse for ghosting (OR = 2.8, p = 0.004) and pulsation artifacts (OR = 1.6, p = 0.004). There was substantial to almost-perfect inter-reconstruction method agreement (AC = 0.73-1.00) and fair to almost-perfect interrater agreement (AC = 0.34-0.86) for all features evaluated. DLRecon-MRI had improved interrater agreement for outer epineurium conspicuity (AC = 0.71, substantial agreement) compared to SOC-MRIs (AC = 0.34, fair agreement). In >80% of images, the radiologist correctly identified an image as SOC- or DLRecon-MRI. DISCUSSION Outer epineurium and fascicular architecture conspicuity, two key morphological features critical to evaluating a nerve injury, were improved in DLRecon-MRIs compared to SOC-MRIs. Although pulsation and ghosting artifacts increased in DLRecon images, image interpretation was unaffected.
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Affiliation(s)
- Kelly C Zochowski
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70(th) Street, New York, NY 10021, United States of America
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70(th) Street, New York, NY 10021, United States of America
| | - Erin C Argentieri
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70(th) Street, New York, NY 10021, United States of America
| | - Bin Lin
- Department of Biostatistics, Hospital for Special Surgery, 535 E 70(th) Street, New York, NY 10021, United States of America
| | - Alissa J Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70(th) Street, New York, NY 10021, United States of America
| | - Sophie C Queler
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70(th) Street, New York, NY 10021, United States of America
| | | | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70(th) Street, New York, NY 10021, United States of America.
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Abstract
Three-dimensional (3D) magnetic resonance imaging of the spine is now clinically feasible due to technological advancements. Its advantages over two-dimensional imaging include higher in-plane spatial resolution and the ability for reformation in any plane that enables time savings in image acquisition and aids more accurate interpretation. Multispectral 3D techniques for imaging around metal are sometimes useful for evaluating anatomy adjacent to spinal fixation hardware. 3D gradient-recalled echo sequences, including ultrashort or zero time to echo sequences, can provide osseous detail similar to conventional computed tomography.
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Affiliation(s)
- Meghan Sahr
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
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38
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Motovilova E, Tan ET, Taracila V, Vincent JM, Grafendorfer T, Shin J, Potter HG, Robb FJL, Sneag DB, Winkler SA. Stretchable self-tuning MRI receive coils based on liquid metal technology (LiquiTune). Sci Rep 2021; 11:16228. [PMID: 34376703 PMCID: PMC8355233 DOI: 10.1038/s41598-021-95335-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/23/2021] [Indexed: 01/14/2023] Open
Abstract
Magnetic resonance imaging systems rely on signal detection via radiofrequency coil arrays which, ideally, need to provide both bendability and form-fitting stretchability to conform to the imaging volume. However, most commercial coils are rigid and of fixed size with a substantial mean offset distance of the coil from the anatomy, which compromises the spatial resolution and diagnostic image quality as well as patient comfort. Here, we propose a soft and stretchable receive coil concept based on liquid metal and ultra-stretchable polymer that conforms closely to a desired anatomy. Moreover, its smart geometry provides a self-tuning mechanism to maintain a stable resonance frequency over a wide range of elongation levels. Theoretical analysis and numerical simulations were experimentally confirmed and demonstrated that the proposed coil withstood the unwanted frequency detuning typically observed with other stretchable coils (0.4% for the proposed coil as compared to 4% for a comparable control coil). Moreover, the signal-to-noise ratio of the proposed coil increased by more than 60% as compared to a typical, rigid, commercial coil.
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Affiliation(s)
- Elizaveta Motovilova
- grid.5386.8000000041936877XDepartment of Radiology, Weill Cornell Medicine, New York, NY 10065 USA ,grid.239915.50000 0001 2285 8823Department of Radiology, Hospital for Special Surgery, New York, NY 10021 USA
| | - Ek Tsoon Tan
- grid.239915.50000 0001 2285 8823Department of Radiology, Hospital for Special Surgery, New York, NY 10021 USA
| | - Victor Taracila
- grid.418143.b0000 0001 0943 0267GE Healthcare, Aurora, OH USA
| | - Jana M. Vincent
- grid.418143.b0000 0001 0943 0267GE Healthcare, Aurora, OH USA
| | | | - James Shin
- grid.5386.8000000041936877XDepartment of Radiology, Weill Cornell Medicine, New York, NY 10065 USA
| | - Hollis G. Potter
- grid.239915.50000 0001 2285 8823Department of Radiology, Hospital for Special Surgery, New York, NY 10021 USA
| | | | - Darryl B. Sneag
- grid.239915.50000 0001 2285 8823Department of Radiology, Hospital for Special Surgery, New York, NY 10021 USA
| | - Simone A. Winkler
- grid.5386.8000000041936877XDepartment of Radiology, Weill Cornell Medicine, New York, NY 10065 USA
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Abstract
Anterior interosseous nerve syndrome (AINS) represents a form of neuralgic amyotrophy (Parsonage-Turner syndrome). AINS does not originate from external compression of the AIN in the forearm. Fascicular constrictions (FCs) of the median nerve are identified within the anterior interosseous fascicular group at or above the medial epicondyle. Spontaneous recovery is not ensured, leaving up to 30% of patients with permanent weakness or palsy. Fascicular microneurolysis of the median nerve, performed at or above the elbow, is a treatment option for patients who do not recover spontaneously.
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Affiliation(s)
- Karthik R Krishnan
- Center for Brachial Plexus and Traumatic Nerve Injury (K.R.K., D.B.S., J.H.F., and S.W.W.) and Department of Radiology and Imaging (D.B.S.), Hospital for Special Surgery, New York, NY.,Weill Medical College of Cornell University, New York, NY
| | - Darryl B Sneag
- Center for Brachial Plexus and Traumatic Nerve Injury (K.R.K., D.B.S., J.H.F., and S.W.W.) and Department of Radiology and Imaging (D.B.S.), Hospital for Special Surgery, New York, NY.,Weill Medical College of Cornell University, New York, NY
| | - Joseph H Feinberg
- Center for Brachial Plexus and Traumatic Nerve Injury (K.R.K., D.B.S., J.H.F., and S.W.W.) and Department of Radiology and Imaging (D.B.S.), Hospital for Special Surgery, New York, NY.,Weill Medical College of Cornell University, New York, NY
| | - Scott W Wolfe
- Center for Brachial Plexus and Traumatic Nerve Injury (K.R.K., D.B.S., J.H.F., and S.W.W.) and Department of Radiology and Imaging (D.B.S.), Hospital for Special Surgery, New York, NY.,Weill Medical College of Cornell University, New York, NY
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40
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Sneag DB, Kiprovski K. MR Neurography of Bilateral Parsonage-Turner Syndrome. Radiology 2021; 300:515. [PMID: 34227884 DOI: 10.1148/radiol.2021204688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Darryl B Sneag
- From the Department of Radiology and Imaging, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E 70th St, New York, NY 10021 (D.B.S.); and Department of Neurology, New York University Grossman School of Medicine, New York, NY (K.K.)
| | - Kiril Kiprovski
- From the Department of Radiology and Imaging, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E 70th St, New York, NY 10021 (D.B.S.); and Department of Neurology, New York University Grossman School of Medicine, New York, NY (K.K.)
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Abstract
As the frequency of orthopedic procedures performed each year in the United States continues to increase, evaluation of peripheral nerve injury (PNI) in the presence of pre-existing metallic hardware is in higher demand. Advances in metal artifact reduction techniques have substantially improved the capability to reduce the susceptibility effect at MRI, but few reports have documented the use of MR neurography in the evaluation of peripheral nerves in the presence of orthopedic hardware. This report delineates the challenges of MR neurography around metal given the high spatial resolution often required to adequately depict small peripheral nerves. It offers practical tips, including strategies for prescan assessment and protocol optimization, including use of more conventional two-dimensional proton density and T2-weighted fat-suppressed sequences and specialized three-dimensional techniques, such as reversed free-induction steady-state precession and multispectral imaging, which enable vascular suppression and metal artifact reduction, respectively. Finally, this article emphasizes the importance of real-time monitoring by radiologists to optimize the diagnostic yield of MR neurography in the presence of orthopedic hardware. © RSNA, 2021.
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Affiliation(s)
- Darryl B Sneag
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, Room 2P-040, New York, NY 10021
| | - Kelly C Zochowski
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, Room 2P-040, New York, NY 10021
| | - Ek T Tan
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, Room 2P-040, New York, NY 10021
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Tan ET, Queler SC, Lin B, Endo Y, Burge AJ, Sternberg J, Potter HG, Sneag DB. Improved nerve conspicuity with water-weighting and denoising in two-point Dixon magnetic resonance neurography. Magn Reson Imaging 2021; 79:103-111. [PMID: 33753136 DOI: 10.1016/j.mri.2021.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND T2-weighted, two-point Dixon fast-spin-echo (FSE) is an effective technique for magnetic resonance neurography (MRN) that can provide quantitative assessment of muscle denervation. Low signal-to-noise ratio and inadequate fat suppression, however, can impede accurate interpretation. PURPOSE To quantify effects of principal component analysis (PCA) denoising on tissue signal intensities and fat fraction (FF) and to determine qualitative image quality improvements from both denoising and water-weighting (WW) algorithms to improve nerve conspicuity and fat suppression. STUDY TYPE Prospective. SUBJECTS Twenty-one subjects undergoing MR neurography evaluation (11/10 male/female, mean age = 46.3±13.7 years) with 60 image volumes. Twelve subjects (23 image volumes) were determined to have muscle denervation based on diffusely elevated T2 signal intensity. FIELD STRENGTH/SEQUENCE 3 T, 2D, two-point Dixon FSE. ASSESSMENT Qualitative assessment included overall image quality, nerve conspicuity, fat suppression, pulsation and ringing artifacts by 3 radiologists separately on a three-point scale (1 = poor, 2 = average, 3 = excellent). Quantitative measurements for FF and signal intensity relative to normal muscle were made for nerve, abnormal muscle and subcutaneous fat. STATISTICAL TESTS Linear and ordinal regression models were used for quantitative and qualitative comparisons, respectively; 95% confidence intervals (CIs) and p-values for pairwise comparisons were adjusted using the Holm-Bonferroni method. Inter-rater agreement was assessed using Gwet's agreement coefficient (AC2). RESULTS Simulations showed PCA-denoising reduced FF error from 2.0% to 1.0%, and from 7.6% to 3.1% at noise levels of 10% and 30%, respectively. In human subjects, PCA-denoising did not change signal levels and FF quantitatively. WW decreased fat signal significantly (-83.6%, p < 0.001). Nerve conspicuity was improved by WW (odds ratio, OR = 5.8, p < 0.001). Fat suppression was improved by both PCA (OR = 3.6, p < 0.001) and WW (OR = 2.2, p < 0.001). Overall image quality was improved by PCA + WW (OR = 1.7, p = 0.04). CONCLUSIONS WW and PCA-denoising improved nerve conspicuity and fat suppression in MR neurography. Denoising can potentially provide improved accuracy of FF maps for assessing fat-infiltrated muscle.
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Affiliation(s)
- Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
| | - Sophie C Queler
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Bin Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Alissa J Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Julia Sternberg
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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Argentieri EC, Tan ET, Whang JS, Queler SC, Feinberg JH, Lin B, Sneag DB. Quantitative T 2 -mapping magnetic resonance imaging for assessment of muscle motor unit recruitment patterns. Muscle Nerve 2021; 63:703-709. [PMID: 33501678 DOI: 10.1002/mus.27186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/17/2021] [Accepted: 01/24/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION In this study, we aimed to determine whether muscle transverse relaxation time (T2 ) magnetic resonance (MR) mapping results correlate with motor unit loss, as defined by motor unit recruitment patterns on electromyography (EMG). METHODS EMG and 3-Tesla MRI exams were acquired no more than 31 days apart in subjects referred for peripheral nerve MRI. Two musculoskeletal radiologists qualitatively graded T2 -weighted, fat-suppressed sequences for severity of muscle edema-like patterns and manually placed regions of interest within muscles to obtain T2 values from T2 -mapping sequences. Concordance was calculated between qualitative and quantitative MR grades and EMG recruitment categories (none, discrete, decreased) as well as interobserver agreement for both MR grades. RESULTS Thirty-four muscles (21 abnormal, 13 control) were assessed in 13 subjects (5 females and 8 males; mean age, 46 years) with 14 EMG-MRI pairs. T2 -relaxation times were significantly (P < .001) increased in all EMG recruitment categories compared with control muscles. T2 differences were not significant between EMG grades of motor unit recruitment (P = .151-.702). T2 and EMG score concordance was acceptable (Harrell's concordance index [c index]: rater A, 0.71; 95% confidence interval [CI], 0.51-0.87; rater B, 0.77; 95% CI, 0.57-0.91). Qualitative MRI and EMG score concordance was poor to acceptable (c index: rater A, 0.60; 95% CI, 0.50-0.79; rater B, 0.72; 95% CI, 0.55-0.89). T2 values had moderate-to-substantial ability to distinguish between absent vs incomplete (ie, decreased or discrete) motor unit recruitment (c index: rater A, 0.78; 95% CI, 0.50-1.00; rater B, 0.86; 95% CI, 0.57-1.00). DISCUSSION Quantitative T2 MR muscle mapping is a promising tool for noninvasive evaluation of the degree of motor unit recruitment loss.
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Affiliation(s)
- Erin C Argentieri
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Jeremy S Whang
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Sophie C Queler
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Joseph H Feinberg
- Departments of Physiatry and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Bin Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
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Sneag DB, Curlin J, Saltzman EB, Carlson MG, Lee SK. Role of high-resolution peripheral nerve magnetic resonance imaging in diagnosing median nerve tethering in a case of both-bone forearm fracture in a child. Pediatr Radiol 2021; 51:148-151. [PMID: 32621015 DOI: 10.1007/s00247-020-04732-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/07/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022]
Abstract
Forearm fractures are common injuries in pediatric patients. We present a case of median nerve tethering as a complication of both-bone forearm fracture in a child, with an emphasis on MRI as an appropriate and important complement to clinical and electrodiagnostic examination. Early intervention is essential because delayed surgical management of median nerve tethering can result in poor clinical outcomes as a result of irreversible muscle denervation. In this case, we highlight the importance of MRI to facilitate management, including early surgical intervention when appropriate, in median neuropathy following forearm fractures.
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Affiliation(s)
- Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th St., New York, NY, 10021, USA.
| | - Jahnavi Curlin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th St., New York, NY, 10021, USA
| | | | - Michelle G Carlson
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Steve K Lee
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Krishnan KR, Sneag DB, Feinberg JH, Nwawka OK, Lee SK, Arányi Z, Wolfe SW. Outcomes of Microneurolysis of Hourglass Constrictions in Chronic Neuralgic Amyotrophy. J Hand Surg Am 2021; 46:43-53. [PMID: 32868098 DOI: 10.1016/j.jhsa.2020.07.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/08/2020] [Accepted: 07/24/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Wide variability in the recovery of patients affected by neuralgic amyotrophy (NA) is recognized, with up to 30% experiencing residual motor deficits. Using magnetic resonance imaging and ultrasound (US), we identified hourglass constrictions (HGCs) in all affected nerves of patients with chronic motor paralysis from NA. We hypothesized that chronic NA patients undergoing microsurgical epineurolysis and perineurolysis of constrictions would experience greater recovery compared with patients managed nonsurgically. METHODS We treated 24 patients with chronic motor palsy from NA and HGCs identified on magnetic resonance imaging and US either with microsurgical epineurolysis and perineurolysis of HGCs (11 of 24) or nonsurgically (13 of 24). Muscle strength (both groups) and electrodiagnostic testing (EDX) (operative group) was performed before and after surgery. Preoperative EDX confirmed muscle denervation in the distribution of affected nerve(s). All patients met criteria for microneurolysis: 12 months without improvement since onset or failure of clinical and EDX improvement after 6 months documented by 3 successive examinations, each at least 6 weeks apart. RESULTS Mean time from onset to surgery was 12.5 ± 4.0 months. Average time to most recent post-onset follow-up occurred at 27.3 months (range, 18-42 months; 15 nerves). Average time to latest follow-up among nonsurgical patients was 33.6 months (range, 18-108 months; 16 nerves). Constrictions involved individual fascicular groups (FCs) of the median nerve and the suprascapular, axillary and radial nerves proper (HGCs). Nine of 11 operative patients experienced clinical recovery compared with 3 of 13 nonsurgical patients. EMG revealed significant motor unit recovery from axonal regeneration in the operative group. CONCLUSIONS Microsurgical epineurolysis and perineurolysis of FCs and HGCs was associated with significantly improved clinical and nerve regeneration at an average follow-up of 14.8 months compared with nonsurgical management. We recommend microneurolysis of HGCs and FCs as a treatment option for patients with chronic NA who have failed to improve with nonsurgical treatment. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Karthik R Krishnan
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - Darryl B Sneag
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - Joseph H Feinberg
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY
| | - Ogonna K Nwawka
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - Steve K Lee
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - Zsuzsanna Arányi
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Scott W Wolfe
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Weill Medical College of Cornell University, New York, NY.
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Sneag DB, Tan ET. Can Quantitative MRI Be Used to Differentiate Physiologic Changes Behind Muscle Weakness in Type 2 Diabetes Mellitus? Radiology 2020; 297:620-621. [PMID: 33064035 PMCID: PMC7706872 DOI: 10.1148/radiol.2020203768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Darryl B. Sneag
- From the MRI Laboratory, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Ek T. Tan
- From the MRI Laboratory, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
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Krishnan KR, Wolfe SW, Feinberg JH, Nwawka OK, Sneag DB. Imaging and treatment of phrenic nerve hourglass-like constrictions in neuralgic amyotrophy. Muscle Nerve 2020; 62:E81-E82. [PMID: 32841403 DOI: 10.1002/mus.27049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/10/2020] [Accepted: 08/16/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Karthik R Krishnan
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, New York, USA.,Weill Medical College of Cornell University, New York, New York, USA
| | - Scott W Wolfe
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, New York, USA.,Weill Medical College of Cornell University, New York, New York, USA
| | - Joseph H Feinberg
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, New York, USA.,Weill Medical College of Cornell University, New York, New York, USA
| | - Ogonna K Nwawka
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, New York, USA.,Weill Medical College of Cornell University, New York, New York, USA
| | - Darryl B Sneag
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, New York, USA.,Weill Medical College of Cornell University, New York, New York, USA
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Lee SC, Geannette CS, Sneag DB. Identification of long thoracic nerve on high-resolution 3T MRI. Clin Imaging 2020; 64:97-102. [DOI: 10.1016/j.clinimag.2020.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/08/2020] [Accepted: 04/20/2020] [Indexed: 01/08/2023]
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Geannette C, Lee SC, Sneag DB. Etiology of Lumbosacral Radiculoplexopathy: Sacral Insufficiency Fracture on Magnetic Resonance Imaging. HSS J 2020; 16:126-129. [PMID: 32523479 PMCID: PMC7253557 DOI: 10.1007/s11420-020-09750-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sacral insufficiency fracture (SIF) can cause lumbosacral radiculoplexopathy (LSRP) and is probably under-recognized. Symptoms may include nonspecific lumbar spine or buttock pain that is exacerbated by physical activity and alleviated with rest. The frequency of LSRP secondary to SIF has not been reported. QUESTIONS/PURPOSES We aimed to determine the frequency of LSRP associated with SIF using magnetic resonance imaging (MRI) of the lumbar spine. METHODS We searched a radiology database at our institution using the keywords "sacral insufficiency fracture" and "lumbar spine MRI" for patient records from January 2014 through December 2017. We assessed for the presence of LSRP, reflected by elevated T2-weighted or short tau inversion recovery (STIR) signal intensity and enlargement of the nerve on noncontrast lumbar spine MRI. An incompletely healed vertically oriented SIF was confirmed if there was a persistent bone marrow edema pattern adjacent to the fracture site; we did not include purely transverse SIFs. The final cohort comprised 57 patients (48 female; age range, 14 to 89 years). RESULTS Abnormalities of the extraforaminal L5 nerve root or the combined L4 and L5 nerve roots (the lumbosacral trunk) were identified in 19 (33%) of 57 patients, with a total of 23 sites (bilateral involvement in four cases). Of the 23 abnormal nerves, 19 (82.6%) had corresponding, clinically documented radicular symptoms and 16 (69.6%) had no other explanation on MRI for their radicular symptoms other than SIF. CONCLUSIONS LSRP caused by SIF is an entity all radiologists should be cognizant of, especially in cases of otherwise unexplained radicular symptoms. The diagnosis of SIF can be helpful in cases involving concomitant multilevel lumbar spondylosis and neural foraminal stenosis.
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Affiliation(s)
- Christian Geannette
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Susan C. Lee
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Darryl B. Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
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50
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Abstract
CASE Two firefighters developed Parsonage-Turner syndrome (PTS) shortly after sustaining episodes of heat stroke. Patient 1 was a 40-year-old man who presented with shoulder pain and supraspinatus and infraspinatus weakness. Patient 2 was a 35-year-old man who presented with shoulder pain and absent external rotation strength. Both had electrodiagnostic testing and magnetic resonance imaging findings consistent with PTS. Both demonstrated partial but incomplete recovery at 1- and 2.5-year follow-ups, respectively. CONCLUSIONS PTS should remain on the differential diagnosis for any patient presenting with sudden onset shoulder pain and neurological deficits after an episode of heat-related illness.
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Affiliation(s)
- Claire D Eliasberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Darryl B Sneag
- Department of Radiology, Hospital for Special Surgery, New York, New York
| | - Anne M Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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