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Jayapal P, Alharthi O, Young V, Obi C, Syed AB, Sandberg JK. Magnetic resonance neurography techniques in the pediatric population. Pediatr Radiol 2023; 53:2167-2179. [PMID: 37710037 DOI: 10.1007/s00247-023-05759-7] [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: 02/23/2023] [Revised: 08/11/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023]
Abstract
The use of magnetic resonance imaging (MRI) in the evaluation of the central extracranial nervous system, namely the brachial and lumbosacral plexuses, is well established and has been performed for many years. Only recently after numerous advances in MRI, has image quality been sufficient to properly visualize small structures, such as nerves in the extremities. Despite the advances, peripheral MR Neurography remains a complex and difficult examination to perform, especially in the pediatric patient population, in which the risk for motion artifact and compliance is always of concern. Thus, technical aspects of the MR imaging protocol must be flexible but robust, to balance image quality with scan time, in a patient population of varying sizes. An additional important step for reliably performing a successful MR Neurography examination is the non-technical pre-imaging preparation, which includes patient/family education and open communication with referring teams. This paper will discuss in detail the individual technical and non-technical/operational aspects of peripheral MR Neurography, to help guide in building a successful program in the pediatric population.
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Affiliation(s)
- Praveen Jayapal
- Department of Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, 94304, USA
| | - Omar Alharthi
- Department of Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, 94304, USA
| | - Victoria Young
- Department of Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, 94304, USA
| | - Chrystal Obi
- Department of Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, 94304, USA
| | - Ali B Syed
- Department of Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, 94304, USA
| | - Jesse K Sandberg
- Department of Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, 94304, USA.
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Taneja AK, Chhabra A. Neuropathy Score Reporting and Data System (NS-RADS): A Practical Review of MRI-Based Peripheral Neuropathy Assessment. Semin Ultrasound CT MR 2023; 44:386-397. [PMID: 37437974 DOI: 10.1053/j.sult.2023.04.003] [Citation(s) in RCA: 1] [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] [Indexed: 07/14/2023]
Abstract
The Neuropathy Score Reporting and Data System (NS-RADS) is a newly developed MR imaging-based classification that standardizes reporting and multidisciplinary communication for MR imaging diagnosis and follow-up of peripheral neuropathies. NS-RADS classification has shown to be accurate and reliable across different centers, readers' experience levels, and degrees of peripheral neuropathies, which include nerve injury, entrapment, neoplasm, diffuse neuropathy, post-interventional status, and temporal changes in muscle denervation. This article brings a practical review of NS-RADS classification, representative MR cases, and a step-by-step tutorial on how to approach this staging system. Readers can gain knowledge and apply it in their practice, aiming to standardize the communications between specialties and improve patient management.
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Affiliation(s)
- Atul K Taneja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Avneesh Chhabra
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX; Johns Hopkins University, Baltimore, MD; Walton Center of Neuroscience, Liverpool, UK; University of Dallas, Richardson, TX; Johns Hopkins University, Maryland, MD; Walton Centre for Neuroscience, Liverpool, UK.
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Mandeville R, Deshmukh S, Tan ET, Kumar V, Sanchez B, Dowlatshahi AS, Luk J, See RHB, Leochico CFD, Thum JA, Bazarek S, Johnston B, Brown J, Wu J, Sneag D, Rutkove SB. A Scoping Review of Current and Emerging Techniques for Evaluation of Peripheral Nerve Health, Degeneration and Regeneration: Part 2, Non-Invasive Imaging. J Neural Eng 2023. [PMID: 37369193 DOI: 10.1088/1741-2552/ace217] [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] [Indexed: 06/29/2023]
Abstract
Peripheral neuroregenerative research and therapeutic options are expanding exponentially. With this expansion comes an increasing need to reliably evaluate and quantify nerve health. Valid and responsive measures of the nerve status are essential for both clinical and research purposes for diagnosis, longitudinal follow-up, and monitoring the impact of any intervention. Furthermore, novel biomarkers can elucidate regenerative mechanisms and open new avenues for research. Without such measures, clinical decision-making is impaired, and research becomes more costly, time-consuming, and sometimes infeasible. Part 1 of this two-part scoping review focused on neurophysiology. In Part 2, we identify and critically examine many current and emerging non-invasive imaging techniques that have the potential to evaluate peripheral nerve health, particularly from the perspective of regenerative therapies and research.
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Affiliation(s)
- Ross Mandeville
- Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts, 02215-5491, UNITED STATES
| | - Swati Deshmukh
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, 02215-5491, UNITED STATES
| | - Ek Tsoon Tan
- Department of Radiology, Hospital for Special Surgery, 535 E 70th St, New York, 10021-4898, UNITED STATES
| | - Viksit Kumar
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114-2696, UNITED STATES
| | - Benjamin Sanchez
- Electrical and Computer Engineering, The University of Utah, 36 S Wasatch Drive, Salt Lake City, Utah, 84112-9057, UNITED STATES
| | - Arriyan S Dowlatshahi
- Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, 02215-5491, UNITED STATES
| | - Justin Luk
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, 02114-2696, UNITED STATES
| | - Reiner Henson B See
- Department of Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114-2696, UNITED STATES
| | - Carl Froilan D Leochico
- Department of Physical Medicine and Rehabilitation, Saint Luke's Medical Center Global City, 5th Ave, 1634, Taguig, 1634, PHILIPPINES
| | - Jasmine A Thum
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, 02114-2696, UNITED STATES
| | - Stanley Bazarek
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts, 02115-6195, UNITED STATES
| | - Benjamin Johnston
- Department of Neurosurgery, Brigham and Women's Hospital, 75Francis Street, Boston, Massachusetts, 02115-6195, UNITED STATES
| | - Justin Brown
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114-2696, UNITED STATES
| | - Jim Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, 02215-5491, UNITED STATES
| | - Darryl Sneag
- Department of Radiology, Hospital for Special Surgery, 535 E 70th St, New York, 10021-4898, UNITED STATES
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts, 02215-5491, UNITED STATES
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Upadhyaya V, Upadhyaya DN, Bansal R, Pandey T, Pandey AK. MR neurography in Parsonage-Turner syndrome. Indian J Radiol Imaging 2019; 29:264-270. [PMID: 31741594 PMCID: PMC6857269 DOI: 10.4103/ijri.ijri_269_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [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: 07/20/2019] [Revised: 09/01/2019] [Accepted: 09/04/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Parsonage Turner Syndrome is a well known clinical entity. Several excellent articles have succinctly described Magnetic Resonance Imaging (MRI) findings in PTS. However, these articles have inferred neural involvement in PTS based on the patterns of denervation of muscles in the shoulder region. The aim of this study is to directly visualize the distribution and extent of abnormality in MR Neurography (MRN) of the brachial plexus in known cases of brachial plexus neuritis or Parsonage-Turner Syndrome (PTS). Methods: 15 patients who were diagnosed with PTS based on clinical and electrophysiological findings participated in the study. MRN of the brachial plexus was done in a 1.5T system using a combination of T1W (T1-weighted), T2W (T2-weighted) fat-saturated, STIR (Short Tau Inversion Recovery), 3D STIR SPACE (Sampling Perfection with Application Optimized Contrasts) and 3D T2W SPACE sequences. Findings were recorded and assessed. Results: The age range of our patients was 7-65 years (mean 37.87 years). Most of the patients had unilateral symptoms. All patients had weakness in shoulder abduction. Other common associated complaints included pain in the shoulder/neck/arm and preceding fever. MRN revealed the percentage of involvement of roots, trunks, cords and terminal branches was 53.3%, 46.7%, 40% and 13.3% respectively. Evidence of muscle denervation in the form of edema, fatty infiltration and atrophy was noted in 8 (53.3%) patients. Conclusion: Most of the patients in this study had unilateral involvement on MRN. The roots were the commonest site of involvement followed by the trunks, cords and terminal branches. C5 was the most commonly involved root.
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Affiliation(s)
- Vaishali Upadhyaya
- Department of Radiology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Nirala Nagar, Uttar Pradesh, India
| | - Divya Narain Upadhyaya
- Department of Plastic Surgery, King George's Medical University, Shah Meena Road, Chowk, Lucknow, Uttar Pradesh, India
| | - Richa Bansal
- Department of Radiology, Max Superspecialty Hospital, Saket, New Delhi, India
| | - Tarun Pandey
- Department of Neurosurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Nirala Nagar, Uttar Pradesh, India
| | - Ashok Kumar Pandey
- Department of Neurology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Nirala Nagar, Uttar Pradesh, India
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Abstract
The authors report an unusual case of ulnar neuropathy caused by granular cell tumor. The report describes the anatomic 3 Tesla MR Neurography and functional diffusion tensor findings of the case, which was subsequently confirmed on surgical excision and histopathology.
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Affiliation(s)
- Vibhor Wadhwa
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Safia N Salaria
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Avneesh Chhabra
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Radiology, UT Southwestern Medical Center, Dallas, Tx, USA
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