Magnetic resonance neurography in children with birth-related brachial plexus injury

Introduction: This study assessed the morphological changes and diffusion tensor imaging (DTI)-derived parameters of the brachial plexus using magnetic resonance neurography (MRN) in patients with anti-myelin-associated glycoprotein (anti-MAG) neuropathy. Methods: Eight patients with anti-MAG neuropathy underwent MRN of the brachial plexus with 3-dimensional (3D) short tau inversion recovery (STIR) and DTI sequences. Two neuroradiologists and a neurologist qualitatively assessed nerve hypertrophy on 3D STIR MRN. The cross-sectional area (CSA) of the nerve roots was measured. Quantitative analyses of fractional anisotropy (FA) and axial, radial, and mean diffusivity (AD, RD, and MD) were obtained after postprocessing on DTI and manual segmentation. Results: There was nerve hypertrophy in 37.5% of the patients with anti-MAG neuropathy. All patients with anti-MAG neuropathy with nerve hypertrophy were refractory to rituximab therapy. The CSA of the nerve roots was inversely correlated with FA and positively correlated with MD and RD. FA decreased in the nerve roots and inversely correlated with disease duration. Conclusions: Nerve hypertrophy appears in the proximal portion of peripheral nerves, such as the brachial plexus, in patients with anti-MAG neuropathy. Altered diffusion in the nerve roots might be associated with the loss of myelin integrity due to the demyelination process in anti-MAG neuropathy.

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Post-Contrast 3D Inversion Recovery Magnetic Resonance Neurography for Evaluation of Branch Nerves of the Brachial Plexus

European Journal of Radiology ◽

10.1016/j.ejrad.2020.109304 ◽

2020 ◽

Vol 132 ◽

pp. 109304

Author(s):

Darryl B. Sneag ◽

Steve P. Daniels ◽

Christian Geannette ◽

Sophie C. Queler ◽

Bin Q. Lin ◽

...

Keyword(s):

Magnetic Resonance ◽

Brachial Plexus ◽

Inversion Recovery ◽

3D Inversion ◽

Magnetic Resonance Neurography ◽

Post Contrast

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Magnetic resonance neurography for the evaluation of peripheral nerve, brachial plexus, and nerve root disorders

Journal of Neurosurgery ◽

10.3171/2009.7.jns09414 ◽

2010 ◽

Vol 112 (2) ◽

pp. 362-371 ◽

Cited By ~ 78

Author(s):

Rose Du ◽

Kurtis I. Auguste ◽

Cynthia T. Chin ◽

John W. Engstrom ◽

Philip R. Weinstein

Keyword(s):

Magnetic Resonance ◽

Mr Imaging ◽

Peripheral Nerve ◽

Brachial Plexus ◽

Nerve Root ◽

Consecutive Series ◽

Brachial Plexopathy ◽

Magnetic Resonance Neurography ◽

Nerve Lesions ◽

Peripheral Nerve Lesions

Object Treatment of spinal and peripheral nerve lesions relies on localization of the pathology by the use of neurological examination, spinal MR imaging and electromyography (EMG)/nerve conduction studies (NCSs). Magnetic resonance neurography (MRN) is a novel imaging technique recently developed for direct imaging of spinal and peripheral nerves. In this study, the authors analyzed the role of MRN in the evaluation of spinal and peripheral nerve lesions. Methods Imaging studies, medical records, and EMG/NCS results were analyzed retrospectively in a consecutive series of 191 patients who underwent MRN for spinal and peripheral nerve disorders at the University of California, San Francisco between March 1999 and February 2005. Ninety-one (47.6%) of these patients also underwent EMG/NCS studies. Results In those who underwent both MRN and EMG/NCS, MRN provided the same or additional diagnostic information 32 and 45% of patients, respectively. Magnetic resonance neurograms were obtained at a median of 12 months after the onset of symptoms. The utility of MRN correlated with the interval between the onset of symptoms to MRN. Twelve patients underwent repeated MRN for serial evaluation. The decrease in abnormal signal detected on subsequent MRN correlated with time from onset of symptoms and the time interval between MRN, but not with resolution of symptoms. Twenty-one patients underwent MRN postoperatively to assess persistent, recurrent, or new symptoms; of these 3 (14.3%) required a subsequent surgery. Conclusions Magnetic resonance neurography is a valuable adjunct to conventional MR imaging and EMG/NCS in the evaluation and localization of nerve root, brachial plexus, and peripheral nerve lesions. The authors found that MRN is indicated in patients: 1) in whom EMG and traditional MR imaging are inconclusive; 2) who present with brachial plexopathy who have previously received radiation therapy to the brachial plexus region; 3) who present with brachial plexopathy and have systemic tumors; and 4) in patients under consideration for surgery for peripheral nerve lesions or after trauma. Magnetic resonance neurography is limited by the size of the nerve trunk imaged and the timing of the study.

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