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

2010 ◽  
Vol 112 (2) ◽  
pp. 362-371 ◽  
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.

Magnetic Resonance Neurography of Peripheral Nerve Lesions in the Lower Extremity

Neurosurgery ◽  
1996 ◽  
Vol 39 (4) ◽  
pp. 750-756 ◽  
Author(s):  
Charles Kuntz ◽  
Lindsey Blake ◽  
Gavin Britz ◽  
Aaron Filler ◽  
Cecil E. Hayes ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Lower Extremity ◽  
Peripheral Nerve ◽  
Magnetic Resonance Neurography ◽  
Nerve Lesions ◽  
Peripheral Nerve Lesions

scholarly journals Magnetic resonance neurography of the brachial plexus

2015 ◽  
Vol 48 (02) ◽  
pp. 129-137 ◽  
Author(s):  
Vaishali Upadhyaya ◽  
Divya Narain Upadhyaya ◽  
Adarsh Kumar ◽  
Ashok Kumar Pandey ◽  
Ratni Gujral ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Brachial Plexus ◽  
Peripheral Nerves ◽  
Imaging Modality ◽  
Nerve Tissue ◽  
Magnetic Resonance Neurography ◽  
Nerve Lesions ◽  
Peripheral Nerve Lesions ◽  
Magnetic Resonance Imaging Mri

ABSTRACTMagnetic Resonance Imaging (MRI) is being increasingly recognised all over the world as the imaging modality of choice for brachial plexus and peripheral nerve lesions. Recent refinements in MRI protocols have helped in imaging nerve tissue with greater clarity thereby helping in the identification, localisation and classification of nerve lesions with greater confidence than was possible till now. This article on Magnetic Resonance Neurography (MRN) is based on the authors’ experience of imaging the brachial plexus and peripheral nerves using these protocols over the last several years.

scholarly journals Additive value of magnetic resonance neurography in diagnosis of brachial plexopathy: a cross-section descriptive study

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Sara Mohamed Mahmoud Mabrouk ◽  
Hossam Abd El Hafiz Zaytoon ◽  
Ashraf Mohamed Farid ◽  
Rania Sobhy Abou Khadrah
Keyword(s):  
Magnetic Resonance ◽  
Brachial Plexus ◽  
Nerve Injury ◽  
Clinical Examination ◽  
Nerve Root ◽  
Nerve Conduction ◽  
Brachial Plexopathy ◽  
Root Avulsion ◽  
Magnetic Resonance Neurography ◽  
Nerve Root Avulsion

Abstract Background Management of brachial plexopathy requires proper localization of the site and nature of nerve injury. Nerve conduction studies and electrophysiological studies (ED) are crucial when diagnosing brachial neuropathy but these do not determine the actual site of the lesion. Conventional MRI has been used to evaluate the brachial plexus. Still, it carried the disadvantage of the inability to provide multi-planar images that depict the entire length of the neural plexus .It might be difficult to differentiate the brachial plexus nerves from adjacent vascular structures. Magnetic resonance neurography (MRN) is an innovative imaging technique for direct imaging of the spinal nerves. Our study aims to detect the additive role of MRN in the diagnosis of brachial plexopathy over ED. Forty cases of clinically suspected and proved by clinical examination and ED—traumatic (N = 30) and non-traumatic (N = 10)—were included in our study. We compared MRN finding with results of clinical examination and ED. Results MRN findings showed that the root was involved in 80% of cases, trunks in 70% of cases affecting the middle trunk in 40% of cases, the middle and posterior cord in 25%, lateral cord in 50%, and terminal branches on 10% of cases. Ten percent of cases were normal according to MRN, and 90% had abnormal findings in the form of preganglionic nerve root avulsion in 30% of cases, mild perineural edema surrounding C6/7 nerve roots in 20%, lower brachial trunk high signal in 10%, complicated with pseudo meningocele in 20%, and with increased shoulder muscle T2 signal intensity with muscle atrophy in 10%. There were minimal differences between clinical examination finding and MRN findings, with very good agreement between electromyography and nerve conduction (p value < 0.05, with sensitivity and specificity values of 94.44% and 100%, respectively). Conclusion MRN is important in differentiating different types of nerve injuries, nerve root avulsion, and nerve edema, playing an important role in differentiating the site of nerve injury, both preganglionic or postganglionic and planning for treatment of the cause of nerve injury, either medical or surgical.

Fascicular Ratio Pilot Study: High-Resolution Neurosonography—A Possible Tool for Quantitative Assessment of Traumatic Peripheral Nerve Lesions Before and After Nerve Surgery

Neurosurgery ◽  
2018 ◽  
Vol 85 (3) ◽  
pp. 415-422 ◽  
Author(s):  
Christian Heinen ◽  
Patrick Dömer ◽  
Thomas Schmidt ◽  
Bettina Kewitz ◽  
Ulrike Janssen-Bienhold ◽  
...  
Keyword(s):  
High Resolution ◽  
Peripheral Nerve ◽  
Quantitative Assessment ◽  
Control Group ◽  
Structural Reorganization ◽  
Magnetic Resonance Neurography ◽  
Nerve Lesions ◽  
Peripheral Nerve Lesions ◽  
Significant Difference ◽  
Nerve Surgery

Abstract BACKGROUND Clinical and electrophysiological assessments prevail in evaluation of traumatic nerve lesions and their regeneration following nerve surgery in humans. Recently, high-resolution neurosonography (HRNS) and magnetic resonance neurography have gained significant importance in peripheral nerve imaging. The use of the grey-scale-based “fascicular ratio” (FR) was established using both modalities allowing for quantitative assessment. OBJECTIVE To find out whether FR using HRNS can assess nerve trauma and structural reorganization in correlation to postoperative clinical development. METHODS Retrospectively, 16 patients with operated traumatic peripheral nerve lesions were included. The control group consisted of 6 healthy volunteers. All imaging was performed with a 15 to 6 MHz ultrasound probe (SonoSite X-Porte; Fujifilm, Tokyo, Japan). FR was calculated using Fiji (兠) on 8-bit-images (“MaxEntropy” using “Auto-Threshold” plug-in). RESULTS Thirteen of 16 patients required autologous nerve grafting and 3 of 16 extra-intraneural neurolysis. There was no statistical difference between the FR of nonaffected patients’ nerve portion with 43.48% and controls with FR 48.12%. The neuromatous nerve portion in grafted patients differed significantly with 85.05%. Postoperatively, FR values returned to normal with a mean of 39.33%. In the neurolyzed patients, FR in the affected portion was 78.54%. After neurolysis, FR returned to healthy values (50.79%). Ten of 16 patients showed clinical reinnervation. CONCLUSION To our best knowledge, this is the first description of FR using HRNS for quantitative assessment of nerve damage and postoperative structural reorganization. Our results show a significant difference in healthy vs lesioned nerves and a change in recovering nerve portions towards a more “physiological” ratio. Further evaluation in larger patient groups is required.

scholarly journals Microsurgical procedures for peripheral nerve lesions: Choice of anesthesia

2003 ◽  
Vol 50 (1) ◽  
pp. 27-31
Author(s):  
Valentina Stevanovic ◽  
Branko Milakovic ◽  
Zorica Stanimirovic ◽  
Mila Stosic
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Sural Nerve ◽  
Brachial Plexus Block ◽  
Body Position ◽  
Nerve Lesions ◽  
Axillary Approach ◽  
Peripheral Nerve Lesions ◽  
Plexus Block ◽  
Endotracheal Anesthesia

Microsurgical procedures on peripheral nerve lesions have their own specifics. Those are: duration and extent of operation, and need to change body position during operation. General endotracheal anesthesia has been used for operations on brachial plexus lesions with neural transpher; on peripheral nerve lesions with sural nerve autotransplantations; on all extracranial lesions (facial n. and lesion hypoglossal n.); for lesions of plexus lumbalis and sciatic nerve. These operations are requesting turning of patient on the lateral or ventral position or they are performed on head and neck. Because operation and anesthesia last longer, general ET anesthesia is more suitable for neurosurgens and anesthesiologist's interventions. Regional anesthesia, i.e. neural plexus block, is suitable for operations on upper extremity. Then we perform brachial plexus block with more approaches. There has been frequently in use axillary approach which is easier to perform, has minimum of complications and is suitable for procedures at cubital region, forearm and hand.

Computer-Aided Localisation of Peripheral Nerve Lesions

1991 ◽  
Vol 16 (1) ◽  
pp. 19-24 ◽  
Author(s):  
P. BURGE ◽  
B. TODD
Keyword(s):  
Retrospective Study ◽  
Peripheral Nerve ◽  
Computer Program ◽  
Simulation Model ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Clinical Findings ◽  
Nerve Lesions ◽  
Peripheral Nerve Lesions ◽  
Computer Aided

The clinical localisation of peripheral nerve lesions can sometimes be difficult, particularly following injury to the brachial plexus when multiple lesions are often present. In this situation, computers may be of assistance in interpreting the complicated patterns of clinical findings. This paper describes the evaluation of a computer program that uses a simulation model of the consequences of nerve injury, based on a representation of the relevant anatomy. A retrospective study of 26 patients with upper limb nerve lesions was carried out. The computer program compared favourably with three clinicians in interpreting the findings correctly. It is suggested that this approach may be transferable to other applications.

Peripheral nervous system alterations in infant and adult neurofibromatosis type 2

Neurology ◽  
2019 ◽  
Vol 93 (6) ◽  
pp. e590-e598 ◽  
Author(s):  
Tim Godel ◽  
Philipp Bäumer ◽  
Said Farschtschi ◽  
Isabel Gugel ◽  
Moritz Kronlage ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Dorsal Root Ganglia ◽  
Dorsal Root ◽  
Neurofibromatosis Type ◽  
Neurofibromatosis Type 2 ◽  
Healthy Controls ◽  
Magnetic Resonance Neurography ◽  
Nerve Lesions ◽  
Peripheral Nerve Lesions

ObjectiveTo examine the involvement of dorsal root ganglia and peripheral nerves in children with neurofibromatosis type 2 compared to healthy controls and symptomatic adults by in vivo high-resolution magnetic resonance neurography.MethodsIn this prospective multicenter study, the lumbosacral dorsal root ganglia and sciatic, tibial, and peroneal nerves were examined in 9 polyneuropathy-negative children diagnosed with neurofibromatosis type 2 by a standardized magnetic resonance neurography protocol at 3T. Volumes of dorsal root ganglia L3 to S2 and peripheral nerve lesions were assessed and compared to those of 29 healthy children. Moreover, dorsal root ganglia volumes and peripheral nerve lesions were compared to those of 14 adults with neurofibromatosis type 2.ResultsCompared to healthy controls, dorsal root ganglia hypertrophy was a consistent finding in children with neurofibromatosis type 2 (L3 +255%, L4 +289%, L5 +250%, S1 +257%, and S2 +218%, p < 0.001) with an excellent diagnostic accuracy. Moreover, peripheral nerve lesions occurred with a high frequency in those children compared to healthy controls (18.89 ± 11.11 vs 0.90 ± 1.08, p < 0.001). Children and adults with neurofibromatosis type 2 showed nonsignificant differences in relative dorsal root ganglia hypertrophy rates (p = 0.85) and peripheral nerve lesions (p = 0.28).ConclusionsAlterations of peripheral nerve segments occur early in the course of neurofibromatosis type 2 and are evident even in children not clinically affected by peripheral polyneuropathy. While those early alterations show similar characteristics compared to adults with neurofibromatosis type 2, the findings of this study suggest that secondary processes might be responsible for the development and severity of associated polyneuropathy.

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