Diffusion tensor imaging to visualize axons in the setting of nerve injury and recovery

Successful management of peripheral nerve trauma relies on accurate localization of the injury and grading of the severity of nerve injury to determine whether surgical intervention is required. Existing techniques, such as electrodiagnostic studies and conventional imaging modalities, provide important information, but are limited by being unable to distinguish severe nerve lesions in continuity that will recover from those that will not. Diffusion tensor imaging (DTI) and tractography of peripheral nerves provide a novel technique to localize and grade nerve injury, by assessing the integrity of the nerve fibers across the site of nerve injury. Diffusion tensor imaging and tractography also hold promise as markers of early nerve regeneration, prior to clinical and electrodiagnostic evidence of recovery. In the present review, the techniques of peripheral nerve DTI and tractography are discussed with respect to peripheral nerve trauma, with illustrative cases demonstrating potential roles of these novel approaches.

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4.7-T diffusion tensor imaging of acute traumatic peripheral nerve injury

Neurosurgical FOCUS ◽

10.3171/2015.6.focus1590 ◽

2015 ◽

Vol 39 (3) ◽

pp. E9 ◽

Cited By ~ 25

Author(s):

Richard B. Boyer ◽

Nathaniel D. Kelm ◽

D. Colton Riley ◽

Kevin W. Sexton ◽

Alonda C. Pollins ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

High Resolution ◽

Peripheral Nerve ◽

Nerve Injury ◽

Peripheral Nerve Injury ◽

Diffusion Tensor ◽

Ex Vivo ◽

Nerve Fibers ◽

Nerve Transection ◽

Nerve Injuries

Diagnosis and management of peripheral nerve injury is complicated by the inability to assess microstructural features of injured nerve fibers via clinical examination and electrophysiology. Diffusion tensor imaging (DTI) has been shown to accurately detect nerve injury and regeneration in crush models of peripheral nerve injury, but no prior studies have been conducted on nerve transection, a surgical emergency that can lead to permanent weakness or paralysis. Acute sciatic nerve injuries were performed microsurgically to produce multiple grades of nerve transection in rats that were harvested 1 hour after surgery. High-resolution diffusion tensor images from ex vivo sciatic nerves were obtained using diffusion-weighted spin-echo acquisitions at 4.7 T. Fractional anisotropy was significantly reduced at the injury sites of transected rats compared with sham rats. Additionally, minor eigenvalues and radial diffusivity were profoundly elevated at all injury sites and were negatively correlated to the degree of injury. Diffusion tensor tractography showed discontinuities at all injury sites and significantly reduced continuous tract counts. These findings demonstrate that high-resolution DTI is a promising tool for acute diagnosis and grading of traumatic peripheral nerve injuries.

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Post-traumatic neuroma due to closed nerve injury. Is recovery after peripheral nerve trauma related to ultrasonographic neuroma size?

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2015.10.034 ◽

2015 ◽

Vol 139 ◽

pp. 314-318 ◽

Cited By ~ 9

Author(s):

Daniele Coraci ◽

Costanza Pazzaglia ◽

Pietro Emiliano Doneddu ◽

Carmen Erra ◽

Ilaria Paolasso ◽

...

Keyword(s):

Peripheral Nerve ◽

Nerve Injury ◽

Traumatic Neuroma ◽

Post Traumatic ◽

Peripheral Nerve Trauma ◽

Nerve Trauma

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Perifeer zenuwletsel en het effect van vitamines op het herstelproces

Tijdschrift voor Geneeskunde ◽

10.47671/tvg.77.21.042 ◽

2021 ◽

Author(s):

M. DESCHRIJVER ◽

K. BULKMANS ◽

I. VANWALLEGHEM ◽

S. GEERS

Keyword(s):

Peripheral Nerve ◽

Nerve Injury ◽

Functional Recovery ◽

Peripheral Nerve Injury ◽

Recovery Process ◽

Surgical Reconstruction ◽

Peripheral Nerve Injuries ◽

Nerve Injuries ◽

Peripheral Nerve Trauma ◽

Nerve Trauma

Peripheral nerve injury and the effect of vitamins on the recovery process Although peripheral nerve injuries are usually not life-threatening, they can have a significant impact on the patient’s quality of life and daily functioning, with typical symptoms such as complete paralysis or severe neuropathic pain. The peripheral nervous system is capable of some regeneration and recovery, allowing conservative treatment in mild to moderate nerve damage. For severe peripheral nerve injuries surgical reconstruction remains the golden standard. However, despite the extensive knowledge of the pathophysiology of peripheral nerve trauma, a full functional recovery after a severe peripheral nerve injury is rare with the current therapeutic options. Success depends on a variety of factors: location and severity of the injury, age and physical condition of the patient, therapeutical approach, … Therefore, it is important to search for the best possible means to achieve maximal functional recovery. This article first discusses the current knowledge about the pathophysiology of peripheral nerve trauma, highlighting the most important factors that influence the recovery process. Subsequently, it will render a review of the influence of vitamins A/B/C/D/E/K on this recovery process: vit B and D seem to enhance the regeneration process of nerves and the functional recovery of the end organ, while vit C and E show an important antinociceptive effect.

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Evaluation of radiation-induced peripheral nerve injury in rabbits with MR neurography using diffusion tensor imaging andT2measurements: Correlation with histological and functional changes

Journal of Magnetic Resonance Imaging ◽

10.1002/jmri.25114 ◽

2015 ◽

Vol 43 (6) ◽

pp. 1492-1499 ◽

Cited By ~ 6

Author(s):

Qi Wan ◽

Shiyang Wang ◽

Jiaxuan Zhou ◽

Qiao Zou ◽

Yingshi Deng ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Peripheral Nerve ◽

Nerve Injury ◽

Peripheral Nerve Injury ◽

Diffusion Tensor ◽

Mr Neurography ◽

Functional Changes ◽

Radiation Induced

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Proliferation of Bilateral Nerve Fibers Following Thalamic Infarction Contributes to Neurological Function Recovery: A Diffusion Tensor Imaging (DTI) Study

Medical Science Monitor ◽

10.12659/msm.909071 ◽

2018 ◽

Vol 24 ◽

pp. 1464-1472

Author(s):

Yayuan Liu ◽

Li Chen ◽

Jinseng Zeng ◽

Wenmei Li ◽

Sudan Zeng ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Diffusion Tensor ◽

Nerve Fibers ◽

Neurological Function ◽

Thalamic Infarction ◽

Function Recovery ◽

Diffusion Tensor Imaging Dti

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Initial findings in traumatic peripheral nerve injury and repair with diffusion tensor imaging

Annals of Clinical and Translational Neurology ◽

10.1002/acn3.51270 ◽

2021 ◽

Author(s):

Michael D. Pridmore ◽

Gabriella E. Glassman ◽

Alonda C. Pollins ◽

Isaac V. Manzanera Esteve ◽

Brian C. Drolet ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Peripheral Nerve ◽

Nerve Injury ◽

Peripheral Nerve Injury ◽

Diffusion Tensor ◽

Injury And Repair

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DTI and MTR Measures of Nerve Fiber Integrity in Pediatric Patients With Ankle Injury

Frontiers in Pediatrics ◽

10.3389/fped.2021.656843 ◽

2021 ◽

Vol 9 ◽

Author(s):

Scott A. Holmes ◽

Anastasia Karapanagou ◽

Steven J. Staffa ◽

David Zurakowski ◽

Ronald Borra ◽

...

Keyword(s):

Neuropathic Pain ◽

Peripheral Nerve ◽

Nerve Fiber ◽

Nerve Injury ◽

Diffusion Tensor ◽

Nerve Fibers ◽

Ankle Injury ◽

Future Research ◽

Post Injury ◽

Fibular Nerve

Acute peripheral nerve injury can lead to chronic neuropathic pain. Having a standardized, non-invasive method to evaluate pathological changes in a nerve following nerve injury would help with diagnostic and therapeutic assessments or interventions. The accurate evaluation of nerve fiber integrity after injury may provide insight into the extent of pathology and a patient's level of self-reported pain. The aim of this investigation was to evaluate the extent to which peripheral nerve integrity could be evaluated in an acute ankle injury cohort and how markers of nerve fiber integrity correlate with self-reported pain levels in afferent nerves. We recruited 39 pediatric participants with clinically defined neuropathic pain within 3 months of an ankle injury and 16 healthy controls. Participants underwent peripheral nerve MRI using diffusion tensor (DTI) and magnetization transfer imaging (MTI) of their injured and non-injured ankles. The imaging window was focused on the branching point of the sciatic nerve into the tibial and fibular division. Each participant completed the Pain Detection Questionnaire (PDQ). Findings demonstrated group differences in DTI and MTI in the sciatic, tibial and fibular nerve in the injured ankle relative to healthy control and contralateral non-injured nerve fibers. Only AD and RD from the injured fibular nerve correlated with PDQ scores which coincides with the inversion-dominant nature of this particular ankle injuruy cohort. Exploratory analyses highlight the potential remodeling stages of nerve injury from neuropathic pain. Future research should emphasize sub-acute time frames of injury to capture post-injury inflammation and nerve fiber recovery.

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Faculty Opinions recommendation of Peripheral nerve diffusion tensor imaging (DTI): normal values and demographic determinants in a cohort of 60 healthy individuals.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732321888.793566466 ◽

2019 ◽

Author(s):

Jun Li

Keyword(s):

Diffusion Tensor Imaging ◽

Peripheral Nerve ◽

Normal Values ◽

Diffusion Tensor ◽

Healthy Individuals ◽

Diffusion Tensor Imaging Dti

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Visualization of nerve fibers and their relationship to peripheral nerve tumors by diffusion tensor imaging

Neurosurgical FOCUS ◽

10.3171/2015.6.focus15235 ◽

2015 ◽

Vol 39 (3) ◽

pp. E16 ◽

Cited By ~ 17

Author(s):

Tene A. Cage ◽

Esther L. Yuh ◽

Stephanie W. Hou ◽

Harjus Birk ◽

Neil G. Simon ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Peripheral Nerve ◽

Nerve Fiber ◽

Predictive Value ◽

Diffusion Tensor ◽

Retrospective Chart Review ◽

Nerve Fibers ◽

Anatomical Location ◽

Nerve Tumor ◽

Intraoperative Localization

OBJECT The majority of growing and/or symptomatic peripheral nerve tumors are schwannomas and neurofibromas. They are almost always benign and can usually be resected while minimizing motor and sensory deficits if approached with the proper expertise and techniques. Intraoperative electrophysiological stimulation and recording techniques allow the surgeon to map the surface of the tumor in an effort to identify and thus avoid damaging functioning nerve fibers. Recently, MR diffusion tensor imaging (DTI) techniques have permitted the visualization of axons, because of their anisotropic properties, in peripheral nerves. The object of this study was to compare the distribution of nerve fibers as revealed by direct electrical stimulation with that seen on preoperative MR DTI. METHODS The authors conducted a retrospective chart review of patients with a peripheral nerve or nerve root tumor between March 2012 and January 2014. Diffusion tensor imaging and intraoperative data had been prospectively collected for patients with peripheral nerve tumors that were resected. Preoperative identification of the nerve fiber location in relation to the nerve tumor surface as seen on DTI studies was compared with the nerve fiber’s intraoperative localization using electrophysiological stimulation and recordings. RESULTS In 23 patients eligible for study there was good correlation between nerve fiber location on DTI and its anatomical location seen intraoperatively. Diffusion tensor imaging demonstrated the relationship of nerve fibers relative to the tumor with 95.7% sensitivity, 66.7% specificity, 75% positive predictive value, and 93.8% negative predictive value. CONCLUSIONS Preoperative DTI techniques are useful in helping the peripheral nerve surgeon to both determine the risks involved in resecting a nerve tumor and plan the safest surgical approach.

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