Assessment of Median Nerve with MR Neurography by Using Diffusion-Tensor Imaging: Normative and Pathologic Diffusion Values

Guggenberger, Roman; Markovic, Daniel; Eppenberger, Patrick; Chhabra, Avneesh; Schiller, A.; Nanz, Daniel; Prüssmann, Klaas P.; Andreisek, Gustav

doi:10.1148/radiol.12111403

Cited by 111 publications

(142 citation statements)

References 40 publications

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“…Group 3 (n ϭ 6) consisted of postradiation changes without evidence of residual tumor in 6 cases of previously irradiated malignancies, including 3 cases of breast cancer, 1 highgrade sarcoma, 1 case of Hodgkin lymphoma, and 1 case of oral squamous cell carcinoma. Lesion volumes ranged from 1 to 5530 cm 3 The nonparametric Kruskal-Wallis test also showed a statistically significant difference in ADC across the 3 groups, with 2 (df ϭ 2, 23 subjects) ϭ 15.0 and P ϭ .00056. Finally, post hoc nonparametric pair-wise comparisons using the Mann-Whitney U test showed a statistically significant difference in ADC between Groups 1 and 2 (P ϭ .00010) and between Groups 2 and 3 (P ϭ .0012), but no statistically significant difference between Groups 1 and 3 (P ϭ .97).…”

Section: Resultsmentioning

confidence: 87%

“…In patients with a classic compression mononeuropathy, such as median nerve compression at the carpal tunnel, the diagnosis can often be made clinically and corroborated by needle electromyography, nerve conduction, and/or imaging studies. [1][2][3][4] For mononeuropathies involving nerves not typically susceptible to compression syndromes, imaging can play an essential role in identifying the lesion and guiding management.…”

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confidence: 99%

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Diffusivity Measurements Differentiate Benign from Malignant Lesions in Patients with Peripheral Neuropathy or Plexopathy

Yuh

Palrecha

Lagemann

et al. 2014

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Peripheral nerve disorders caused by benign and malignant primary nerve sheath tumors, infiltration or compression of nerves by metastatic disease, and postradiation neuritis demonstrate overlapping features on conventional MR imaging but require vastly different therapeutic approaches. We characterize and compare diffusivities of peripheral nerve lesions in patients undergoing MR neurography for peripheral neuropathy or brachial or lumbosacral plexopathy.

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Section: Resultsmentioning

confidence: 87%

mentioning

confidence: 99%

Diffusivity Measurements Differentiate Benign from Malignant Lesions in Patients with Peripheral Neuropathy or Plexopathy

Yuh

Palrecha

Lagemann

et al. 2014

American Journal of Neuroradiology

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“…Interest is growing in the use of DTI tractography in the assessment of CTS as a result of evidence for its diagnostic value. A correlation between median DTI metrics and electrophysiology for the carpal tunnel nerve has been reported, suggesting a role for DTI in the in vivo assessment of axon and myelin sheath integrity 7,[42][43][44] . According to a meta-analysis published in 2016 that included 316 patients and 293 healthy controls across 12 studies, fractional anisotropy of the median nerve was significantly lower in patients with CTS, and this measure enabled diagnosis of CTS with an overall sensitivity of 82.8% and a specificity of 77.8% 44 .…”

Section: Entrapment Neuropathiesmentioning

confidence: 94%

“…Diffusion tensor imaging (DTI) is another magnetic resonance technique that in the past decade has been introduced to investigations of peripheral nerve disorders. The technique is sensitive to subtle changes of tissue microstructure and enables measure ment of nerve integrity on the basis of quantitative para meters, such as fractional anisotropy, apparent diffusion coefficient, and mean, axial and radial diffusivity 7 . DTI has been used extensively to examine the median nerve at the carpal tunnel and, more recently, to assess the brachial plexus, lumbar plexus and sciatic nerves [8][9][10][11][12][13][14] , although its full diagnostic value remains to be determined.…”

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confidence: 99%

New technologies for the assessment of neuropathies

et al. 2017

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Peripheral neuropathies are among the most common neurological disorders 1 . In routine clinical practice, diagnosis of peripheral neuropathies is typically based on clinical assessment, nerve conduction studies and needle electromyography, which can determine whether symptoms are caused by primary axonal damage or demyelinating damage. This distinction is often relevant to therapeutic choices and to prognosis, as axonal damage typically reflects an inflammatory (for example, vasculitic) or degenerative (for example, hereditary or idiopathic) process that correlates with disability, whereas demyelinating damage can reflect a hereditary neuro pathy, but more often reflects an acquired immunemediated neuropathy. Besides metabolic, inflammatory or primary degenerative neuropathies, peripheral nerves can also be damaged by compression from adjacent tissue structures, such as tendons, cysts or haematomas. In this case, proper identification of the site, nature and degree of the lesion might be challenging, but is relevant to treatment and prognosis. Moreover, some patients present with symptoms that suggest damage to small nerve fibres, which nerve conduction studies cannot be used to detect.In the past 15 years, several techniques have become available to investigate focal and diffuse peripheral neuropathies, and their reliability has widened the spectrum of diagnostic tools for clinicians and improved assessment of neuropathies. In this Review, we provide an overview of these new and emerging technologies. We first discuss peripheral nerve imaging with MRI and ultrasonography, which can provide information about the precise localization of neuro pathies and the pathological processes involved in large-fibre neuropathies, and can complement clinical and electrophysiological evaluation. We then consider techniques that can provide diagnostic information when the pathological process is restricted to small nerve fibres and is consequently not detectable with nerve conduction studies or neuroimaging. These include skin biopsy, which is established in clinical practice, and the emerging techniques of corneal confocal microscopy, laser-evoked potentials and heat-related and pain-related evoked potentials, and microneurography.Nerve imaging technology Advances in imaging techniques have made it possible to gain great insight into nerve pathology with magnetic resonance and ultrasound. Each approach offers distinct advantages, and can provide different information about damage to large myelinated fibres. Abstract | Technical advances are rapidly changing the clinical and instrumental approach to peripheral nerve diseases. Magnetic resonance neurography, diffusion tensor imaging and nerve ultrasonography are increasingly entering the diagnostic workup of peripheral neuropathies as tools that complement neurophysiology and enable investigation of proximal structures, such as plexuses and roots. Progress in the design of magnetic resonance scanners and sequences, and the development of high-frequency ultrasound probes mean th...

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“…It is in this group of Median nerve has been one of the first PN deeply studied by DTI. Several studies have detailed the technical optimizations for DTN comparing healthy controls with patients with carpal tunnel syndrome (22,61,62). These studies have shown a reduction in FA values in patients with symptoms consistent with carpal tunnel syndrome, suggesting that due to compression, the median nerve loses its physiological anisotropic structure as the extracellular space increases, Also, DTN can detect long-standing neural changes (63).…”

Section: Peripheral Nerve Tunnel Syndromes and Entrapmentsmentioning

confidence: 99%

Quantitative magnetic resonance (MR) neurography for evaluation of peripheral nerves and plexus injuries

Noguerol¹,

Barousse²,

Socolovsky

et al. 2017

Quant. Imaging Med. Surg.

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Traumatic conditions of peripheral nerves and plexus have been classically evaluated by morphological imaging techniques and electrophysiological tests. New magnetic resonance imaging (MRI) studies based on 3D fat-suppressed techniques are providing high accuracy for peripheral nerve injury evaluation from a qualitative point of view. However, these techniques do not provide quantitative information. Diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) are functional MRI techniques that are able to evaluate and quantify the movement of water molecules within different biological structures. These techniques have been successfully applied in other anatomical areas, especially in the assessment of central nervous system, and now are being imported, with promising results for peripheral nerve and plexus evaluation. DWI and DTI allow performing a qualitative and quantitative peripheral nerve analysis, providing valuable pathophysiological information about functional integrity of these structures.In the field of trauma and peripheral nerve or plexus injury, several derived parameters from DWI and DTI studies such as apparent diffusion coefficient (ADC) or fractional anisotropy (FA) among others, can be used as potential biomarkers of neural damage providing information about fiber organization, axonal flow or myelin integrity. A proper knowledge of physical basis of these techniques and their limitations is important for an optimal interpretation of the imaging findings and derived data. In this paper, a comprehensive review of the potential applications of DWI and DTI neurographic studies is performed with a focus on traumatic conditions, including main nerve entrapment syndromes in both peripheral nerves and brachial or lumbar plexus.

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Assessment of Median Nerve with MR Neurography by Using Diffusion-Tensor Imaging: Normative and Pathologic Diffusion Values

Abstract: Normative diffusion values for MR neurography of the median nerve with DTI depend on the anatomic location and age but not on sex. Age-specific FA and ADC threshold values might be used to diagnose carpal tunnel syndrome.

Cited by 111 publications

References 40 publications

Diffusivity Measurements Differentiate Benign from Malignant Lesions in Patients with Peripheral Neuropathy or Plexopathy

Diffusivity Measurements Differentiate Benign from Malignant Lesions in Patients with Peripheral Neuropathy or Plexopathy

New technologies for the assessment of neuropathies

Quantitative magnetic resonance (MR) neurography for evaluation of peripheral nerves and plexus injuries

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