Diffusion-weighted MR Neurography of the Brachial Plexus: Feasibility Study

Takahara, Taro; Hendrikse, Jeroen; Yamashita, Tomohiro; Mali, Willem P.Th.M.; Kwee, Thomas C.; Imai, Yutaka; Luijten, Peter R.

doi:10.1148/radiol.2492071826

Cited by 117 publications

(89 citation statements)

References 21 publications

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“…The development of DWI for MRN solved this issue. 7 DWI can simultaneously suppress blood vessels and show the nerves as high signal intensity structures. Consequently, DWI allowed visualization of the nerves over long trajectories on maximum intensity projection (MIP) images, which is advantageous to understand the distribution/extent of lesions.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Formerly presented MRN techniques include fat-suppressed T 2 -weighted imaging, 4,5 diŠusion-weighted imaging (DWI), [6][7][8][9] and three-dimensional (3D) diŠusion-weighted steadystate free precession imaging (3D DW-SSFP). [10][11][12] Although these techniques can produce excellentquality images, they have several limitations.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, nerves can be easily separated from surrounding structures and visualization of the 3D trajectory of the entire nerve system has become possible with DWI. [6][7][8][9] However, DWI suŠers from a relatively low spatial resolution and image distortion. Both are non-negligible issues, especially when aiming to visualizeˆne peripheral nerve structure or to obtain close-up views to evaluate focal pathology.…”

Section: Introductionmentioning

confidence: 99%

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Rapid High Resolution MR Neurography with a Diffusion-weighted Pre-pulse

Yoneyama¹,

Takahara

Kwee

et al. 2013

MRMS

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Purpose: To introduce, optimize, and assess the feasibility of a new scheme to rapidly acquire high-resolution volumetric neurographic images using a three-dimensional turbo spin-echo sequence combined with a diŠusion-weighted pre-pulse called improved motionsensitized driven equilibrium (iMSDE): DiŠusion-prepared MR Neurography (D-prep MRN).Methods: In order to optimize the signal suppression of blood vessels and muscle at Dprep MRN, coronal lumbosacral plexus images were acquired inˆve volunteers at 3T, and the following parameters were examined: iMSDE gradient-strength (b-value) of 0, 2 and 10 s/mm 2 (with the aim to suppress blood vessels) and iMSDE preparation duration (iMSDE prep-time ) of 18, 50 and 100 ms (with the aim to suppress muscle signal). Subsequently, the feasibility of the optimized D-prep MRN sequence in visualizing the brachial plexus, lumbosacral plexus, and cranial nerves was evaluated in 5 healthy volunteers.Results: A higher b-value of 10 s/mm 2 was better in signal suppression of blood vessels, whereas an intermediate iMSDE prep-time of 50 ms provided the best compromise between suppression of muscle signal and minimization of signal loss of nerves. With these parameters, the normal nerve structures showed high signal intensity, while the blood vessels and muscles were eŠectively suppressed. The optimized D-prep MRN sequence clearly showed the three-dimensional trajectory of the brachial plexus, lumbosacral plexus, and cranial nerves.Conclusion: D-prep MRN was introduced and optimized, and clearly showed detailed anatomy of the brachial plexus, lumbosacral plexus, and cranial nerves. These results suggest that the D-prep MRN can be used for fast, high-resolution, volumetric imaging of the peripheral nervous system.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rapid High Resolution MR Neurography with a Diffusion-weighted Pre-pulse

Yoneyama¹,

Takahara

Kwee

et al. 2013

MRMS

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“…The inclusion of a fat-suppression technique in DWN sequences is mandatory, which may be performed using spectral or non-spectral fat suppression techniques. Diffusion weighted imaging with background signal suppression (DWIBS), a sequence designed particularly for whole-body applications, benefits from the use of shorttau inversion recovery (STIR), a non-selective, non-spectral fat suppression technique to increase the contrast of nerve structures with background structures, allowing at the same time to studying wider fields of view than DWN sequences based on spectral fat suppression techniques such as spectral presaturation with inversion recovery (SPIR) or spectral attenuated inversion recovery (SPAIR), which can be used for specific evaluation of determined anatomical regions (10). DWN provides quantitative data by means of the apparent diffusion coefficient (ADC).…”

Section: Dwi Neurographymentioning

confidence: 99%

“…Brachial and lumbosacral plexus have been widely studied by DWN, in fact the first DWN sequences, described by Takahara et al (10) were based on the visualization of either the brachial plexus or whole body neurography using DWIBS (diffusion-weighted imaging with background body signal suppression) (44). Brachial and lumbar plexus have also been studied by DTI.…”

Section: Plexus Evaluation and Degenerative Disk Nerve Roots Entrapmementioning

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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Prospective respiratory triggering improves high‐resolution brachial plexus MRI quality

Sneag

Mendapara

Zhu

et al. 2018

Magnetic Resonance Imaging

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Background Oblique sagittal MRI sequences, orthogonal to the longitudinal axis of the brachial plexus, can reliably depict morphologic and signal abnormalities. However, nerve visualization may be obscured by ghosting artifact from periodic respiratory motion. Respiratory triggering (RT) with a thoracoabdominal bellows can reduce ghosting artifact, but it is not routinely used for brachial plexus MRI. Furthermore, the efficacy of prospective RT for brachial plexus imaging has not yet been reported. Purpose To compare brachial plexus MRI sequences acquired with and without respiratory triggering. Study Type Prospective. Subjects Five volunteers and 20 patients were included. Each subject was imaged with and without RT during the same session. Field Strength/Sequence Proton density or T2‐weighted Dixon fat suppressed sequences were obtained at 3.0T using receive‐only 16‐channel flexible array coils. Assessment Three musculoskeletal radiologists blindly evaluated each sequence using subjective scoring criteria for ghosting artifact, nerve conspicuity, and diagnostic confidence. Nerve conspicuity scores at three distinct plexus levels were summed to calculate an overall image quality score. Statistical Tests Marginal proportional odds logistic regression models were used to compare all scores between RT and non‐RT. Gwet's agreement coefficient was used to assess interobserver and intraobserver reliability. Results Mean scan time per sequence increased from 4:25 minutes (95% confidence interval [CI], 4:02–4:49 min) with non‐RT to 6:09 minutes (95% CI, 5:42–6:35 min) with RT. RT reduced ghosting artifact (odds ratio [OR] = 0.21, 95% CI: 0.09–0.46, P < 0.001), improved overall image quality (OR = 4.88, 95% CI: 2.18–10.95, P < 0.001), and increased diagnostic confidence (OR = 3.72, 95% CI: 1.61–8.63, P = 0.002) for all readers. Interobserver agreement for ghosting artifact and image quality was substantial to almost perfect (AC2 = 0.74–0.85). Interobserver agreement for all other scores was moderate to almost perfect (AC2 = 0.61–0.82). Intraobserver agreement was substantial to almost perfect for all parameters (AC2 = 0.76–1.0). Data Conclusion Prospective RT with bellows can effectively minimize ghosting artifact and improve image quality for brachial plexus MRI within clinically optimal acquisition times. Level of Evidence: 1 Technical Efficacy: Stage 2

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Diffusion-weighted MR Neurography of the Brachial Plexus: Feasibility Study

Cited by 117 publications

References 21 publications

Rapid High Resolution MR Neurography with a Diffusion-weighted Pre-pulse

Rapid High Resolution MR Neurography with a Diffusion-weighted Pre-pulse

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

Prospective respiratory triggering improves high‐resolution brachial plexus MRI quality

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