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

Sneag, Darryl B.; Daniels, Steve P.; Geannette, Christian; Queler, Sophie C.; Lin, Bin; Silva, Chinthaka de; Tan, Ek Tsoon

doi:10.1016/j.ejrad.2020.109304

Cited by 32 publications

(29 citation statements)

References 24 publications

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“…30 Studies demonstrate that GBCA-based vascular suppression qualitatively and quanti-tatively improves nerve visualization in the BP proper roots to the cords, using bilateral and unilateral BP 3D T2 STIR-FSE/TSE. 30 In comparison with noncontrast vascular suppression (Fig. 13A), GBCA-based vascular suppression can facilitate effective visualization of the small peripheral nerve branches (Fig.…”

Section: Gbca For Vascular Suppressionmentioning

confidence: 90%

“…Gadolinium-based contrast agent–based vascular suppression relies on shortening both the T1 and T2 signal of blood 30 . Reducing T2 results in blood signal suppression when performing a long echo time acquisition with FSE/TSE 30 . Simultaneously, in STIR-FSE, the shortened blood T1 is closer to that of fat T1, reducing longitudinal magnetization magnitude after the inversion pulse 30 .…”

Section: Technical Considerationsmentioning

confidence: 99%

“…[32][33][34] Finally, T2-weighted STIR sequences can be coupled with gadolinium to provide vascular suppression, as detailed in the next section. 30,35 Vascular Suppression Blood vessels have similar T2 properties to, and may run alongside, peripheral nerves, impeding nerve identification and visualization. This is particularly true for small-caliber nerves (≤1 mm diameter) with nonlinear courses.…”

Section: Application Of Gadolinium-based Contrast Agentsmentioning

confidence: 99%

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Brachial Plexus Magnetic Resonance Neurography

et al. 2022

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Magnetic resonance neurography of the brachial plexus (BP) is challenging owing to its complex anatomy and technical obstacles around this anatomic region. Magnetic resonance techniques to improve image quality center around increasing nerve-to-background contrast ratio and mitigating imaging artifacts. General considerations include unilateral imaging of the BP at 3.0 T, appropriate selection and placement of surface coils, and optimization of pulse sequences. Technical considerations to improve nerve conspicuity include fat, vascular, and respiratory artifact suppression techniques; metal artifact reduction techniques; and 3-dimensional sequences. Specific optimization of these techniques for BP magnetic resonance neurography greatly improves image quality and diagnostic confidence to help guide nonoperative and operative management.

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Section: Gbca For Vascular Suppressionmentioning

confidence: 90%

Section: Technical Considerationsmentioning

confidence: 99%

Section: Application Of Gadolinium-based Contrast Agentsmentioning

confidence: 99%

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Brachial Plexus Magnetic Resonance Neurography

et al. 2022

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“…Even with the Lr_NerveVIEW sequence, we are still unable to assess smaller nerve branches due to the inadequate spatial resolution and suppression of slow-flowing vessels. To address this challenge, more advanced imaging techniques, such as the use of gadolinium-based contrast agents to improve small nerve conspicuity, could be implemented ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

Contouring lumbosacral plexus nerves with MR neurography and MR/CT deformable registration technique

Cao

Gao²,

Li³

et al. 2022

Front. Oncol.

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PurposeIt is difficult to contour nerve structures with the naked eye due to poor differentiation between the nerve structures with other soft tissues on CT images. Magnetic resonance neurography (MRN) has the advantage in nerve visualization. The purpose of this study is to identify one MRN sequence to better assist the delineation of the lumbosacral plexus (LSP) nerves to assess the radiation dose to the LSP using the magnetic resonance (MR)/CT deformable coregistration technique.MethodsA total of 18 cases of patients with prostate cancer and one volunteer with radiation-induced lumbosacral plexopathy (RILSP) were enrolled. The data of simulation CT images and original treatment plans were collected. Two MRN sequences (Lr_NerveVIEW sequence and Cs_NerveVIEW sequence) were optimized from a published MRN sequence (3D NerveVIEW sequence). The nerve visualization ability of the Lr_NerveVIEW sequence and the Cs_NerveVIEW sequence was evaluated via a four-point nerve visualization score (NVS) scale in the first 10 patients enrolled to determine the better MRN sequence for assisting nerve contouring. Deformable registration was applied to the selected MRN sequence and simulation CT images to get fused MR/CT images, on which the LSP was delineated. The contouring of the LSP did not alter treatment planning. The dosimetric data of the LSP nerve were collected from the dose–volume histogram in the original treatment plans. The data of the maximal dose (Dmax) and the location of the maximal radiation point received by the LSP structures were collected.ResultsThe Cs_NerveVIEW sequence gained lower NVS scores than the Lr_NerveVIEW sequence (Z=-2.887, p=0.004). The LSP structures were successfully created in 18 patients and one volunteer with MRN (Lr_NerveVIEW)/CT deformable registration techniques, and the LSP structures conformed with the anatomic distribution. In the patient cohort, the percentage of the LSP receiving doses exceeding 50, 55, and 60 Gy was 68% (12/18), 33% (6/18), and 17% (3/18), respectively. For the volunteer with RILSP, the maximum irradiation dose to his LSP nerves was 69 Gy.ConclusionThe Lr_NerveVIEW MRN sequence performed better than the Cs_NerveVIEW sequence in nerve visualization. The dose in the LSP needs to be measured to understand the potential impact on treatment-induced neuropathy.

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“…visibility of peripheral nerves. It may also play a significant role in assessing brachial plexopathy and surrounding blood vessels using the combination of contrast-enhanced MRN and MR angiography (MRA) techniques(46)(47)(48)(49).…”

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confidence: 99%

Magnetic resonance tractography of the brachial plexus: step-by-step

Ibrahim¹,

Škoch²,

Herynek³

et al. 2022

Quant Imaging Med Surg

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Background: Magnetic resonance (MR) tractography of the brachial plexus (BP) is challenging due to different factors such as motion artifacts, pulsation artifacts, signal-to-noise ratio, spatial resolution; eddy currents induced geometric distortions, sequence parameters and choice of used coils. Notably challenging is the separation of the peripheral nerve bundles and skeletal muscles as both structures have similar fractional anisotropy values. We proposed an algorithm for robust visualization and assessment of BP root bundles using the segmentation of the spinal cord (SSC, C4-T1) as seed points for the initial starting area for the fibre tracking algorithm.Methods: Twenty-seven healthy volunteers and four patients with root avulsions underwent magnetic resonance imaging (MRI) examinations on a 3T MR scanner with optimized measurement protocols for diffusion-weighted images and coronal T2 weighted 3D short-term inversion recovery sampling perfection with application optimized contrast using varying flip angle evaluation sequences used for BP fibre reconstruction and MR neurography (MRN). The fibre bundles reconstruction was optimized in terms of eliminating the skeletal muscle fibres contamination using the SSC and the tracking threshold of the normalized quantitative anisotropy (NQA) on reconstruction of the BP. In our study, the NQA parameter has been used for fiber tracking instead of fractional anisotropy (FA). The diffusion data were processed in individual C4-T1 root bundles using the generalized q-sampling imaging (GQI) algorithm. Calculated diffusion parameters were statistically analysed using the two-sample t-test. The MRN was performed in MedINRIA and post-processed using the maximum intensity projection (MIP) method to demonstrate BP root bundles in multiple planes.Results: In control subjects, no significant effect of laterality in diffusion parameters was found (P>0.05) in the BP. In the central part of the BP, a significant difference between control subjects and patients at P=0.02 was found in the NQA values. Other diffusion parameters were not significantly different.Conclusions: Using NQA instead of FA in the proposed algorithm allowed for a better separation of muscle and root nerve bundles. The presented algorithm yields a high quality reconstruction of the BP bundles that may be helpful both in research and clinical practice.

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

Cited by 32 publications

References 24 publications

Brachial Plexus Magnetic Resonance Neurography

Brachial Plexus Magnetic Resonance Neurography

Contouring lumbosacral plexus nerves with MR neurography and MR/CT deformable registration technique

Magnetic resonance tractography of the brachial plexus: step-by-step

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