Top-10 Tips for Getting Started with Magnetic Resonance Neurography

Abstract

Magnetic resonance neurography (MRN), also known as MR neurography, is a dedicated imaging technique for the peripheral nerves, used both in a clinical setting and research. However, like any other new diagnostic processes, there are technical, cost, and patient selection issues to overcome as well as potential imaging pitfalls to recognize before MRN can be adopted efficiently into routine clinical practice. This review focuses on the 10 most important practical tips to get started with MRN with a view to shortening the time needed for radiologists to implement this clinically useful technique into their imaging practices.

Keywords

magnetic resonance neurography - MRN - peripheral nerve MRI - neuropathy - structured interpretation

Financial Disclosure

Avneesh Chhabra is a consultant for ICON Medical and receives royalties from Jaypee and Wolters.

• References

• 1 Filler AG, Kliot M, Howe FA. , et al. Application of magnetic resonance neurography in the evaluation of patients with peripheral nerve pathology. J Neurosurg 1996; 85 (02) 299-309
• 2 Manoliu A, Ho M, Nanz D. , et al. MR neurographic orthopantomogram: Ultrashort echo-time imaging of mandibular bone and teeth complemented with high-resolution morphological and functional MR neurography. J Magn Reson Imaging 2016; 44 (02) 393-400
• 3 Viallon M, Vargas MI, Jlassi H, Lövblad KO, Delavelle J. High-resolution and functional magnetic resonance imaging of the brachial plexus using an isotropic 3D T2 STIR (short term inversion recovery) SPACE sequence and diffusion tensor imaging. Eur Radiol 2008; 18 (05) 1018-1023
• 4 Linda DD, Harish S, Stewart BG, Finlay K, Parasu N, Rebello RP. Multimodality imaging of peripheral neuropathies of the upper limb and brachial plexus. Radiographics 2010; 30 (05) 1373-1400
• 5 Andreisek G, Burg D, Studer A, Weishaupt D. Upper extremity peripheral neuropathies: role and impact of MR imaging on patient management. Eur Radiol 2008; 18 (09) 1953-1961
• 6 Bashir WA, Connell DA. Imaging of entrapment and compressive neuropathies. Semin Musculoskelet Radiol 2008; 12 (02) 170-181
• 7 Chalian M, Behzadi AH, Williams EH, Shores JT, Chhabra A. High-resolution magnetic resonance neurography in upper extremity neuropathy. Neuroimaging Clin N Am 2014; 24 (01) 109-125
• 8 Subhawong TK, Wang KC, Thawait SK. , et al. High resolution imaging of tunnels by magnetic resonance neurography. Skeletal Radiol 2012; 41 (01) 15-31
• 9 Martinoli C, Bianchi S, Pugliese F. , et al. Sonography of entrapment neuropathies in the upper limb (wrist excluded). J Clin Ultrasound 2004; 32 (09) 438-450
• 10 Salvalaggio A, Cacciavillani M, Coraci D. , et al. Nerve ultrasound and 3D-MR neurography suggestive of intraneural perineurioma. Neurology 2016; 86 (12) 1169-1170
• 11 Brown JM, Yablon CM, Morag Y, Brandon CJ, Jacobson JA. US of the peripheral nerves of the upper extremity: a landmark approach. Radiographics 2016; 36 (02) 452-463
• 12 Ohana M, Moser T, Moussaouï A. , et al. Current and future imaging of the peripheral nervous system. Diagn Interv Imaging 2014; 95 (01) 17-26
• 13 Chhabra A, Belzberg AJ, Rosson GD. , et al. Impact of high resolution 3 Tesla MR neurography (MRN) on diagnostic thinking and therapeutic patient management. Eur Radiol 2016; 26 (05) 1235-1244
• 14 Fisher S, Wadhwa V, Manthuruthil C, Cheng J, Chhabra A. Clinical impact of magnetic resonance neurography in patients with brachial plexus neuropathies. Br J Radiol 2016; 89 (1067): 20160503
• 15 Andreisek G, Bolog NV. Getting started with magnetic resonance neurography. Semin Musculoskelet Radiol 2018; 22 (03) 334-343
• 16 Filler AG, Maravilla KR, Tsuruda JS. MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature. Neurol Clin 2004; 22 (03) 643-682 , vi–vii
• 17 Kierszenbaum AL, Tres L. Histology and Cell Biology Pageburst E-book on Vitalsource Retail Access Card: An Introduction to Pathology. 4th ed. Philadelphia, PA: Saunders; 2015
• 18 Ratner S, Khwaja R, Zhang L. , et al. Sciatic neurosteatosis: relationship with age, gender, obesity and height. Eur Radiol 2018; 28 (04) 1673-1680
• 19 Eastlack J, Tenorio L, Wadhwa V, Scott K, Starr A, Chhabra A. Sciatic neuromuscular variants on MR neurography: frequency study and interobserver performance. Br J Radiol 2017; 90 (1079): 20170116
• 20 Jabaley ME, Wallace WH, Heckler FR. Internal topography of major nerves of the forearm and hand: a current view. J Hand Surg Am 1980; 5 (01) 1-18
• 21 Thawait SK, Chaudhry V, Thawait GK. , et al. High-resolution MR neurography of diffuse peripheral nerve lesions. AJNR Am J Neuroradiol 2011; 32 (08) 1365-1372
• 22 Zuniga JR, Mistry C, Tikhonov I, Dessouky R, Chhabra A. Magnetic resonance neurography of traumatic and nontraumatic peripheral trigeminal neuropathies. J Oral Maxillofac Surg 2018; 76 (04) 725-736
• 23 Seddon H. Three types of nerve injury. Brain 1943; 66: 237-288
• 24 Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951; 74 (04) 491-516
• 25 Mackinnon S, Dellon A. Surgery of the Peripheral Nerve. New York, NY: Thieme; 1988: 74-78
• 26 Dyck PJ. Invited review: limitations in predicting pathologic abnormality of nerves from the EMG examination. Muscle Nerve 1990; 13 (05) 371-375
• 27 Belzberg AJ. Acute nerve injuries. In: Rengachary SS, Ellenbogen RG. , eds. Principles of Neurosurgery. 2nd ed. Philadelphia, PA: Elsevier Mosby; 2005: 387-395
• 28 Zhang H, Xiao B, Zou T. Clinical application of magnetic resonance neurography in peripheral nerve disorders. Neurosci Bull 2006; 22 (06) 361-367
• 29 Andreisek G, Chhabra A. MR neurography: pitfalls in imaging and interpretation. Semin Musculoskelet Radiol 2015; 19 (02) 94-102
• 30 Andreisek G, White LM, Kassner A, Sussman MS. Evaluation of diffusion tensor imaging and fiber tractography of the median nerve: preliminary results on intrasubject variability and precision of measurements. AJR Am J Roentgenol 2010; 194 (01) W65–W72
• 31 Guggenberger R, Nanz D, Puippe G. , et al. Diffusion tensor imaging of the median nerve: intra-, inter-reader agreement, and agreement between two software packages. Skeletal Radiol 2012; 41 (08) 971-980
• 32 Guggenberger R, Eppenberger P, Markovic D. , et al. MR neurography of the median nerve at 3.0T: optimization of diffusion tensor imaging and fiber tractography. Eur J Radiol 2012; 81 (07) e775-e782
• 33 Guggenberger R, Nanz D, Bussmann L. , et al. Diffusion tensor imaging of the median nerve at 3.0 T using different MR scanners: agreement of FA and ADC measurements. Eur J Radiol 2013; 82 (10) e590-e596
• 34 Chhabra A, Lee PP, Bizzell C, Soldatos T. 3 Tesla MR neurography—technique, interpretation, and pitfalls. Skeletal Radiol 2011; 40 (10) 1249-1260
• 35 Chhabra A, Flammang A, Padua Jr A, Carrino JA, Andreisek G. Magnetic resonance neurography: technical considerations. Neuroimaging Clin N Am 2014; 24 (01) 67-78
• 36 Menezes CM, de Andrade LM, Herrero Cda S. , et al. Diffusion-weighted magnetic resonance (DW-MR) neurography of the lumbar plexus in the preoperative planning of lateral access lumbar surgery. Eur Spine J 2015; 24 (04) 817-826
• 37 Chhabra A, Faridian-Aragh N, Chalian M. , et al. High-resolution 3-T MR neurography of peroneal neuropathy. Skeletal Radiol 2012; 41 (03) 257-271
• 38 Wang X, Harrison C, Mariappan YK. , et al. MR neurography of brachial plexus at 3.0 T with robust fat and blood suppression. Radiology 2017; 283 (02) 538-546
• 39 Ahlawat S, Stern SE, Belzberg AJ, Fritz J. High-resolution metal artifact reduction MR imaging of the lumbosacral plexus in patients with metallic implants. Skeletal Radiol 2017; 46 (07) 897-908
• 40 Mürtz P, Kaschner M, Lakghomi A. , et al. Diffusion-weighted MR neurography of the brachial and lumbosacral plexus: 3.0 T versus 1.5 T imaging. Eur J Radiol 2015; 84 (04) 696-702
• 41 Eppenberger P, Andreisek G, Chhabra A. Magnetic resonance neurography: diffusion tensor imaging and future directions. Neuroimaging Clin N Am 2014; 24 (01) 245-256
• 42 Yoneyama M, Takahara T, Kwee TC, Nakamura M, Tabuchi T. Rapid high resolution MR neurography with a diffusion-weighted pre-pulse. Magn Reson Med Sci 2013; 12 (02) 111-119
• 43 Chhabra A, Carrino JA, Farahani SJ. , et al. Whole-body MR neurography: Prospective feasibility study in polyneuropathy and Charcot-Marie-Tooth disease. J Magn Reson Imaging 2016; 44 (06) 1513-1521
• 44 Vaeggemose M, Vaeth S, Pham M. , et al. Magnetic resonance neurography and diffusion tensor imaging of the peripheral nerves in patients with Charcot-Marie-Tooth type 1A. Muscle Nerve 2017; 56 (06) E78-E84
• 45 Vaeggemose M, Pham M, Ringgaard S. , et al. Magnetic resonance neurography visualizes abnormalities in sciatic and tibial nerves in patients with type 1 diabetes and neuropathy. Diabetes 2017; 66 (07) 1779-1788
• 46 Wu C, Wang G, Zhao Y. , et al. Assessment of tibial and common peroneal nerves in diabetic peripheral neuropathy by diffusion tensor imaging: a case control study. Eur Radiol 2017; 27 (08) 3523-3531
• 47 Soldatos T, Andreisek G, Thawait GK. , et al. High-resolution 3-T MR neurography of the lumbosacral plexus. Radiographics 2013; 33 (04) 967-987
• 48 Chhabra A, Madhuranthakam AJ, Andreisek G. Magnetic resonance neurography: current perspectives and literature review. Eur Radiol 2018; 28 (02) 698-707
• 49 Bendszus M, Wessig C, Solymosi L, Reiners K, Koltzenburg M. MRI of peripheral nerve degeneration and regeneration: correlation with electrophysiology and histology. Exp Neurol 2004; 188 (01) 171-177
• 50 van Ouwerkerk WJR, Strijers RLM, Barkhof F, Umans U, Vandertop WP. Detection of root avulsion in the dominant C7 obstetric brachial plexus lesion: experience with three-dimensional constructive interference in steady-state magnetic resonance imaging and electrophysiology. Neurosurgery 2005; 57 (05) 930-940 ; discussion 930–940
• 51 Chabbra A, Andreisek G. Magnetic Resonance Neurography. London, UK: Jaypee; 2012
• 52 Viddeleer AR, Sijens PE, van Ooijen PMA. , et al. Quantitative STIR of muscle for monitoring nerve regeneration. J Magn Reson Imaging 2016; 44 (02) 401-410
• 53 Husarik DB, Saupe N, Pfirrmann CWA, Jost B, Hodler J, Zanetti M. Elbow nerves: MR findings in 60 asymptomatic subjects—normal anatomy, variants, and pitfalls. Radiology 2009; 252 (01) 148-156
• 54 Bäumer P, Dombert T, Staub F. , et al. Ulnar neuropathy at the elbow: MR neurography—nerve T2 signal increase and caliber. Radiology 2011; 260 (01) 199-206
• 55 Sneag DB, Saltzman EB, Meister DW, Feinberg JH, Lee SK, Wolfe SW. MRI bullseye sign: an indicator of peripheral nerve constriction in Parsonage-Turner syndrome. Muscle Nerve 2017; 56 (01) 99-106
• 56 Thakkar RS, Del Grande F, Thawait GK, Andreisek G, Carrino JA, Chhabra A. Spectrum of high-resolution MRI findings in diabetic neuropathy. AJR Am J Roentgenol 2012; 199 (02) 407-412
• 57 Chhabra A, Farahani SJ, Thawait GK, Wadhwa V, Belzberg AJ, Carrino JA. Incremental value of magnetic resonance neurography of lumbosacral plexus over non-contributory lumbar spine magnetic resonance imaging in radiculopathy: a prospective study. World J Radiol 2016; 8 (01) 109-116
• 58 Wolf M, Bäumer P, Pedro M. , et al. Sciatic nerve injury related to hip replacement surgery: imaging detection by MR neurography despite susceptibility artifacts. PLoS One 2014; 9 (02) e89154
• 59 Chhabra A, Ahlawat S, Belzberg A, Andreseik G. Peripheral nerve injury grading simplified on MR neurography: as referenced to Seddon and Sunderland classifications. Indian J Radiol Imaging 2014; 24 (03) 217-224
• 60 Dessouky R, Khaleel M, Khalifa DN, Tantawy HI, Chhabra A. Magnetic resonance neurography of the lumbosacral plexus in failed back surgery syndrome. Spine 2018; 43 (12) 839-847
• 61 Dessouky R, Xi Y, Scott KM. , et al. Magnetic resonance neurography in chronic lumbosacral and pelvic pain: diagnostic and management impact-institutional audit. World Neurosurg 2018; 114: e77-e113