Subscribe to RSS
Performance Evaluation of High-Resolution Ultrasound versus Magnetic Resonance Imaging in Diagnosing Peripheral Nerve Pathologies
Background High-resolution ultrasound (HRUS) and magnetic resonance neurography (MRN) are considered complementary to clinical and neurophysiological assessment for neuropathies.
Aims The aim of our study was to compare the accuracy of HRUS and MRN for detecting various peripheral nerve pathologies, to choose the correct investigation to facilitate prompt patient management.
Materials and Methods This prospective study was done using HRUS with 14 MHz linear-transducer and 3 or 1.5T MR in cases referred for the assessment of peripheral nerve pathologies. Image interpretation was done using a scoring system (score 0–3 confidence level) to assess for nerve continuity/discontinuity, increased nerve signal/edema, fascicular change, caliber change, and neuroma/mass lesion. We determined the accuracy, sensitivity, and specificity of these modalities compared with the diagnostic standard determined by surgical and/or histopathological, if not performed then clinical and/or electrodiagnostic evaluation.
Results The overall accuracy of MRN was 89.3% (specificity: 66.6%, sensitivity: 92.6%, negative predictive value [NPV]: 57.1%, positive predictive value [PPV]: 95%) and that of HRUS was 82.9% (specificity: 100%, sensitivity: 80.4%, NPV: 42.8, PPV: 100). The confidence level for detecting nerve discontinuity and change in nerve caliber was found to be higher on ultrasonography than magnetic resonance imaging (MRI) (100 vs. 70% and 100 vs. 50%, respectively). Pathology of submillimeter caliber nerves was accurately detected by HRUS and these could not be well-visualized on MRI.
Conclusion HRUS is a powerful tool that may be used as the first-line imaging modality for the evaluation of peripheral nerve pathologies, and a better means of evaluation of peripheral nerves with submillimeter caliber.
19 April 2021 (online)
© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Simon NG, Talbott J, Chin CT, Kliot M. Peripheral nerve imaging. Handb Clin Neurol 2016; 136: 811-826
- 2 Gagliardo A, Toia F, Maggì F, Mariolo AV, Cillino M, Moschella F. Clinical neurophysiology and imaging of nerve injuries: preoperative diagnostic work-up and post-operative monitoring. PlastAesthet Res 2015; 2: 149-155
- 3 Kwee RM, Chhabra A, Wang KC, Marker DR, Carrino JA. Accuracy of MRI in diagnosing peripheral nerve disease: a systematic review of the literature. AJR Am J Roentgenol 2014; 203 (06) 1303-1309
- 4 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
- 5 Yablon CM, Hammer MR, Morag Y, Brandon CJ, Fessell DP, Jacobson JA. US of the peripheral nerves of the lower extremity: a landmark approach. Radiographics 2016; 36 (02) 464-478
- 6 Jablecki CK, Andary MT, So YT, Wilkins DE, Williams FH. AAEM Quality Assurance Committee. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. Muscle Nerve 1993; 16 (12) 1392-1414
- 7 Dellon AL. Management of peripheral nerve problems in the upper and lower extremity using quantitative sensory testing. Hand Clin 1999; 15 (04) 697-715, x
- 8 Agarwal A, Chandra A, Jaipal U. et al. Can imaging be the new yardstick for diagnosing peripheral neuropathy? A comparison between high resolution ultrasound and MR neurography with an approach to diagnosis. Insights Imaging 2019; 10 (01) 104
- 9 Garg K, Aggarwal A, Srivastava DN. et al. Comparison of different sequences of MRI and ultrasonogram with nerve conduction studies in peripheral neuropathies. World Neurosurg 2017; 31355-4
- 10 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
- 11 Zaidman CM, Seelig MJ, Baker JC, Mackinnon SE, Pestronk A. Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology 2013; 80 (18) 1634-1640