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American Journal of Neuroradiology

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REPLY:

B. Hill, K. Padgett, V. Karla and R. Quencer
American Journal of Neuroradiology July 2018, 39 (7) E83; DOI: https://doi.org/10.3174/ajnr.A5661
B. Hill
aDepartment of Radiology Miller School of Medicine
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K. Padgett
bDepartments of Radiology and Radiation Oncology, Miller School of Medicine Department of Biomedical Engineering, College of Engineering
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V. Karla
cMiller School of Medicine
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R. Quencer
dDepartment of Radiology Miller School of Medicine, University of Miami Miami, Florida
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Thank you very much for your interest and insight regarding our study. We agree that any potential clinical implementation of contrast-enhanced MR neurography for trauma would require a thoughtful risk-benefit analysis. However, the current widespread use and established safety profile of Gd-DTPA would be conducive to implementation. Regarding our noncontrast data, at your suggestion, we performed ROI-based SNR measurements on our T2-weighted sequences using the same approach described in the original article.

Between days 3 and 7, forceps-injured nerves did indeed demonstrate higher T2 signal compared with clip-injured nerves, both when comparing mean SNR of each group (P = .02) and when directly comparing injured nerves with their contralateral, nonoperative counterparts (P = .04). This difference was best detected using the contralateral, normal nerve as an internal control: Using this methodology, we found that forceps-injured nerves demonstrated 44% more T2 signal, while clip-injured nerves demonstrated 31% more T2 signal.

We agree that the relationship between T2 signal changes and Gd-DTPA enhancement warrants further investigation. Potentially, a multiparametric approach including T2 signal hyperintensity, enhancement data, and diffusion tractography would yield the greatest prognostic value.

  • © 2018 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 39 (7)
American Journal of Neuroradiology
Vol. 39, Issue 7
1 Jul 2018
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B. Hill, K. Padgett, V. Karla, R. Quencer
American Journal of Neuroradiology Jul 2018, 39 (7) E83; DOI: 10.3174/ajnr.A5661

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REPLY:
B. Hill, K. Padgett, V. Karla, R. Quencer
American Journal of Neuroradiology Jul 2018, 39 (7) E83; DOI: 10.3174/ajnr.A5661
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