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Magnetic resonance neurography: current perspectives and literature review

  • Magnetic Resonance
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Abstract

Magnetic resonance neurography (also called MRN or MR neurography) refers to MR imaging dedicated to the peripheral nerves. It is a technique that enhances selective multiplanar visualisation of the peripheral nerve and pathology by encompassing a combination of two-dimensional, three-dimensional and diffusion imaging pulse sequences. Referring physicians who seek imaging techniques that can depict and diagnose peripheral nerve pathologies superior to conventional MR imaging are driving the demand for MRN. This article reviews the pathophysiology of peripheral nerves in common practice scenarios, technical considerations of MRN, current indications of MRN, normal and abnormal neuromuscular appearances, and imaging pitfalls. Finally, the emerging utility of diffusion-weighted and diffusion tensor imaging is discussed and future directions are highlighted.

Key points

• Lesion relationship to neural architecture is more conspicuous on MRN than MRI.

• 3D multiplanar imaging technique is essential for pre-surgical planning.

• Nerve injuries can be classified on MRN using Sunderland’s classification.

• DTI provides quantitative information and insight into intraneural integrity and pathophysiology.

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References

  1. Howe FA, Filler AG, Bell BA, Griffiths JR (1992) Magnetic resonance neurography. Magn Reson Med 28:328–338

    Article  CAS  PubMed  Google Scholar 

  2. Filler AG, Kliot M, Howe FA, Hayes CE, Saunders DE, Goodkin R et al (1996) Application of magnetic resonance neurography in the evaluation of patients with peripheral nerve pathology. J Neurosurg 85:299–309

    Article  CAS  PubMed  Google Scholar 

  3. Mauermann ML, Amrami KK, Kuntz NL, Spinner RJ, Dyck PJ, Bosch EP et al (2009) Longitudinal study of intraneural perineurioma –a benign, focal hypertrophic neuropathy of youth. Brain 132:2265–2276

    Article  PubMed  PubMed Central  Google Scholar 

  4. Thawait SK, Wang K, Subhawong TK, Williams EH, Hashemi SS, Machado AJ et al (2012) Peripheral nerve surgery: the role of high-resolution MR neurography. AJNR Am J Neuroradiol 33:203–210

    Article  CAS  PubMed  Google Scholar 

  5. Baumer P, Kele H, Kretschmer T, Koenig R, Pedro M, Bendszus M et al (2014) Thoracic outlet syndrome in 3T MR neurography-fibrous bands causing discernible lesions of the lower brachial plexus. Eur Radiol 24:756–761

    Article  CAS  PubMed  Google Scholar 

  6. Filler AG, Maravilla KR, Tsuruda JS (2004) MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature. Neurol Clin 22:643–682, vi–vii

    Article  PubMed  Google Scholar 

  7. Subhawong TK, Wang KC, Thawait SK, Williams EH, Hashemi SS, Machado AJ et al (2012) High resolution imaging of tunnels by magnetic resonance neurography. Skeletal Radiol 41:15–31

    Article  PubMed  Google Scholar 

  8. Gyftopoulos S, Rosenberg ZS, Petchprapa C (2010) Increased MR signal intensity in the pronator quadratus muscle: Does it always indicate anterior interosseous neuropathy? AJR Am J Roentgenol 194:490–493

    Article  PubMed  Google Scholar 

  9. Schmid DT, Hodler J, Mengiardi B, Pfirrmann CW, Espinosa N, Zanetti M (2009) Fatty muscle atrophy: prevalence in the hindfoot muscles on MR images of asymptomatic volunteers and patients with foot pain. Radiology 253:160–166

    Article  PubMed  Google Scholar 

  10. Sunderland S (1951) A classification of peripheral nerve injuries producing loss of function. Brain 74:491–516

    Article  CAS  PubMed  Google Scholar 

  11. Chhabra A, Ahlawat S, Belzberg A, Andreseik G (2014) Peripheral nerve injury grading simplified on MR neurography: As referenced to Seddon and Sunderland classifications. Indian J Radiol Imaging 24:217–224

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cox B, Zuniga JR, Panchal N, Cheng J, Chhabra A (2016) Magnetic resonance neurography in the management of peripheral trigeminal neuropathy: experience in a tertiary care centre. Eur Radiol 26:3392–3400

    Article  PubMed  Google Scholar 

  13. Menorca RM, Fussell TS, Elfar JC (2013) Nerve physiology: mechanisms of injury and recovery. Hand Clin 29:317–330

    Article  PubMed  PubMed Central  Google Scholar 

  14. Li X, Shen J, Chen J, Wang X, Liu Q, Liang B (2008) Magnetic resonance imaging evaluation of acute crush injury of rabbit sciatic nerve: correlation with histology. Can Assoc Radiol J 59:123–130

    PubMed  Google Scholar 

  15. Thakkar RS, Del Grande F, Thawait GK et al (2012) Spectrum of high-resolution MRI findings in diabetic neuropathy. AJR Am J Roentgenol 199:407–412

    Article  PubMed  Google Scholar 

  16. Cudlip SA, Howe FA, Griffiths JR, Bell BA (2002) Magnetic resonance neurography of peripheral nerve following experimental crush injury, and correlation with functional deficit. J Neurosurg 96:755–759

    Article  PubMed  Google Scholar 

  17. Gulati AK (1996) Peripheral nerve regeneration through short- and long-term degenerated nerve transplants. Brain Res 742:265–270

    Article  CAS  PubMed  Google Scholar 

  18. Hsieh SY, Kuo HC, Chu CC, Lin KP, Huang CC (2004) Charcot-Marie-Tooth disease type 1A: a clinical, electrophysiological, pathological, and genetic study. Chang Gung Med J 27:300–306

    PubMed  Google Scholar 

  19. Chung T, Prasad K, Lloyd TE (2014) Peripheral neuropathy: clinical and electrophysiological considerations. Neuroimaging Clin N Am 24:49–65

    Article  PubMed  Google Scholar 

  20. Feinberg J (2006) EMG: myths and facts. HSS J 2:19–21

    Article  PubMed  PubMed Central  Google Scholar 

  21. Padua L, Liotta G, Di Pasquale A, Granata G, Pazzaglia C, Caliandro P et al (2012) Contribution of ultrasound in the assessment of nerve diseases. Eur J Neurol 19:47–54

    Article  CAS  PubMed  Google Scholar 

  22. Di Pasquale A, Morino S, Loreti S, Bucci E, Vanacore N, Antonini G (2015) Peripheral nerve ultrasound changes in CIDP and correlations with nerve conduction velocity. Neurology 84:803–809

    Article  PubMed  Google Scholar 

  23. Chhabra A, Lee PP, Bizzell C, Soldatos T (2011) 3 Tesla MR neurography – technique, interpretation, and pitfalls. Skeletal Radiol 40:1249–1260

    Article  PubMed  Google Scholar 

  24. Delaney H, Bencardino J, Rosenberg ZS (2014) Magnetic resonance neurography of the pelvis and lumbosacral plexus. Neuroimaging Clin N Am 24:127–150

    Article  PubMed  Google Scholar 

  25. Chhabra A, Del Grande F, Soldatos T, Chalian M, Belzberg AJ, Williams EH et al (2013) Meralgia paresthetica: 3-Tesla magnetic resonance neurography. Skeletal Radiol 42:803–808

    Article  PubMed  Google Scholar 

  26. Bäumer P, Dombert T, Staub F, Kaestel T, Bartsch AJ, Heiland S et al (2011) Ulnar neuropathy at the elbow: MR neurography – nerve T2 signal increase and caliber. Radiology 260:199–206

    Article  PubMed  Google Scholar 

  27. Chhabra A, Chalian M, Soldatos T, Andreisek G, Faridian-Aragh N, Williams E et al (2012) 3-T high-resolution MR neurography of sciatic neuropathy. AJR Am J Roentgenol 198:W357–W364

    Article  PubMed  Google Scholar 

  28. Bendszus M, Wessig C, Solymosi L, Reiners K, Koltzenburg M (2004) MRI of peripheral nerve degeneration and regeneration: correlation with electrophysiology and histology. Exp Neurol 188:171–177

    Article  PubMed  Google Scholar 

  29. Viddeleer AR, Sijens PE, van Ooijen PM, Kuypers PD, Hovius SE, De Deyn PP et al (2016) Quantitative STIR of muscle for monitoring nerve regeneration. J Magn Reson Imaging 44:401–410

    Article  PubMed  Google Scholar 

  30. Stanisz GJ, Midha R, Munro CA, Henkelman RM (2001) MR properties of rat sciatic nerve following trauma. Magn Reson Med 45:415–420

    Article  CAS  PubMed  Google Scholar 

  31. Madhuranthakam AJ, Yu H, Shimakawa A et al (2010) T(2)-weighted 3D fast spin echo imaging with water-fat separation in a single acquisition. J Magn Reson Imaging 32:745–751

    Article  PubMed  PubMed Central  Google Scholar 

  32. Gatehouse PD, Bydder GM (2003) Magnetic resonance imaging of short T2 components in tissue. Clin Radiol 58:1–19

    Article  CAS  PubMed  Google Scholar 

  33. Ishida G, Oishi M, Morii K, Hasegawa K, Saito A, Sato M et al (2015) Application of brain diffusion-weighted imaging performed using readout segmentation of long variable echo trains. No Shinkei Geka 43:31–40

    PubMed  Google Scholar 

  34. Busse RF, Hariharan H, Vu A, Brittain JH (2006) Fast spin echo sequences with very long echo trains: design of variable refocusing flip angle schedules and generation of clinical T2 contrast. Magn Reson Med 55:1030–1037

    Article  PubMed  Google Scholar 

  35. Vargas MI, Viallon M, Nguyen D, Beaulieu JY, Delavelle J, Becker M (2010) New approaches in imaging of the brachial plexus. Eur J Radiol 74:403–410

    Article  CAS  PubMed  Google Scholar 

  36. Madhuranthakam AJ, Lenkinski RE (2015) Technical advancements in MR Neurography. Semin Musculoskelet Radiol 19:86–93

    Article  PubMed  Google Scholar 

  37. Kasper JM, Wadhwa V, Scott KM, Rozen S, Xi Y, Chhabra A (2015) SHINKEI – a novel 3D isotropic MR neurography technique: technical advantages over 3DIRTSE-based imaging. Eur Radiol 25:1672–1677

    Article  PubMed  Google Scholar 

  38. Chhabra A, Soldatos T, Subhawong TK, Machado AJ, Thawait SK, Wang KC et al (2011) The application of three-dimensional diffusion-weighted PSIF technique in peripheral nerve imaging of the distal extremities. J Magn Reson Imaging 34:962–967

    Article  PubMed  Google Scholar 

  39. Merkle EM, Dale BM, Barboriak DP (2007) Gain in signal-to-noise for first-pass contrast-enhanced abdominal MR angiography at 3 Tesla over standard 1.5 Tesla: prediction with a computer model. Acad Radiol 14:795–803

    Article  PubMed  Google Scholar 

  40. Bäumer P, Kele H, Xia A, Weiler M, Schwarz D, Bendszus M et al (2016) Posterior interosseous neuropathy: Supinator syndrome vs fascicular radial neuropathy. Neurology 87:1884–1891

    Article  PubMed  PubMed Central  Google Scholar 

  41. Chhabra A, Thakkar RS, Andreisek G, Chalian M, Belzberg AJ, Blakeley J et al (2013) Anatomic MR imaging and functional diffusion tensor imaging of peripheral nerve tumors and tumorlike conditions. AJNR Am J Neuroradiol 34:802–807

    Article  CAS  PubMed  Google Scholar 

  42. Soldatos T, Andreisek G, Thawait GK, Guggenberger R, Williams EH, Carrino JA et al (2013) High-resolution 3-T MR neurography of the lumbosacral plexus. Radiographics 33:967–987

    Article  PubMed  Google Scholar 

  43. Wadhwa V, Thakkar RS, Maragakis N, Höke A et al (2012) Sciatic nerve tumor and tumor-like lesions – uncommon pathologies. Skeletal Radiol 41:763–774

    Article  PubMed  Google Scholar 

  44. Breckwoldt MO, Stock C, Xia A, Heckel A, Bendszus M, Pham M et al (2015) Diffusion Tensor Imaging Adds Diagnostic Accuracy in Magnetic Resonance Neurography. Invest Radiol 50:498–504

    Article  CAS  PubMed  Google Scholar 

  45. van Ouwerkerk WJ, Strijers RL, Barkhof F, Umans U, Vandertop WP (2005) 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 57:930–940

    Article  PubMed  Google Scholar 

  46. Breitenseher JB, Kranz G, Hold A, Berzaczy D, Nemec SF, Sycha T et al (2015) MR neurography of ulnar nerve entrapment at the cubital tunnel: a diffusion tensor imaging study. Eur Radiol 25:1911–1918

    Article  PubMed  Google Scholar 

  47. Sneag DB, Saltzman EB, Meister DW, Feinberg JH, Lee SK, Wolfe SW (2016) MRI bullseye sign: An indicator of peripheral nerve constriction in parsonage-turner syndrome. Muscle Nerve. doi:10.1002/mus.25480

    Google Scholar 

  48. Chhabra A (2014) Peripheral MR, neurography: approach to interpretation. Neuroimaging Clin N Am 24:79–89

    Article  PubMed  Google Scholar 

  49. Wasa J, Nishida Y, Tsukushi S, Shido Y, Sugiura H, Nakashima H et al (2010) MRI features in the differentiation of malignant peripheral nerve sheath tumors and neurofibromas. AJR Am J Roentgenol 194:1568–1574

    Article  PubMed  Google Scholar 

  50. Descamps MJ, Barrett L, Groves M, Yung L, Birch R, Murray NM et al (2006) Primary sciatic nerve lymphoma: a case report and review of the literature. J Neurol Neurosurg Psychiatry 77:1087–1089

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Demehri S, Belzberg A, Blakeley J, Fayad LM (2014) Conventional and functional MR imaging of peripheral nerve sheath tumors: initial experience. AJNR Am J Neuroradiol 35:1615–1620

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Schmidt M, Kasprian G, Amann G, Duscher D, Aszmann OC (2015) Diffusion tensor tractography for the surgical management of peripheral nerve sheath tumors. Neurosurg Focus 39, E17

    Article  PubMed  Google Scholar 

  53. Kästel T, Heiland S, Bäumer P, Bartsch AJ, Bendszus M, Pham M (2011) Magic angle effect: a relevant artifact in MR neurography at 3T? AJNR Am J Neuroradiol 32:821–827

    Article  PubMed  Google Scholar 

  54. Husarik DB, Saupe N, Pfirrmann CW, Jost B, Hodler J, Zanetti M (2009) Elbow nerves: MR findings in 60 asymptomatic subjects – normal anatomy, variants, and pitfalls. Radiology 252:148–156

    Article  PubMed  Google Scholar 

  55. Thawait SK, Chaudhry V, Thawait GK, Wang KC, Belzberg A, Carrino JA et al (2011) High-resolution MR neurography of diffuse peripheral nerve lesions. AJNR Am J Neuroradiol 32:1365–1372

    Article  CAS  PubMed  Google Scholar 

  56. Chhabra A, Carrino JA, Farahani SJ, Thawait GK, Sumner CJ, Wadhwa V et al (2016) Whole-body MR neurography: Prospective feasibility study in polyneuropathy and Charcot-Marie-Tooth disease. J Magn Reson Imaging 44:1513–1521

    Article  PubMed  Google Scholar 

  57. Vaeggemose M, Vaeth S, Pham M, Ringgaard S, Jensen UB, Tankisi H et al (2017) Magnetic Resonance Neurography and Diffusion Tensor Imaging of the peripheral nerves in patients with CMT Type 1A. Muscle Nerve. doi:10.1002/mus.25691

    PubMed  Google Scholar 

  58. Trivedi JR, Phillips L, Chhabra A (2015) Hereditary and acquired polyneuropathy conditions of the peripheral nerves: clinical considerations and MR neurography imaging. Semin Musculoskelet Radiol 19:130–136

    Article  PubMed  Google Scholar 

  59. Staff NP, Amrami KK, Howe BM (2015) Magnetic resonance imaging abnormalities of peripheral nerve and muscle is common in amyotrophic lateral sclerosis and share features with multifocal motor neuropathy. Muscle Nerve 52:137–139

    Article  PubMed  PubMed Central  Google Scholar 

  60. Pham M, Oikonomou D, Bäumer P, Bierhaus A, Heiland S, Humpert PM et al (2011) Proximal neuropathic lesions in distal symmetric diabetic polyneuropathy: findings of high-resolution magnetic resonance neurography. Diabetes Care 34:721–723

    Article  PubMed  PubMed Central  Google Scholar 

  61. Vaeggemose M, Pham M, Ringgaard S, Tankisi H, Ejskjaer N, Heiland S et al (2017) Magnetic Resonance Neurography Visualises Abnormalities in Sciatic and Tibial Nerves in Patients with Type 1 Diabetes and Neuropathy. Diabetes. doi:10.2337/db16-1049

    PubMed  Google Scholar 

  62. Wu C, Wang G, Zhao Y, Hao W, Zhao L, Zhang X et al (2016) Assessment of tibial and common peroneal nerves in diabetic peripheral neuropathy by diffusion tensor imaging: a case control study. Eur Radiol. doi:10.1007/s00330-016-4698-3

    PubMed Central  Google Scholar 

  63. Kollmer J, Hund E, Hornung B, Hegenbart U, Schönland SO, Kimmich C et al (2015) In vivo detection of nerve injury in familial amyloid polyneuropathy by magnetic resonance neurography. Brain 138:549–562

    Article  PubMed  Google Scholar 

  64. Guggenberger R et al (2012) Assessment of median nerve with MR neurography by using diffusion-tensor imaging: normative and pathologic diffusion values. Radiology 265:194–203

    Article  PubMed  Google Scholar 

  65. Boyer RB, Kelm ND, Riley DC, Sexton KW, Pollins AC, Shack RB et al (2015) 4.7-T diffusion tensor imaging of acute traumatic peripheral nerve injury. Neurosurg Focus 39:E9

    Article  PubMed  PubMed Central  Google Scholar 

  66. Kasprian G et al (2015) Peripheral nerve tractography in soft tissue tumors: a preliminary 3-tesla diffusion tensor magnetic resonance imaging study. Muscle Nerve 51:338–345

    Article  PubMed  Google Scholar 

  67. Chhabra A, Belzberg AJ, Rosson GD, Thawait GK, Chalian M, Farahani SJ et al (2016) Impact of high resolution 3 tesla MR neurography (MRN) on diagnostic thinking and therapeutic patient management. Eur Radiol 26:1235–1244

    Article  PubMed  Google Scholar 

  68. Fisher S, Wadhwa V et al (2016) Clinical impact of magnetic resonance neurography in patients with brachial plexus neuropathies. Br J Radiol 89:20160503

    Article  PubMed  PubMed Central  Google Scholar 

  69. Andreisek G, Burg D, Studer A, Weishaupt D (2008) Upper extremity peripheral neuropathies: role and impact of MR imaging on patient management. Eur Radiol 18:1953–1961

    Article  PubMed  Google Scholar 

  70. Kwee RM, Chhabra A, Wang KC, Marker DR, Carrino JA (2014) Accuracy of MRI in diagnosing peripheral nerve disease: a systematic review of the literature. AJR Am J Roentgenol 203:1303–1309

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors acknowledge the contribution of Mr. Jon Garinn in editing this manuscript and Dr. Jaya Trivedi for editing the electrophysiology section of the manuscript.

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Authors and Affiliations

  1. Radiology and Orthopedic Surgery and Musculoskeletal Radiology, UT Southwestern Medical Center, Dallas, TX, USA

    Avneesh Chhabra

  2. Adjunct Faculty, Johns Hopkins University, Baltimore, MD, USA

    Avneesh Chhabra

  3. Department of Radiology and Advanced Imaging Research Institute, UT Southwestern Medical Center, Dallas, TX, USA

    Ananth J. Madhuranthakam

  4. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zürich, Switzerland

    Gustav Andreisek

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  1. Avneesh Chhabra
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Correspondence to Avneesh Chhabra.

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Guarantor

The scientific guarantor of this publication is Avneesh Chhabra, MD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies

Avneesh Chhabra

AC has received prior research grants from GE-AUR (GERRAF), Siemens Medical Solutions, Gatewood Fellowship Award and Integra Life Sciences unrelated to this work. He serves as a research consultant with ICON Medical group. He also receives book royalties from Jaypee, Elsevier and Wolters Kluwer.

Ananth Madhuranthakam

None.

Gustav Andreisek

Gustav Andreisek was co-worker of a study that resulted in a US patent (USPTO Number 12/947,256). He has received grants from the Swiss National Science Foundation (SNCF), Holcim, MayenfischTtrust and Siemens. He is currently Co-PI or Sub-PI in several third party-funded clinical trials at the University of Zurich where renumeration is given to the department he works for (sponsors include: Millennium Pharmaceuticals, Eli Lilly, GlaxoSmithKline, Cytheris SA, Roche, BioChemics, Novartis, Bristol-Meyers Squibb, TopoTarget, Otsuka and Merck Sharp & Dohme). The department also receives grants from Bayer and Guerbet and has ongoing research collaborations with Siemens, GE and Philips. Gustav Andreisek has given workshops and talks at a congress which was sponsored by Mepha Pharma AG, Switzerland, and received a speaker fee. He also gives talks at Lunch symposia and CME courses, which are organized and sponsored by Guerbet AG, and receives speakers fees and travel reimbursements. He served as a consultant for Otsuka Pharmaceutical Europe Ltd and Siemens Healthcare AG, Germany, and received a consultancy fee and reimbursement of travel costs. Furthermore, he has been invited in the past by AGFA, Bracco, GE, Philips and Siemens for official company receptions at international radiological congresses (RSNA, ECR, SGR). As a book author, Gustav Andreisek receives royalties from Springer, Heidelberg and as author of CME articles, he receives royalties from Rheuma Schweiz.

The other authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Chhabra, A., Madhuranthakam, A.J. & Andreisek, G. Magnetic resonance neurography: current perspectives and literature review. Eur Radiol 28, 698–707 (2018). https://doi.org/10.1007/s00330-017-4976-8

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  • DOI: https://doi.org/10.1007/s00330-017-4976-8

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