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Technology Insight: visualizing peripheral nerve injury using MRI

Nature Clinical Practice Neurology volume 1, pages 45–53 (2005)Cite this article

Abstract

Currently, the evaluation of peripheral nerve disorders depends on clinical examination, supplemented by electrophysiological studies. These approaches provide general information on the distribution and classification of nerve lesions—for example, axonal versus demyelinative—but nerve biopsies are still required to obtain morphological and pathophysiological details. In this article, we review recent progress in the imaging of peripheral nerve injury by magnetic resonance (MR) neurography. Axonal nerve injury leads to Wallerian degeneration, resulting in a hyperintense nerve signal on T2-weighted MR images of the distal nerve segment. This signal is lost following successful regeneration. Concomitant denervation-induced signal alterations in muscles can further help us to determine whether nerve trunks or roots are affected. These signal changes are caused by various combinations of nonspecific tissue alterations, however, and are not related to particular pathoanatomical findings, such as inflammation, demyelination or axonal injury. New experimental MR contrast agents, such as gadofluorine M and superparamagnetic iron oxide particles, allow visualization of the dynamics of peripheral nerve injury and repair. Further clinical development of these MR contrast agents should allow these functional aspects of nerve injury and repair to be assessed in humans, thereby aiding the differential diagnosis of peripheral nerve disorders.

Key Points

  • MRI is an indispensable tool in the diagnosis of CNS disorders, but is only just beginning to be applied to diseases of the peripheral nervous system

  • Lesioned nerves reveal a marked prolongation of the T2-relaxation time, and consequently they appear bright on T2-weighted MRI. Prolongation of the T2-relaxation time is also observed in acutely denervated muscle

  • Functional and electrophysiological studies substantiate a close relationship between return of motor function and regression of muscle signal hyperintensity

  • In humans, MRI has been shown to have considerable value in the diagnosis of entrapment neuropathies, and also shows promise for the evaluation of traumatic nerve injury and inflammatory nerve lesions

  • As well as revealing muscle hyperintensity on T2-weighted images, MRI might also reveal morphological changes, such as muscle-fiber loss and interposition of fat tissue

  • The limitations of MRI as a diagnostic tool are mainly attributable to the lack of specificity of signal changes. Novel contrast agents are being developed to overcome these limitations

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Figure 1: MRI after axonal nerve lesion in the rat.
Figure 2: MRI after traumatic nerve injury.
Figure 3: MRI of proximal sciatic nerve compression by varicosis.
Figure 4: Magnetic resonance neurography of a human sciatic nerve after injection trauma.
Figure 5: Differential diagnosis of foot drop in humans by MRI.
Figure 6: Visualization of nerve degeneration and macrophage inflammation by contrast-enhanced MRI in rats.

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Acknowledgements

We thank K Reiners and L Solymosi for helpful comments, and KV Toyka for support and critical reading of the manuscript. MB holds a professorship donated by Schering GmbH, Berlin, Germany, to the University of Wuerzburg, but has no financial interest. This work was in part supported by the IZKF, Wuerzburg (grant F-20).

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Authors and Affiliations

  1. Consultant in the Department of Neuroradiology and G Stoll is a Professor of Neurology in the Department of Neurology at the University of Würzburg, Germany

    Martin Bendszus & Guido Stoll

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  1. Martin Bendszus
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Correspondence to Martin Bendszus.

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Bendszus, M., Stoll, G. Technology Insight: visualizing peripheral nerve injury using MRI. Nat Rev Neurol 1, 45–53 (2005). https://doi.org/10.1038/ncpneuro0017

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