Magnetic resonance neurography for the evaluation of peripheral nerve, brachial plexus, and nerve root disorders

Clinical article

View More View Less
  • 1 Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachussetts; and the
  • 2 Departments of Neurological Surgery,
  • 3 Radiology, and
  • 4 Neurology, University of California San Francisco, California
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

Treatment of spinal and peripheral nerve lesions relies on localization of the pathology by the use of neurological examination, spinal MR imaging and electromyography (EMG)/nerve conduction studies (NCSs). Magnetic resonance neurography (MRN) is a novel imaging technique recently developed for direct imaging of spinal and peripheral nerves. In this study, the authors analyzed the role of MRN in the evaluation of spinal and peripheral nerve lesions.

Methods

Imaging studies, medical records, and EMG/NCS results were analyzed retrospectively in a consecutive series of 191 patients who underwent MRN for spinal and peripheral nerve disorders at the University of California, San Francisco between March 1999 and February 2005. Ninety-one (47.6%) of these patients also underwent EMG/NCS studies.

Results

In those who underwent both MRN and EMG/NCS, MRN provided the same or additional diagnostic information 32 and 45% of patients, respectively. Magnetic resonance neurograms were obtained at a median of 12 months after the onset of symptoms. The utility of MRN correlated with the interval between the onset of symptoms to MRN. Twelve patients underwent repeated MRN for serial evaluation. The decrease in abnormal signal detected on subsequent MRN correlated with time from onset of symptoms and the time interval between MRN, but not with resolution of symptoms. Twenty-one patients underwent MRN postoperatively to assess persistent, recurrent, or new symptoms; of these 3 (14.3%) required a subsequent surgery.

Conclusions

Magnetic resonance neurography is a valuable adjunct to conventional MR imaging and EMG/NCS in the evaluation and localization of nerve root, brachial plexus, and peripheral nerve lesions. The authors found that MRN is indicated in patients: 1) in whom EMG and traditional MR imaging are inconclusive; 2) who present with brachial plexopathy who have previously received radiation therapy to the brachial plexus region; 3) who present with brachial plexopathy and have systemic tumors; and 4) in patients under consideration for surgery for peripheral nerve lesions or after trauma. Magnetic resonance neurography is limited by the size of the nerve trunk imaged and the timing of the study.

Abbreviations used in this paper: DESS = double echo steady state; EMG = electromyography; MRN = MR neurography; NCS = nerve conduction studies; STIR = short tau inversion recovery.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Rose Du, M.D., Ph.D., Department of Neurological Surgery, Brigham and Women's Hospital, 75 Francis Street Boston, Massachussets 02115. email: rdu@partners.org.

Please include this information when citing this paper: published online August 7, 2009; DOI: 10.3171/2009.7.JNS09414.

  • 1

    Boden SD, , McCowin PR, , Davis DO, , Dina TS, , Mark AS, & Weisel S: Abnormal magnetic resonance scans of the cervical spine in asymptomatic subjects. J Bone Joint Surg Am 72:11781184, 1990

    • Search Google Scholar
    • Export Citation
  • 2

    Farber JM, & Buckwalter KA: MR imaging in nonneoplastic muscle disorders of the lower extremity. Radiol Clin North Am 40:10131031, 2002

    • Search Google Scholar
    • Export Citation
  • 3

    Filler AG, , Howe FA, , Hayes CE, , Kliot M, , Winn HR, & Bell BA, : Magnetic resonance neurography. Lancet 341:659661, 1993

  • 4

    Filler AG, , Kliot M, , Howe FA, , Hayes CE, , Saunders DE, & Goodkin R, : Application of magnetic resonance neurography in the evaluation of patients with peripheral nerve pathology. J Neurosurg 85:299309, 1996

    • Search Google Scholar
    • Export Citation
  • 5

    Fisher MA: Electrophysiology of radiculopathies. Clin Neurophysiol 113:317335, 2002

  • 6

    Gupta R, , Villablanca PJ, & Jones NF: Evaluation of an acute nerve compression injury with magnetic resonance neurography. J Hand Surg [Am] 26:10931099, 2001

    • Search Google Scholar
    • Export Citation
  • 7

    Kuntz C IV, , Blake L, , Britz G, , Filler A, , Hayes CE, & Goodkin R, : Magnetic resonance neurography of peripheral nerve lesions in the lower extremity. Neurosurgery 39:750757, 1996

    • Search Google Scholar
    • Export Citation
  • 8

    Modic MT, , Masaryk TJ, , Mulopulos GP, , Bundschuh C, , Han JS, & Bohlman H: Cervical radiculopathy: prospective evaluation with surface coil MR imaging, CT with metrizamide, and metrizamide myelography. Radiology 161:753759, 1986

    • Search Google Scholar
    • Export Citation
  • 9

    O'Connell MJ, , Powell T, , Brennan D, , Lynch T, , McCarthy CJ, & Eustace SJ: Whole-body MR imaging in the diagnosis of polymyositis. AJR Am J Roentgenol 179:967971, 2002

    • Search Google Scholar
    • Export Citation
  • 10

    Park JH, & Olsen NJ: Utility of magnetic resonance imaging in the evaluation of patients with inflammatory myopathies. Curr Rheumatol Rep 3:334345, 2001

    • Search Google Scholar
    • Export Citation
  • 11

    Pullman SL, , Goodin DS, , Marquinez AI, , Tabbal S, & Rubin M: Clinical utility of surface EMG: report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology 55:171177, 2000

    • Search Google Scholar
    • Export Citation
  • 12

    Subramony SH, & Carpenter DE, Electromyography. Youmans JR: Neurological Surgery Philadelphia, WB Saunders, 1996. 223246

  • 13

    Wiesel SW, , Tsourmas N, , Feffer H, , Citrin CM, & Patronas N: A study of computer-assisted tomography. I. The incidence of CAT scans in an asymptomatic group of patients. Spine 9:549551, 1984

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 953 431 39
Full Text Views 392 57 2
PDF Downloads 203 38 3
EPUB Downloads 0 0 0