Abstract
The diagnostic work up of patients with peripheral neuropathy largely depends on clinical and electrophysiological investigations. In contrast to disorders of the CNS, magnetic resonance imaging (MRI) has not been widely used as a diagnostic tool in the PNS except for detection of nerve compressing mass lesions. Normal nerves appear isointense to the surrounding tissue on T1- and T2-weighted (w) MRIs, but upon injury the nerves become hyperintense and thus visible on T2-w MRI. These signal alterations can be exploited to diagnose nerve damage in vivo and to follow regeneration. In patients with peripheral nerve disorders, MRI has been especially useful in detecting focal intrinsic and extrinsic nerve lesions and may reveal treatable conditions even in the absence of gross electrophysiological alterations. This clinical review provides practical guidelines on the performance of nerve imaging by MRI and will focus on focal lesions exemplified by case presentations.
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Abbreviations
- DTI:
-
Diffusion tensor imaging
- MRI:
-
Magnetic resonance imaging
- MRN:
-
Magnetic resonance neurography
- T1-w:
-
T1-weighted
- T2-w:
-
T2-weighted
- TIRM:
-
Turbo inversion recovery magnitude
References
Aagaard BD, Lazar DA, Lankerovich L, Andrus K, Hayes CE, Maravills K, Kliot M (2003) High-resolution magnetic resonance imaging is a noninvasive method of observing injury and recovery in the peripheral nervous system. Neurosurg 53:199–203. doi:10.1227/01.NEU.0000069534.43067.28
Allen DC, Smallman CA, Mills KR (2006) Multifocal acquired demyelinating sensory and motor neuropathy presenting as a peripheral nerve tumor. Muscle Nerve 34:373–379. doi:10.1002/mus.20552
Andreisek G, Crrok DW, Burg D, Marincek B, Weishaupt D (2006) Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics 26:1267–1287. doi:10.1148/rg.265055712
Bashir WA, Connell DA (2008) Imaging of entrapment and compressive neuropathies. Semin Musculoskelet Radiol 12:170–182. doi:10.1055/s-2008-1078704
Bazot M, Darai E, Hournai R, Thomassin I, Cortez A, Uzan S, Buy JN (2004) Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 232:379–389. doi:10.1148/radiol.2322030762
Bendszus M, Rieckmann P, Perez J, Kolzenburg M, Reiners K, Solymosi L (2003) A novel painful vascular compression syndrome of the sciatic nerve caused by gluteal varicosis. Neurology 61:985–987
Bendszus M, Stoll G (2003) Caught in the act: in vivo mapping of macrophage infiltration in nerve injury by magnetic resonance imaging. J Neurosci 23:10892–10896
Bendszus M, Stoll G (2005) Technology insight: visualizing peripheral nerve iniury using MRI. Nat Clin Pract Neurol 1:45–53. doi:10.1038/ncpneuro0017
Bendszus M, Wessig C, Reiners K, Bartsch AJ, Solymosi L, Koltzenburg M (2003) MR imaging in the differential diagnosis of neurogenic foot drop. AJNR Am J Neuroradiol 24:1283–1289
Bendszus M, Wessig C, Schütz A, Horn T, Kleinschnitz C, Sommer C, Misselwitz B, Stoll G (2005) In vivo assessment of nerve degeneration and regeneration by Gadofluorine M enhanced magnetic resonance imaging. Ann Neurol 57:388–395. doi:10.1002/ana.20404
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. doi:10.1016/j.expneurol.2004.03.025
Bouldin TW, Earnhardt TS, Goines ND (1991) Restoration of blood-nerve barrier in neuropathy is associated with axonal regeneration and remyelination. J Neuropathol Exp Neurol 50:719–728. doi:10.1097/00005072-199111000-00004
Britz GW, Haynor DR, Kuntz C, Goodkin R, Gitter A, Maravilla K, Kliot M (1996) Ulnar nerve entrapment at the elbow: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurg 38:458–465. doi:10.1097/00006123-199603000-00007
Bydder M, Rahal A, Fullerton GD, Bydder GM (2007) The magic angle effect: a source of artefact, determinant of image contrast, and techniques for imaging. J Magn Reson Imaging 25:290–300. doi:10.1002/jmri.20850
Crino PB, Grossman RI, Rostami A (1993) Magnetic resonance imaging of the cauda equina in chronic inflammatory demyelinating polyneuropathy. Ann Neurol 33:311–313. doi:10.1002/ana.410330314
Cudlip SA, Howe FA, Clifton A, Schart MS, Bell BA (2002) Magnetic resonance neurography studies of the median nerve before and after carpal tunnel depression. J Neurosurg 96:1046–1051
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 96:755–775
Does MD, Snyder RE (1996) Multiexponential T2 relaxation in degenerating peripheral nerve. Magn Reson Med 35:207–213. doi:10.1002/mrm.1910350212
Duggins AJ, McLeod JG, Pollard JD, Davies L, Yang F, Thompson EO, Soper JR (1999) Spinal root and plexus hypertrophy in chronic inflammatory demyelinating polyneuropathy. Brain 122:1383–1390. doi:10.1093/brain/122.7.1383
Filler AG, Haynes J, Jordan SE, Prager J, Villablanca JP, Farahani K, McBride DQ, Tsuruda JS, Morisoli B, Batzdorf U, Johnson JP (2005) Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment. J Neurosurg Spine 2:99–115
Filler AG, Howe FA, Hayes CE, Kliot M, Winn HR, Bell BA, Griffiths JR, Tsuruda JS (1993) Magnetic resonance neurography. Lancet 341:659–661. doi:10.1016/0140-6736(93)90422-D
Garry R (2006) Diagnosis of endometriosis and pelvic pain. Fertil Steril 86:1307–1309. doi:10.1016/j.fertnstert.2006.06.045
Grant GA, Britz GW, Goodkin R, Jarvik JG, Maravilla K, Kliot M (2002) The utility of magnetic resonance imaging in evaluating peripheral nerve disorders. Muscle Nerve 25:314–331. doi:10.1002/mus.10013
Gupta G, Mammis A, Maniker A (2008) Malignant peripheral nerve sheath tumors. Neurosurg Clin N Am 19:533–543. doi:10.1016/j.nec.2008.07.004
Hari S, Subramanian S, Sharma R (2006) Magnetic resonance imaging of ulnar nerve abscess in leprosy: a case report. Lepr Rev 77:381–385
Howe FA, Filler AG, Bell BA, Griffiths JR (1992) Magnetic resonance neurography. Magn Reson Med 28:328–338. doi:10.1002/mrm.1910280215
Jarvik JG, Comstock BA, Heagerty PJ, Haynor DR, Fulton-Kehoe D, Kliot M, Franklin GM (2008) Magnetic resonance imaging compared with electrodiagnostic studies in patients with suspected carpal tunnel syndrome: predicting symptoms, function, and surgical benefit at 1 year. J Neurosurg 108:541–550. doi:10.3171/JNS/2008/108/3/0541
Jonas D, Conrad B, Von Einsiedel HG, Bischoff C (2000) Correlation between quantitative EMG and muscle MRI in patients with axonal neuropathy. Muscle Nerve 23:1265–1269. doi:10.1002/1097-4598(200008)23:8<1265::AID-MUS17>3.0.CO;2-F
Kabakci N, Gürses B, Firat Z, Bayram A, Uluğ AM, Kovanlikaya A, Kovanlikaya I (2007) Diffusion tensor imaging and tractography of median nerve: normative diffusion values. AJR Am J Roentgenol 189:923–927. doi:10.2214/AJR.07.2423
Kuwabara S, Nakajima M, Matsuda S, Hattori T (1997) Magnetic resonance imaging at the demyelinative foci in chronic inflammatory demyelinating polyneuropathy. Neurology 48:874–877
Lewis AM, Layzer R, Endstrom JW, Barbaro NM, Chin CT (2006) Magnetic resonance neurography in extraspinal sciatica. Arch Neurol 63:1469–1472. doi:10.1001/archneur.63.10.1469
Li CS, Huang GS, Wu HD, Chen WT, Shih LS, Lii JM, Duh SJ, Chen RC, Tu HY, Chan WP (2008) Differentiation of soft tissue benign and malignant peripheral nerve sheath tumors with magnetic resonance imaging. Clin Imaging 32:121–127. doi:10.1016/j.clinimag.2007.05.006
Meding J, Ulrich M, Licha K, Reinhardt M, Misselwitz B, Fayad ZA, Weinmann HJ (2007) Magnetic resonance imaging of atherosclerosis by targeting extracellular matrix deposition with Gadofluorine M. Contrast Media Mol Imaging 2:120–129. doi:10.1002/cmmi.137
Meek MF, Stenekes MW, Hoogduin HM, Nicolai JP (2006) In vivo three-dimensional reconstruction of human median nerves by diffusion tensor imaging. Exp Neurol 198:479–482. doi:10.1016/j.expneurol.2005.12.014
Nguyen D, Dyck PJ, Daube JR (2007) Intraneural perineurioma of the radial nerve visualized by 3.0 T MRI. Muscle Nerve 36:715–720. doi:10.1002/mus.20795
Pham M, Bendszus M (2009) MRI as an additional diagnostic tool in cubital tunnel syndrome. Handchir Mikrochir Plast Chir 41:18–22
Reddy S, Porter D, Patton JT, Al-Nafussi A, Beggs I (2007) Endometriosis of the superior gluteal nerve. Skeletal Radiol 36:879–883. doi:10.1007/s00256-007-0316-4
Seitz R, Reiners K, Himmelmann F, Heininger K, Hartung HP, Toyka KV (1989) The blood-nerve barrier in Wallerian degeneration: a sequential long-term study. Muscle Nerve 12:627–635. doi:10.1002/mus.880120803
Simmons Z, Mahadeen ZI, Kothari MJ, Powers S, Wise S, Towfighi J (1999) Localized hypertrophic neuropathy: magnetic imaging findings and long-term follow-up. Muscle Nerve 22:28–36. doi:10.1002/(SICI)1097-4598(199901)22:1<28::AID-MUS6>3.0.CO;2-H
Singh T, Kliot M (2007) Imaging of peripheral nerve tumors. Neurosurg Focus 22(E6):1–10. doi:10.3171/foc.2007.22.6.7
Stanisz GJ, Midha R, Munro CA, Henkelman RM (2001) MR properties of rat sciatic nerve following trauma. Magn Reson Med 45:415–420. doi:10.1002/1522-2594(200103)45:3<415::AID-MRM1054>3.0.CO;2-M
Stoll G, Bendszus M (2009) Imaging of inflammation in the peripheral and central nervous system by magnetic resonance imaging. Neuroscience 158:1151–1160. doi:10.10.16/j.neuroscience.2008.06.045
Stoll G, Jander S, Myers RR (2002) Degeneration and regeneration of the peripheral nervous system: from Augustus Waller’s observations to neuroinflammation. J Peripher Nerv Syst 7:13–27. doi:10.1046/j.1529-8027.2002.02002.x
Stoll G, Wesemeier C, Gold R, Solymosi L, Toyka KV, Bendszus M (2004) In vivo monitoring of macrophage infiltration in experimental autoimmune neuritis by magnetic resonance imaging. J Neuroimmunol 149:142–146. doi:10.1016/j.jneuroim.2003.12.024
Thompson PD, Thomas PK (2005) Clinical patterns of peripheral neuropathy. In: Dyck PJ, Thomas PK (eds) Peripheral neuropathy, 4th edn. Elsevier, Saunders, pp 1137–1161
Titelbaum DS, Frazier JL, Grossman RI, Joseph PM, Yu LT, Kassab EA, Hickey WF, La Rossa D, Brown MJ (1998) Wallerian degeneration and inflammation in rat peripheral nerve detected by in vivo MR imaging. AJNR Am J Neuroradiol 10:741–746
Van den Berg-Vos RM, Van den Berg LH, Franssen H, Van Doorn PA, Merkies IS, Wokke JH (2000) Multifocal inflammatory neuropathy. Neurology 54:26–32
Van Es HW, Van den Berg LH, Franssen H, Witkamp TD, Ramos LMP, Notermanns NC, Feldberg MAM, Wokke JHJ (1997) Magnetic resonance imaging in the brachial plexus in patients with multifocal neuropathy. Neurology 48:1218–1224
Vellinga MM, Oude Engberink RD, Seewann A, Pouwels PJ, Wattjes MP, van der Pol SM, Pering C, Polman CH, de Vries HE, Geurts JJ, Barkhof F (2008) Pluriformity of inflammation in multiple sclerosis shown by ultra-small iron oxide particle enhancement. Brain 131:800–807. doi:10.1093/brain/awn009
Vucic S, Cordato DJ, Yiannikas C, Schwartz RS, Shnier RC (2006) Utility of magnetic resonance imaging in diagnosing ulnar neuropathy at the elbow. Clin Neurophysiol 117:590–595. doi:10.1016/j.clinph.2005.09.022
Wessig C, Koltzenburg M, Reiners K, Solymosi L, Bendszus M (2004) Muscle magnetic resonance imaging of denervation and reinnervation: correlation with electrophysiology and histology. Exp Neurol 185:254–261. doi:10.1016/j.expneurol.2003.10.012
West GA, Haynor DR, Goodkin R, Tsuruda JS, Bronstein AD, Kraft G, Winter T, Kliot M (1994) Magnetic resonance imaging signal changes in denervated muscles after peripheral nerve injury. Neurosurgery 35:1077–1086. doi:10.1097/00006123-199412000-00010
Zhou L, Yousem DM, Chaudhry V (2004) Role of magnetic resonance neurography in brachial plexus lesions. Muscle Nerve 30:305–309. doi:10.1002/mus.20108
Acknowledgments
Presented in part at the “Teaching Course Peripheral Neuropathies, 18th meeting of the European Neurological Society, June 8th 2008, Nice, France and at the IV. Neuromuscular Meeting, November 13th 2008, Havanna, Cuba sponsored by the ENS. Work of the authors cited in this review has been supported by the Research Fund of the State of Bavaria through the IZKF/Würzburg and by a research professorship for neuroimaging to M.B. (2003–2007) by the Department of Neurology sponsored by Schering Pharma AG, Berlin. We thank Profs. K. V. Toyka and L. Solymosi (Würzburg) for valuable comments on the manuscript and continuous support.
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Stoll, G., Bendszus, M., Perez, J. et al. Magnetic resonance imaging of the peripheral nervous system. J Neurol 256, 1043–1051 (2009). https://doi.org/10.1007/s00415-009-5064-z
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DOI: https://doi.org/10.1007/s00415-009-5064-z