• J Neuroradiology · Jul 2011

    Review

    Look for the nerves! MR neurography adds essential diagnostic value to routine MRI in pediatric practice: a pictorial overview.

    • Laura Merlini, Maria I Vargas, Mehrak Anooshiravani, Magalie Viallon, Joel Fluss, and Sylviane Hanquinet.
    • Unit of Pediatric Radiology, Geneva University Hospital HUG, 6, Willy-Donzé, 1205 Geneva, Switzerland. Laura.Merlini@hcuge.ch
    • J Neuroradiology. 2011 Jul 1;38(3):141-7.

    PurposeThis study aimed to assess the feasibility of magnetic resonance (MR) neurography in children, and the potential roles of diffusion-weighted imaging (DWI) and fiber-tracking (FT) techniques.MethodsFive pediatric patients (age range: 6-12 years) underwent magnetic resonance imaging (MRI) for various clinical indications: neurogenic bladder (case 1); persistent hand pain following minor trauma (case 2); progressive atrophy of the lower left extremity muscles (case 3); bilateral hip pain (case 4); and palpable left supraclavicular mass (case 5). All studies were performed using a 1.5-T Avanto MRI scanner (Siemens, Erlangen, Germany). The protocol included 3D T2-weighted STIR and SPACE imaging, T1-weighted fat-saturation post-gadolinium imaging and diffusion tensor imaging (DTI) with tractography. ADC (N×10(-3) mm(2)/s) and FA values were calculated from regions of interest (ROIs) centered on the nerves. Nerve-fiber tracks were calculated using a fourth-order Runge-Kutta algorithm (NeuroD software).ResultsMR neurography allowed satisfactory visualization of all neural structures, and FA and ADC measurements were feasible. The final diagnoses were Tarlov cysts, median-nerve compression, sciatic perineurioma, Charcot-Marie-Tooth disease and plexiform neurofibroma in a patient with NF-1.DiscussionFA and ADC measurements are of little value because of the lack of normal reference values. Nerve-fiber tractography (FT) may be of value in the characterization of tumor pathology, and is also helpful in the planning of surgical treatments.ConclusionMR neurography is feasible in pediatric patients. However, a considerable amount of work has yet to be done to establish its role in the clinical management of the wide range of peripheral nerve diseases.Copyright © 2010 Elsevier Masson SAS. All rights reserved.

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