Seminars in musculoskeletal radiology
-
Semin Musculoskelet Radiol · Nov 2010
ReviewUltrasound and magnetic resonance imaging of the peripheral nerves: current techniques, promising directions, and open issues.
High-resolution ultrasound (US) and magnetic resonance (MR) imaging are the two imaging methods of choice for the study of peripheral nerves. The many advances that have been made in recent years, either by US or MR imaging, including diffusion tensor imaging and tractography, offer new perspectives for the assessment of many pathological processes affecting peripheral nerves such as entrapment syndromes, tumors and tumor-like lesions, and traumatic disorders. ⋯ US and MR imaging are complementary, each having advantages and disadvantages. Tractography is still emerging in the musculoskeletal field, particularly for the analysis of peripheral nerves, but this technique seems promising.
-
The diagnosis of a peripheral nerve tumor can often be suggested on imaging. Direct continuity with a neural structure or location along a typical nerve distribution, shape, and intrinsic magnetic resonance (MR) signal characteristics represent the most important signs in this regard. ⋯ This article reviews the MR imaging appearance, clinical and pathological features of schwannoma, localized neurofibroma, plexiform neurofibroma, intraneural perineurioma, fibrolipomatous hamartoma, nerve sheath ganglion, traumatic neuroma, malignant peripheral nerve sheath tumor, and secondary malignant neoplasms of peripheral nerves. Typical findings are illustrated on the basis of histologically confirmed cases.
-
Semin Musculoskelet Radiol · Nov 2010
ReviewTraumatic neuropathies: spectrum of imaging findings and postoperative assessment.
Traumatic injury to peripheral nerves is a significant cause of morbidity and disability. Until reinnervation occurs, electrodiagnostic studies cannot differentiate severe axonotmetic lesions (Sunderland class 4) from complete nerve transection or neurotmesis (Sunderland class 5). This limitation is relevant clinically because in cases of neurotmesis an improved outcome may be achieved with an early surgical repair (within 1 week after trauma). ⋯ The role of diagnostic imaging in stretching injuries, contusion trauma, penetrating wounds, and after surgery is discussed. A multimodality diagnostic approach including physical examination, electrophysiology, and US and MR imaging allows an accurate evaluation of most peripheral nerves. Imaging assessment of peripheral nerves trauma is useful for the diagnosis, follow-up, and postoperative evaluation.