Seminars in musculoskeletal radiology
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Pathologic conditions of the brachial plexus often result in serious and disabling complications. With the increasing availability and use of new and powerful MRI sequences and coils, understanding and assessment of the complex anatomy and pathology of the brachial plexus have been greatly facilitated. ⋯ The main characteristics of pathologic conditions affecting the brachial plexus are discussed and illustrated, as well as their differential diagnoses, with an emphasis on key imaging findings and relevance for patient management. Pitfalls related to suboptimal technique and image interpretation are also addressed.
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Diffusion tensor imaging (DTI) is a powerful MR imaging technique that can be used to probe the microstructural environment of highly anisotropic tissues such as peripheral nerves. DTI has been used predominantly in the central nervous system, and its application in the peripheral nervous system does pose some challenges related to imaging artifacts, the small caliber of peripheral nerves, and low water proton density. However advances in MRI hardware and software have made it possible to use the technique in the peripheral nervous system and to obtain functional data relating to the effect of pathologic processes on peripheral nerves. This article reviews the imaging principles behind DTI and examines the literature regarding its application in assessing peripheral nerves.
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Semin Musculoskelet Radiol · Apr 2015
ReviewHereditary and acquired polyneuropathy conditions of the peripheral nerves: clinical considerations and MR neurography imaging.
Polyneuropathies can be classified as either primarily demyelinating or axonal, and further as hereditary or acquired. It is important to recognize acquired neuropathies because some are amenable to treatment. ⋯ Magnetic resonance neurography (MRN) is a helpful supplementary diagnostic tool. This article discusses the typical clinical findings, electrophysiology findings, and MRN appearances of common hereditary or acquired neuropathies such as chronic inflammatory demyelinating neuropathy, multifocal motor neuropathy, diabetic neuropathy, chemotherapy-induced neuropathy, and postsurgical neuropathy.
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Peripheral nerve pathology can be detected on high-resolution MRI on the basis of primary or secondary findings. Primary findings of nerve pathology include alterations in signal, course, and caliber; secondary findings include skeletal muscle denervation. ⋯ This article discusses the benefits of 3D MRI with respect to lower limb neuropathies. The article also reviews the normal anatomy of the nerves in the lower extremity from the hip joint to the foot, and it illustrates common causes and the imaging appearance of lower limb peripheral neuropathy.
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MR imaging of peripheral nerves, typically referred to as MR neurography, is a rapidly evolving technique that currently is drawing huge attention, both in research and in clinical settings. Both training and experience are necessary to detect the sometimes subtle findings and to avoid misinterpretation of abnormalities. This review article is intended to help radiologists with image evaluation and interpretation. Typical pitfalls are discussed as well as strategies to avoid them.