Seminars in musculoskeletal radiology
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Semin Musculoskelet Radiol · Apr 2015
ReviewCurrent MR neurography techniques and whole-body MR neurography.
MR neurography (MRN) techniques continue to evolve, leading to a better demonstration of peripheral nerve anatomy and pathology. This article discusses various technical perspectives and provides recommendations to obtain the best possible high-resolution imaging of the peripheral nerves in various areas of the body. We also discuss technical perspectives of whole-body MRN and its potential utility.
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MR neurography (MRN) has evolved to become a clinically useful imaging modality for evaluating nerve pathologies. Anatomically, nerves are often surrounded by fat and blood vessels, which appear bright on MR images impeding the conspicuity of nerve visualization. ⋯ These advancements enabled optimized imaging protocols for better visualization of the nerves. This review article discusses some of these technical advancements that enabled current MRN protocols in routine clinical imaging and certain research techniques that may facilitate nerve disorder characterization following interventions.
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Molecular and cellular imaging of neuropathic pain, utilizing the myriad of receptors and inflammatory mediators involved in nociceptive activity, is a promising approach toward objectively identifying peripheral pain generators. Neuropathic conditions arise from injured and inflamed nerves, which have been shown to elaborate several molecular and cellular elements that give rise to the neuropathic phenotype and can be exploited for imaging purposes. ⋯ By combining the sensitivity and specificity of molecular imaging with the high anatomical, spatial and contrast resolution afforded by computed tomography and MRI, radiologists can potentially identify sites of nerve injury or neuroinflammation that are implicated as peripheral pain drivers with greater accuracy and confidence. In addition to guiding therapy, these approaches will aid in new drug designs for analgesia and more individualized treatment options.
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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.