Conventional magnetic resonance imaging of peripheral nerves: MR-neurography

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Abstract

Peripheral neuropathy is known to be one of the most common neurological disorders. Despite the great diagnostic value of electroneuromyography and ultrasound, addressing the diagnostics and differential diagnostics of peripheral nerve diseases of different origin could be challenging. In recent years, magnetic resonance tomography has been increasingly used for evaluating cases of suspected or established peripheral neuropathy with excellent results.

This manuscript mainly deals with the advantages and limitations of the aforementioned diagnostic instruments, technical considerations according to different anatomy of peripheral nerves, along with state-of-the-art technical decisions, frequently used magnetic resonance imaging sequences and their diagnostic value based on own observation, and recommendations for contrast enhancement use and different methods of fat suppression.

Currently, there is practically no standardized description of normal magnetic resonance imaging features of peripheral nerves, as well as their changes in different diseases. The evaluation of images is mainly based on the radiologist experience, which obviously decreases method’s diagnostic value. Studies of large numbers involving healthy volunteers and patients with peripheral neuropathies of different origin are required to address this issue.

About the authors

Sofya N. Morozova

Research Center of Neurology

Author for correspondence.
Email: kulikovasn@gmail.com
ORCID iD: 0000-0002-9093-344X
SPIN-code: 2434-7827

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Viktoriya V. Sinkova

Research Center of Neurology

Email: 000564321@mail.ru
ORCID iD: 0000-0003-2285-2725
Russian Federation, Moscow

Darya A. Grishina

Research Center of Neurology

Email: dgrishina82@gmail.com
ORCID iD: 0000-0002-7924-3405
SPIN-code: 6577-1799

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Taisia A. Tumilovich

Research Center of Neurology

Email: tumilovich.taisiya@bk.ru
ORCID iD: 0000-0002-9538-9690
SPIN-code: 2264-9457
Russian Federation, Moscow

Andrey O. Chechetkin

Research Center of Neurology

Email: andreychechetkin@gmail.com
ORCID iD: 0000-0002-8726-8928
SPIN-code: 9394-6995

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

Marina V. Krotenkova

Research Center of Neurology

Email: krotenkova_mrt@mail.ru
ORCID iD: 0000-0003-3820-4554
SPIN-code: 9663-8828

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

Natalya A. Suponeva

Research Center of Neurology

Email: nasu2709@mail.ru
ORCID iD: 0000-0003-3956-6362
SPIN-code: 3223-6006

MD, Dr. Sci. (Med.), Professor, Corresponding member of the Russian Academy of Sciences

Russian Federation, Moscow

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2. Fig. 1. Magnetic resonance imaging of the brachial plexuses in 3D-T1 mode. A coronal projection: (1) the upper trunk, (2) the middle trunk, (3) the lower trunk, (4) the perineural fatty tissue, (5) the endoneurial fat, (6) a mass lesion (schwannoma), and (7) the intact fatty tissue around the lesion.

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3. Fig. 2. Magnetic resonance imaging of the hand in T2 mode in a patient with carpal tunnel syndrome. An axial projection: (a) at the level of proximal epiphyses of metacarpal bonesand (b) at the level of distal parts of the capitate bone (1: individual fascicles as part of the median nerve, 2: epineurium, and 3: flexor retinaculum with a thickness of up to 1.29 mm).

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4. Fig. 3. Various techniques of fat suppression for magnetic resonance imaging: (a) brachial plexuses in T2-FatSat mode, an axial projection: the anterior branches of C5, C6, and C7 spinal nerves are noted, without abnormalities, with a slightly increased signal; heterogeneous fat suppression with unsatisfactory signal along the periphery of the area of interest (arrowed); (b) brachial plexuses in STIR mode, a coronal projection: homogenous fat suppression throughout the entire field of view, typical elements of brachial plexuses with a slightly increased signal (arrowed); and (c) sciatic nerves in T2-Dixon mode, a coronal projection: homogenous fat suppression, normal sciatic nerves with a slightly increased MR signal (arrowed).

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