The elbow: MR features of nerve disorders

Magnetic resonance neurography of peripheral nerve lesions in the lower extremity

OBJECTIVE

We describe the clinical application and utility of high-resolution magnetic resonance neurography (MRN) techniques to image the normal fascicular structure of peripheral nerves and its distortion by mass lesions or trauma in the lower extremity.

METHODS

MRN images were obtained using a standard 1.5 Tesla magnet and custom built phased-array coils. Patients were imaged using T1-weighted spin echo without and with gadolinium, T2-weighted fast spin echo with fat peripheral nerve tumors (three neurofibromas and one schwannoma), two with intraneural cysts, and three with traumatic peripheral nerve lesions. Six patients with peripheral nerve mass lesions underwent surgery, thereby allowing MRN images to be correlated with intraoperative and pathological findings.

RESULTS

Preoperative MRN accurately imaged the normal fascicular anatomy of peripheral nerves and precisely depicted its relation to tumor and cystic lesions. Increased signal on T2-weighted fast spin-echo and short tau inversion recovery fast spin-echo pulse sequences was seen in the peripheral nerve fascicles of patients with clinical and electrodiagnostic evidence of nerve injury.

CONCLUSION

MRN proved useful in the preoperative evaluation and planning of surgery in patients with peripheral nerve lesions.

Magnetic resonance imaging of the musculoskeletal system: Part 3. The elbow

Magnetic resonance imaging provides clinically useful information in assessing the elbow joint. Superior depiction of muscles, ligaments, and tendons as well as the ability to directly visualize nerves, bone marrow, and hyaline cartilage are advantages of magnetic resonance imaging relative to conventional imaging techniques. Ongoing improvements in surface coil design and newer pulse sequences have resulted in higher quality magnetic resonance images of the elbow. Traumatic and degenerative disorders of the elbow are well seen with MR imaging. The sequelae of medial traction and lateral compression from valgus stress include medial collateral ligament injury, common flexor tendon pathology, medial traction spurs, ulnar neuropathy, and osteochondritis dissecans. These conditions as well as lateral collateral ligament injury and lateral epicondylitis may be characterized with magnetic resonance imaging. Posttraumatic osseous abnormalities well seen by magnetic resonance imaging include radiographically occult fractures, stress fractures, bone contusions, and apophyseal avulsions. Magnetic resonance imaging also can be used to assess cartilaginous extension of fractures in children. Intraarticular loose bodies can be identified with magnetic resonance imaging, especially if fluid or contrast material is present within the elbow joint. Biceps and triceps tendon injuries can be diagnosed and characterized. Magnetic resonance imaging also can provide additional information regarding entrapment neuropathies about the elbow. Magnetic resonance imaging is perhaps most useful when patients have not responded to conservative therapy and therefore surgery and additional diagnoses are being considered.

Multiexponential T2 relaxation in degenerating peripheral nerve

The multiexponential T2 relaxation spectrum of peripheral nerve undergoing Wallerian degeneration has been measured both in vivo and in vitro. Degeneration of the sciatic nerve of the amphibian Xenopus laevis was induced by crush injury, and T2 relaxation spectra of the nerve were measured at several times up to 35 days following injury. Histologic evidence verified that the nerve underwent Wallerian degeneration. Relaxation spectra were observed to undergo measurable changes as degeneration progressed, the most evident being a reduction from three well-resolved T2 components to one and a decline in the fraction of the spectra associated with the shortest T2 component. The former appears to reflect the collapse and loss of myelinated fibers, while the latter a combination of interstitial edema and myelin loss.

MR assessment of posttraumatic flexion contracture of the elbow

Preoperative assessment of posttraumatic flexion contracture of the elbow includes plain radiographs and tomograms, which are difficult to obtain in the coronal plane due to the contracture. We conducted this study to determine the usefulness of MR imaging in the work-up of these patients. Twelve patients with flexion contracture of the elbow were studied. In addition to standard spin-echo sequences, a sagittally acquired spoiled gradient-recalled echo 3D data set of the flexed elbow was obtained and reformatted coronally using a curved plane of reconstruction. The MR findings were compared to the plain films, tomograms and surgical results. MRI allowed identification of loose bodies that were sometimes poorly visualized, or not seen, on plain films, and demonstrated degenerative changes equally as well as tomograms. MR showed soft tissue abnormalities including capsular and collateral ligament thickening. Curvilinear reconstructions were helpful in the assessment of collateral ligaments in patients with severe contractures. We conclude that MR is useful in the evaluation of elbow flexion contractures, particularly in assessing soft tissue causes.

T2 relaxation of peripheral nerve measured in vivo

It is demonstrated that multi-exponential transverse (T2) relaxation components can be estimated from multi-echo images of peripheral nerve. Three T2-relaxation components with T2 values +/- standard deviations (populations +/- standard deviations) of 19 +/- 7 ms (26 +/- 9%), 63 +/- 31 ms (29 +/- 11%) and 241 +/- 24 ms (45 +/- 7%) have been identified in vivo in the sciatic nerve of the amphibian Xenopus laevis. The longer-lived component, not identified previously in vivo, provides a significant contrast-to-noise ratio (CNR) between nerve and muscle in the latter-echo images. It is shown that the CNR can be further improved by the averaging of selected images from the multi-echo set.

Magnetic resonance imaging of the elbow

Technical improvements in MR imaging have resulted in the ability to detect soft tissue and bone pathology, with great facility in the elbow joint. This allows application of MRI to the elbow in the same valuable ways it has been used in other joints for a much longer period.