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Awais K, Snoj Ž, Cvetko E, Serša I. Diffusion Tensor Imaging of a Median Nerve by Magnetic Resonance: A Pilot Study. Life (Basel) 2022; 12:life12050748. [PMID: 35629414 PMCID: PMC9143877 DOI: 10.3390/life12050748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 12/03/2022] Open
Abstract
The magnetic resonance Diffusion Tensor Imaging (DTI) is a powerful extension of Diffusion Weighted Imaging (DWI) utilizing multiple bipolar gradients, allowing for the evaluation of the microstructural environment of the highly anisotropic tissues. DTI was predominantly used for the assessment of the central nervous system (CNS), but with the advancement in magnetic resonance (MR) hardware and software, it has now become possible to image the peripheral nerves which were difficult to evaluate previously because of their small caliber. This study focuses on the assessment of the human median peripheral nerve ex vivo by DTI microscopy at 9.4 T magnetic field which allowed the evaluation of diffusion eigenvalues, the mean diffusivity and the fractional anisotropy at 35 μm in-plane resolution. The resolution was sufficient for clear depiction of all nerve anatomical structures and therefore further image analysis allowed the obtaining of average values for DT parameters in nerve fascicles (intrafascicular region and perineurium) as well as in the surrounding epineurium. The results confirmed the highest fractional anisotropy of 0.33 and principal diffusion eigenvalue of 1.0 × 10−9 m2/s in the intrafascicular region, somewhat lower values of 0.27 and 0.95 × 10−9 m2/s in the perineurium region and close to isotropic with very slow diffusion (0.15 and 0.05 × 10−9 m2/s) in the epineurium region.
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Affiliation(s)
- Kanza Awais
- Jožef Stefan International Postgraduate School, 1000 Ljubljana, Slovenia;
| | - Žiga Snoj
- Department of Radiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Erika Cvetko
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Igor Serša
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Jožef Stefan Institute, 1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +386-1-477-3696
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2
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Bajaj G, Callan AK, Weinschenk RC, Chhabra A. Multiparametric Evaluation of Soft Tissue Sarcoma: Current Perspectives and Future Directions. Semin Roentgenol 2022; 57:212-231. [DOI: 10.1053/j.ro.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/11/2022]
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3
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Wang Q, Xiao X, Liang Y, Wen H, Wen X, Gu M, Ren C, Li K, Yu L, Lu L. Diagnostic Performance of Diffusion MRI for differentiating Benign and Malignant Nonfatty Musculoskeletal Soft Tissue Tumors: A Systematic Review and Meta-analysis. J Cancer 2022; 12:7399-7412. [PMID: 35003360 PMCID: PMC8734420 DOI: 10.7150/jca.62131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/02/2021] [Indexed: 01/15/2023] Open
Abstract
Objective: To evaluate the diagnostic performance of standard diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI), for differentiating benign and malignant soft tissue tumors (STTs). Materials and methods: A thorough search was carried out to identify suitable studies published up to September 2020. The quality of the studies involved was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The pooled sensitivity (SEN), specificity (SPE), and summary receiver operating characteristic (SROC) curve were calculated using bivariate mixed effects models. A subgroup analysis was also performed to explore the heterogeneity. Results: Eighteen studies investigating 1319 patients with musculoskeletal STTs (malignant, n=623; benign, n=696) were enrolled. Thirteen standard DWI studies using the apparent diffusion coefficient (ADC) showed that the pooled SEN and SPE of ADC were 0.80 (95% CI: 0.77-0.82) and 0.63 (95% CI: 0.60-0.67), respectively. The area under the curve (AUC) calculated from the SROC curve was 0.806. The subgroup analysis indicated that the percentage of myxoid malignant tumors, magnet strength, study design, and ROI placement were significant factors affecting heterogeneity. Four IVIM studies showed that the AUCs calculated from the SROC curves of the parameters ADC and D were 0.859 and 0.874, respectively. The AUCs for the IVIM parameters pseudo diffusion coefficient (D*) and perfusion fraction (f) calculated from the SROC curve were 0.736 and 0.573, respectively. Two DKI studies showed that the AUCs of the DKI parameter mean kurtosis (MK) were 0.97 and 0.89, respectively. Conclusion: The DWI-derived ADC value and the IVIM DWI-derived D value might be accurate tools for discriminating musculoskeletal STTs, especially for non-myxoid SSTs, using more than two b values, with maximal b value ranging from 600 to 800 s/mm2, additionally, a high-field strength (3.0 T) optimizes the diagnostic performance.
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Affiliation(s)
- Qian Wang
- Department of Medical Imaging, Zhengzhou Central Hospital Affiliated to Zhengzhou University, 195 Tongbai Road, 455007, Zhengzhou, China
| | - Xinguang Xiao
- Department of Medical Imaging, Zhengzhou Central Hospital Affiliated to Zhengzhou University, 195 Tongbai Road, 455007, Zhengzhou, China
| | - Yanchang Liang
- Guangzhou University of Chinese Medicine, 510006, Guangzhou, China
| | - Hao Wen
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, China
| | - Xiaopeng Wen
- Department of neurological rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, 450000, Zhengzhou, China
| | - Meilan Gu
- Department of Medical Imaging, Zhengzhou Central Hospital Affiliated to Zhengzhou University, 195 Tongbai Road, 455007, Zhengzhou, China
| | - Cuiping Ren
- Department of Medical Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kunbin Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, China
| | - Liangwen Yu
- Guangzhou University of Chinese Medicine, 510006, Guangzhou, China
| | - Liming Lu
- Clinical Research and Data Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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Rodriguez JD, Selleck AM, Abdel Razek AAK, Huang BY. Update on MR Imaging of Soft Tissue Tumors of Head and Neck. Magn Reson Imaging Clin N Am 2021; 30:151-198. [PMID: 34802577 DOI: 10.1016/j.mric.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reviews soft tissue tumors of the head and neck following the 2020 revision of WHO Classification of Soft Tissue and Bone Tumours. Common soft tissue tumors in the head and neck and tumors are discussed, along with newly added entities to the classification system. Salient clinical and imaging features that may allow for improved diagnostic accuracy or to narrow the imaging differential diagnosis are covered. Advanced imaging techniques are discussed, with a focus on diffusion-weighted and dynamic contrast imaging and their potential to help characterize soft tissue tumors and aid in distinguishing malignant from benign tumors.
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Affiliation(s)
- Justin D Rodriguez
- Department of Radiology, Duke University, 2301 Erwin Rd, Durham, NC 27705, USA
| | - A Morgan Selleck
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina Hospitals, 170 Manning Drive, CB 7070, Physicians Office Building, Rm G190A, Chapel Hill, NC 27599, USA
| | | | - Benjamin Y Huang
- Department of Radiology, UNC School of Medicine, 101 Manning Drive, CB#7510, Chapel Hill, NC 27599, USA.
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Martin E, Dullaart MJ, Verhoef C, Coert JH. A systematic review of functional outcomes after nerve reconstruction in extremity soft tissue sarcomas: A need for general implementation in the armamentarium. J Plast Reconstr Aesthet Surg 2020; 73:621-632. [PMID: 32088187 DOI: 10.1016/j.bjps.2019.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/16/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
Resection of nerves in extremity soft tissue sarcomas (STS) can lead to large functional deficits. Nerve reconstructions are rarely performed and little is known on their outcomes and indications for their use, even though they are essential in restoring sensation in limb salvage procedures. This study investigated current knowledge on functional outcomes and considerations to be taken before performing such reconstructions after sarcoma resection. A systematic search was performed in July 2018 in PubMed and Embase databases according to PRISMA guidelines. Search terms related to "soft tissue sarcoma" and "nerve reconstruction" were used. Studies evaluating functional outcomes after nerve grafting or nerve transfers in extremity STS were included. Qualitative synthesis was performed on all studies. Nineteen studies were included after full-text screening, describing 26 patients. The majority of patients had a nerve reconstruction in the upper extremity (65%). Perioperative radiotherapy was administered in 67% and perioperative chemotherapy in 29% of patients. Nerve grafting was most commonly performed (n = 23) and nerve transfers were performed in six patients. A wide variety of outcome measures were used. Most patients recovered at least some motor function and sensation, but success rates were higher after upper than lower extremity defects. Multimodal treatment did not preclude successful reconstructions. Nerve reconstructions in extremity STS allow the restoration of sensation in limb salvation, even motor nerve function can be restored with satisfactory function. The use of multimodal therapy does not seem to interfere with success. Nerve reconstructions should therefore be considered in STS patients.
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Affiliation(s)
- Enrico Martin
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, the Netherlands.
| | - Max J Dullaart
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, Molewaterplein 40, Rotterdam, the Netherlands
| | - J Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, the Netherlands.
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Gasparotti R, Shah L. Brachial and Lumbosacral Plexus and Peripheral Nerves. IDKD SPRINGER SERIES 2020. [DOI: 10.1007/978-3-030-38490-6_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Bruno F, Arrigoni F, Mariani S, Patriarca L, Palumbo P, Natella R, Ma L, Guglielmi G, Galzio RJ, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Application of diffusion tensor imaging (DTI) and MR-tractography in the evaluation of peripheral nerve tumours: state of the art and review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:68-76. [PMID: 31085975 PMCID: PMC6625568 DOI: 10.23750/abm.v90i5-s.8326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Indexed: 12/18/2022]
Abstract
Peripheral nerves can be affected by a variety of benign and malignant tumour and tumour-like lesions. Besides clinical evaluation and electrophysiologic studies, MRI is the imaging modality of choice for the assessment of these soft tissue tumours. Conventional MR sequences, however, can fail to assess the histologic features of the lesions. Moreover, the precise topographical relationship between the peripheral nerve and the tumor must be delineated preoperatively for complete tumour resection minimizing nerve damage. Using Diffusion tensor imaging (DTI) and tractography, it is possible to obtain functional information on tumour and nerve structures, allowing the assess anatomy, function and biological features. In this article, we review the technical aspects and clinical application of DTI for the evaluation of peripheral nerve tumours. (www.actabiomedica.it)
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Affiliation(s)
- Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
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Bruno F, Arrigoni F, Mariani S, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Advanced magnetic resonance imaging (MRI) of soft tissue tumors: techniques and applications. Radiol Med 2019; 124:243-252. [PMID: 30949892 DOI: 10.1007/s11547-019-01035-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 03/29/2019] [Indexed: 12/20/2022]
Abstract
Imaging evaluation of soft tissue tumors is important for the diagnosis, staging, and follow-up. Magnetic resonance imaging (MRI) is the preferred imaging modality due to its multiplanarity and optimal tissue contrast resolution. However, standard morphological sequences are often not sufficient to characterize the exact nature of the lesion, addressing the patient to an invasive bioptic examination for the definitive diagnosis. The recent technological advances with the development of functional MRI modalities such as diffusion-weighted imaging, dynamic contrast-enhanced perfusion imaging, magnetic resonance spectroscopy, and diffusion tensor imaging with tractography have implemented the multiparametricity of MR to evaluate in a noninvasive manner the biochemical, structural, and metabolic features of tumor tissues. The purpose of this article is to review the state of the art of these advanced MRI techniques, with focus on their technique and clinical application.
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Affiliation(s)
- Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, S. Salvatore Hospital, University of L'Aquila, Vetoio Street, 1, 67100, L'Aquila, Italy
| | - Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Sciences, S. Salvatore Hospital, University of L'Aquila, Vetoio Street, 1, 67100, L'Aquila, Italy
| | - Silvia Mariani
- Department of Biotechnology and Applied Clinical Sciences, S. Salvatore Hospital, University of L'Aquila, Vetoio Street, 1, 67100, L'Aquila, Italy
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Sciences, S. Salvatore Hospital, University of L'Aquila, Vetoio Street, 1, 67100, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnology and Applied Clinical Sciences, S. Salvatore Hospital, University of L'Aquila, Vetoio Street, 1, 67100, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Sciences, S. Salvatore Hospital, University of L'Aquila, Vetoio Street, 1, 67100, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, S. Salvatore Hospital, University of L'Aquila, Vetoio Street, 1, 67100, L'Aquila, Italy.
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9
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MR Imaging of Pediatric Musculoskeletal Tumors:: Recent Advances and Clinical Applications. Magn Reson Imaging Clin N Am 2019; 27:341-371. [PMID: 30910102 DOI: 10.1016/j.mric.2019.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pediatric musculoskeletal tumors comprise approximately 10% of childhood neoplasms, and MR imaging has been used as the imaging evaluation standard for these tumors. The role of MR imaging in these cases includes identification of tumor origin, tissue characterization, and definition of tumor extent and relationship to adjacent structures as well as therapeutic response in posttreatment surveillance. Technical advances have enabled quantitative evaluation of biochemical changes in tumors. This article reviews recent updates to MR imaging of pediatric musculoskeletal tumors, focusing on advanced MR imaging techniques and providing information on the relevant physics of these techniques, clinical applications, and pitfalls.
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10
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Magnetic Resonance Imaging of the Peripheral Nerve. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Magnetic Resonance Imaging of the Peripheral Nerve. Clin Neuroradiol 2018. [DOI: 10.1007/978-3-319-61423-6_76-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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Kronlage M, Schwehr V, Schwarz D, Godel T, Uhlmann L, Heiland S, Bendszus M, Bäumer P. Peripheral nerve diffusion tensor imaging (DTI): normal values and demographic determinants in a cohort of 60 healthy individuals. Eur Radiol 2017; 28:1801-1808. [PMID: 29230526 DOI: 10.1007/s00330-017-5134-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/14/2017] [Accepted: 10/12/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify demographic determinants of peripheral nerve diffusion tensor imaging (DTI) and to establish normal values for fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD). METHODS Sixty subjects were examined at 3 Tesla by single-shot DTI. FA, AD, RD, and MD were collected for the sciatic, tibial, median, ulnar, and radial nerve and were correlated with demographic variables. RESULTS Mean FA of all nerves declined with increasing age (r = -0.77), which could be explained by RD increasing (r = 0.56) and AD declining (r = -0.40) with age. Moreover, FA was inversely associated with height (r = -0.28), weight (r = -0.38) and BMI (r = -0.35). Although FA tended to be lower in men than women (p = 0.052), this difference became completely negligible after adjustment to body weight. A multiple linear regression model for FA was calculated with age and weight as predictors (defined by backward variable selection), yielding an R 2 = 0.71 and providing a correction formula to adjust FA for age and weight. CONCLUSION Peripheral nerve DTI parameters depend on demographic variables. The most important determinants age and weight should be considered in all studies employing peripheral nerve DTI. KEY POINTS • Peripheral nerve diffusion tensor imaging (DTI) parameters depend on demographic variables. • Fractional anisotropy (FA) declines with increasing age and weight. • Gender does not systematically affect peripheral nerve DTI. • The formula presented here allows adjustment of FA for demographic variables.
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Affiliation(s)
- Moritz Kronlage
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Véronique Schwehr
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Tim Godel
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute for medical biometry and informatics, Heidelberg University, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Philipp Bäumer
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
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14
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Jeon T, Fung MM, Koch KM, Tan ET, Sneag DB. Peripheral nerve diffusion tensor imaging: Overview, pitfalls, and future directions. J Magn Reson Imaging 2017; 47:1171-1189. [DOI: 10.1002/jmri.25876] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/09/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Tina Jeon
- Department of Radiology and Imaging; Hospital for Special Surgery; New York New York USA
| | - Maggie M. Fung
- MR Apps & Workflow; GE Healthcare; New York New York USA
| | - Kevin M. Koch
- Department of Radiology; Medical College of Wisconsin; Milwaukee Wisconsin USA
| | - Ek T. Tan
- GE Global Research Center; Niskayuna New York USA
| | - Darryl B. Sneag
- Department of Radiology and Imaging; Hospital for Special Surgery; New York New York USA
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Kastler A, Attye A, Heck O, Tahon F, Boubagra K, Tropes I, Grand S, Krainik A. Greater occipital nerve MR tractography: Feasibility and anatomical considerations. J Neuroradiol 2017; 45:54-58. [PMID: 28964923 DOI: 10.1016/j.neurad.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/23/2017] [Accepted: 09/16/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE To assess the feasibility of greater occipital nerve (GON) tractography using a fully automated tractography technique on the whole-neck volume, in comparison with anatomical knowledge. METHODS Healthy subjects were consecutively included in this study if they had no history or symptoms of headache or brain disorder. A 3T MRI scanner with a 32 channel head coil was used. The following parameters for Diffusion Weighed (DWI) were used: b value of 1000 s/mm2, 32 directions, acquired voxel size: 2 mm isotropic. High-Order tractography with the Constrained Spherical Deconvolution (CSD) model was generated. Track-Weighted Imaging (TWI) maps were generated with MRTrix. Two radiologists performed blind evaluations of the GON pathways on TWI maps. RESULTS A total of 20 healthy subjects were included (12 males and eight females, mean age 53.8 years old). In comparison with anatomical atlas, GON complete visualization (from C1-C2 origin to muscular emergence) was possible in 18 out of 20 healthy subjects. In two cases, GON was not visible in the cervical spine foramen. CONCLUSION Tractography through TWI is a feasible technique to accurately depict GON. This technique may appear as a promising technique for therapeutic management of patients with occipital neuralgia.
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Affiliation(s)
- Adrian Kastler
- Neuroradiology and MRI Unit, CS 10217, Grenoble Alpes University, 38043 Grenoble cedex 9, France; Grenoble Alpes University, IRMaGe, 38000 Grenoble, France.
| | - Arnaud Attye
- Neuroradiology and MRI Unit, CS 10217, Grenoble Alpes University, 38043 Grenoble cedex 9, France; Grenoble Alpes University, IRMaGe, 38000 Grenoble, France
| | - Olivier Heck
- Neuroradiology and MRI Unit, CS 10217, Grenoble Alpes University, 38043 Grenoble cedex 9, France; Grenoble Alpes University, IRMaGe, 38000 Grenoble, France
| | - Florence Tahon
- Neuroradiology and MRI Unit, CS 10217, Grenoble Alpes University, 38043 Grenoble cedex 9, France
| | - Kamel Boubagra
- Neuroradiology and MRI Unit, CS 10217, Grenoble Alpes University, 38043 Grenoble cedex 9, France
| | - Irène Tropes
- Grenoble Alpes University, IRMaGe, 38000 Grenoble, France
| | - Sylvie Grand
- Neuroradiology and MRI Unit, CS 10217, Grenoble Alpes University, 38043 Grenoble cedex 9, France; Grenoble Alpes University, IRMaGe, 38000 Grenoble, France
| | - Alexandre Krainik
- Neuroradiology and MRI Unit, CS 10217, Grenoble Alpes University, 38043 Grenoble cedex 9, France; Grenoble Alpes University, IRMaGe, 38000 Grenoble, France
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Chhabra A, Madhuranthakam AJ, Andreisek G. Magnetic resonance neurography: current perspectives and literature review. Eur Radiol 2017; 28:698-707. [PMID: 28710579 DOI: 10.1007/s00330-017-4976-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/14/2017] [Accepted: 06/29/2017] [Indexed: 12/19/2022]
Abstract
Magnetic resonance neurography (also called MRN or MR neurography) refers to MR imaging dedicated to the peripheral nerves. It is a technique that enhances selective multiplanar visualisation of the peripheral nerve and pathology by encompassing a combination of two-dimensional, three-dimensional and diffusion imaging pulse sequences. Referring physicians who seek imaging techniques that can depict and diagnose peripheral nerve pathologies superior to conventional MR imaging are driving the demand for MRN. This article reviews the pathophysiology of peripheral nerves in common practice scenarios, technical considerations of MRN, current indications of MRN, normal and abnormal neuromuscular appearances, and imaging pitfalls. Finally, the emerging utility of diffusion-weighted and diffusion tensor imaging is discussed and future directions are highlighted. KEY POINTS • Lesion relationship to neural architecture is more conspicuous on MRN than MRI. • 3D multiplanar imaging technique is essential for pre-surgical planning. • Nerve injuries can be classified on MRN using Sunderland's classification. • DTI provides quantitative information and insight into intraneural integrity and pathophysiology.
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Affiliation(s)
- Avneesh Chhabra
- Radiology and Orthopedic Surgery and Musculoskeletal Radiology, UT Southwestern Medical Center, Dallas, TX, USA.
- Adjunct Faculty, Johns Hopkins University, Baltimore, MD, USA.
| | - Ananth J Madhuranthakam
- Department of Radiology and Advanced Imaging Research Institute, UT Southwestern Medical Center, Dallas, TX, USA
| | - Gustav Andreisek
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
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18
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[Imaging of the lumbosacral plexus : Diagnostics and treatment planning with high-resolution procedures]. Radiologe 2017; 57:195-203. [PMID: 28213852 DOI: 10.1007/s00117-017-0222-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Technical advances in magnetic resonance (MR) and ultrasound-based neurography nowadays facilitate the radiological assessment of the lumbosacral plexus. OBJECTIVE Anatomy and imaging of the lumbosacral plexus and diagnostics of the most common pathologies. MATERIAL AND METHODS Description of the clinically feasible combination of magnetic resonance imaging (MRI) and ultrasound diagnostics, case-based illustration of imaging techniques and individual advantages of MRI and ultrasound-based diagnostics for various pathologies of the lumbosacral plexus and its peripheral nerves. RESULTS High-resolution ultrasound-based neurography (HRUS) is particularly valuable for the assessment of superficial structures of the lumbosacral plexus. Depending on the examiner's experience, anatomical variations of the sciatic nerve (e. g. relevant in piriformis syndrome) as well as more subtle variations, for example as seen in neuritis, can be sonographically depicted and assessed. The use of MRI enables the diagnostic evaluation of more deeply located nerve structures, such as the pudendal and the femoral nerves. Modern MRI techniques, such as peripheral nerve tractography allow three-dimensional depiction of the spatial relationship between nerves and local tumors or traumatic alterations. This can be beneficial for further therapy planning. CONCLUSION The anatomy and pathology of the lumbosacral plexus can be reliably imaged by the meaningful combination of MRI and ultrasound-based high resolution neurography.
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Attyé A, Troprès I, Rouchy RC, Righini C, Espinoza S, Kastler A, Krainik A. Diffusion MRI: literature review in salivary gland tumors. Oral Dis 2016; 23:572-575. [DOI: 10.1111/odi.12543] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 11/30/2022]
Affiliation(s)
- A Attyé
- Department of Neuroradiology and MRI; Grenoble Alpes University Hospital - SFR RMN Neurosciences; Grenoble France
- University Grenoble Alpes; IRMaGe; Grenoble France
| | - I Troprès
- Inserm US 17; CNRS; IRMaGe; Grenoble France
| | - R-C Rouchy
- Department of Neuroradiology and MRI; Grenoble Alpes University Hospital - SFR RMN Neurosciences; Grenoble France
| | - C Righini
- Department of Otology; Grenoble Alpes University Hospital; Grenoble France
| | - S Espinoza
- Georges Pompidou European Hospital; Paris France
| | - A Kastler
- Department of Neuroradiology and MRI; Grenoble Alpes University Hospital - SFR RMN Neurosciences; Grenoble France
- University Grenoble Alpes; IRMaGe; Grenoble France
| | - A Krainik
- Department of Neuroradiology and MRI; Grenoble Alpes University Hospital - SFR RMN Neurosciences; Grenoble France
- University Grenoble Alpes; IRMaGe; Grenoble France
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Natori Y, Yoshizawa H, Mizuno H, Hayashi A. Preoperative transcutaneous electrical nerve stimulation for localizing superficial nerve paths. J Plast Reconstr Aesthet Surg 2015; 68:1713-8. [PMID: 26420473 DOI: 10.1016/j.bjps.2015.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 05/26/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
Abstract
During surgery, peripheral nerves are often seen to follow unpredictable paths because of previous surgeries and/or compression caused by a tumor. Iatrogenic nerve injury is a serious complication that must be avoided, and preoperative evaluation of nerve paths is important for preventing it. In this study, transcutaneous electrical nerve stimulation (TENS) was used for an in-depth analysis of peripheral nerve paths. This study included 27 patients who underwent the TENS procedure to evaluate the peripheral nerve path (17 males and 10 females; mean age: 59.9 years, range: 18-83 years) of each patient preoperatively. An electrode pen coupled to an electrical nerve stimulator was used for superficial nerve mapping. The TENS procedure was performed on patients' major peripheral nerves that passed close to the surgical field of tumor resection or trauma surgery, and intraoperative damage to those nerves was apprehensive. The paths of the target nerve were detected in most patients preoperatively. The nerve paths of 26 patients were precisely under the markings drawn preoperatively. The nerve path of one patient substantially differed from the preoperative markings with numbness at the surgical region. During surgery, the nerve paths could be accurately mapped preoperatively using the TENS procedure as confirmed by direct visualization of the nerve. This stimulation device is easy to use and offers highly accurate mapping of nerves for surgical planning without major complications. The authors conclude that TENS is a useful tool for noninvasive nerve localization and makes tumor resection a safe and smooth procedure.
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Affiliation(s)
- Yuhei Natori
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hidekazu Yoshizawa
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hiroshi Mizuno
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
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Cage TA, Yuh EL, Hou SW, Birk H, Simon NG, Noss R, Rao A, Chin CT, Kliot M. Visualization of nerve fibers and their relationship to peripheral nerve tumors by diffusion tensor imaging. Neurosurg Focus 2015; 39:E16. [DOI: 10.3171/2015.6.focus15235] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The majority of growing and/or symptomatic peripheral nerve tumors are schwannomas and neurofibromas. They are almost always benign and can usually be resected while minimizing motor and sensory deficits if approached with the proper expertise and techniques. Intraoperative electrophysiological stimulation and recording techniques allow the surgeon to map the surface of the tumor in an effort to identify and thus avoid damaging functioning nerve fibers. Recently, MR diffusion tensor imaging (DTI) techniques have permitted the visualization of axons, because of their anisotropic properties, in peripheral nerves. The object of this study was to compare the distribution of nerve fibers as revealed by direct electrical stimulation with that seen on preoperative MR DTI.
METHODS
The authors conducted a retrospective chart review of patients with a peripheral nerve or nerve root tumor between March 2012 and January 2014. Diffusion tensor imaging and intraoperative data had been prospectively collected for patients with peripheral nerve tumors that were resected. Preoperative identification of the nerve fiber location in relation to the nerve tumor surface as seen on DTI studies was compared with the nerve fiber’s intraoperative localization using electrophysiological stimulation and recordings.
RESULTS
In 23 patients eligible for study there was good correlation between nerve fiber location on DTI and its anatomical location seen intraoperatively. Diffusion tensor imaging demonstrated the relationship of nerve fibers relative to the tumor with 95.7% sensitivity, 66.7% specificity, 75% positive predictive value, and 93.8% negative predictive value.
CONCLUSIONS
Preoperative DTI techniques are useful in helping the peripheral nerve surgeon to both determine the risks involved in resecting a nerve tumor and plan the safest surgical approach.
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Affiliation(s)
| | | | | | - Harjus Birk
- 3School of Medicine, University of California, San Francisco, California
| | - Neil G. Simon
- 4Prince of Wales Clinical School, University of New South Wales Australia, Sydney, Australia; and
| | - Roger Noss
- Departments of 1Neurological Surgery and
| | | | | | - Michel Kliot
- 5Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Diffusion Tensor Imaging Adds Diagnostic Accuracy in Magnetic Resonance Neurography. Invest Radiol 2015; 50:498-504. [DOI: 10.1097/rli.0000000000000156] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Heckel A, Weiler M, Xia A, Ruetters M, Pham M, Bendszus M, Heiland S, Baeumer P. Peripheral Nerve Diffusion Tensor Imaging: Assessment of Axon and Myelin Sheath Integrity. PLoS One 2015; 10:e0130833. [PMID: 26114630 PMCID: PMC4482724 DOI: 10.1371/journal.pone.0130833] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 05/26/2015] [Indexed: 12/15/2022] Open
Abstract
Purpose To investigate the potential of diffusion tensor imaging (DTI) parameters as in-vivo biomarkers of axon and myelin sheath integrity of the median nerve in the carpal tunnel as validated by correlation with electrophysiology. Methods MRI examinations at 3T including DTI were conducted on wrists in 30 healthy subjects. After manual segmentation of the median nerve quantitative analysis of fractional anisotropy (FA) as well as axial, radial and mean diffusivity (AD, RD, and MD) was carried out. Pairwise Pearson correlations with electrophysiological parameters comprising sensory nerve action potential (SNAP) and compound muscle action potential (CMAP) as markers of axon integrity, and distal motor latency (dml) and sensory nerve conduction velocity (sNCV) as markers of myelin sheath integrity were computed. The significance criterion was set at P=0.05, Bonferroni corrected for multiple comparisons. Results DTI parameters showed a distinct proximal-to-distal profile with FA, MD, and RD extrema coinciding in the center of the carpal tunnel. AD correlated with CMAP (r=0.50, p=0.04, Bonf. corr.) but not with markers of myelin sheath integrity. RD correlated with sNCV (r=-0.53, p=0.02, Bonf. corr.) but not with markers of axon integrity. FA correlated with dml (r=-0.63, p=0.002, Bonf. corr.) and sNCV (r=0.68, p=0.001, Bonf. corr.) but not with markers of axon integrity. Conclusion AD reflects axon integrity, while RD (and FA) reflect myelin sheath integrity as validated by correlation with electrophysiology. DTI parameters consistently indicate a slight decrease of structural integrity in the carpal tunnel as a physiological site of median nerve entrapment. DTI is particularly sensitive, since these findings are observed in healthy participants. Our results encourage future studies to evaluate the potential of DTI in differentiating axon from myelin sheath injury in patients with manifest peripheral neuropathies.
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Affiliation(s)
- A Heckel
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Diagnostic Radiology, Freiburg University Hospital, Freiburg, Germany
| | - M Weiler
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Xia
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Ruetters
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Pham
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - S Heiland
- Section of Experimental Neuroradiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - P Baeumer
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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