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Filz von Reiterdank ICLJ, Defize IL, de Groot EM, Wedel T, Grimminger PP, Egberts JH, Stein H, Ruurda JP, van Hillegersberg R, Bleys RLAW. The surgical anatomy of a (robot-assisted) minimally invasive transcervical esophagectomy. Dis Esophagus 2022; 36:6758199. [PMID: 36222066 DOI: 10.1093/dote/doac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/26/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Transcervical esophagectomy allows for esophagectomy through transcervical access and bypasses the thoracic cavity, thereby eliminating single lung ventilation. A challenging surgical approach demands thorough understanding of the encountered anatomy. This study aims to provide a comprehensive overview of surgical anatomy encountered during the (robot-assisted) minimally invasive transcervical esophagectomy (RACE and MICE). METHODS To assess the surgical anatomy of the lower neck and mediastinum, MR images were made of a body donor after, which it was sliced at 24-μm intervals with a cryomacrotome. Images were made every 3 slices resulting in 3.200 images of which a digital 3D multiplanar reconstruction was made. For macroscopic verification, microscopic slices were made and stained every 5 mm (Mallory-Cason). Schematic drawings were made of the 3D reconstruction to demonstrate the course of essential anatomical structures in the operation field and identify anatomical landmarks. RESULTS Surgical anatomy 'boxes' of three levels (superior thoracic aperture, upper mediastinum, subcarinal) were created. Four landmarks were identified: (i) the course of the thoracic duct in the mediastinum; (ii) the course of the left recurrent laryngeal nerve; (iii) the crossing of the azygos vein right and dorsal of the esophagus; and (iv) the position of the aortic arch, the pulmonary arteries, and veins. CONCLUSIONS The presented 3D reconstruction of unmanipulated human anatomy and schematic 3D 'boxes' provide a comprehensive overview of the surgical anatomy during the RACE or MICE. Our findings provide a useful tool to aid surgeons in learning the complex anatomy of the mediastinum and the exploration of new surgical approaches such as the RACE or MICE.
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Affiliation(s)
| | - I L Defize
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E M de Groot
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T Wedel
- Institute of Anatomy, Center of Clinical Anatomy, Kurt Semm Center for Minimal Invasive and Robotic Surgery, Kiel University, Kiel, Germany
| | - P P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - J H Egberts
- Department of Surgery, Jewish Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Stein
- Department of Surgical Applications Engineering, Intuitive Surgical, Sunnyvale CA, USA
| | - J P Ruurda
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R van Hillegersberg
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
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Mabrouk SMM, Zaytoon HAEH, Farid AM, Khadrah RSA. Additive value of magnetic resonance neurography in diagnosis of brachial plexopathy: a cross-section descriptive study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Management of brachial plexopathy requires proper localization of the site and nature of nerve injury. Nerve conduction studies and electrophysiological studies (ED) are crucial when diagnosing brachial neuropathy but these do not determine the actual site of the lesion. Conventional MRI has been used to evaluate the brachial plexus. Still, it carried the disadvantage of the inability to provide multi-planar images that depict the entire length of the neural plexus .It might be difficult to differentiate the brachial plexus nerves from adjacent vascular structures. Magnetic resonance neurography (MRN) is an innovative imaging technique for direct imaging of the spinal nerves. Our study aims to detect the additive role of MRN in the diagnosis of brachial plexopathy over ED. Forty cases of clinically suspected and proved by clinical examination and ED—traumatic (N = 30) and non-traumatic (N = 10)—were included in our study. We compared MRN finding with results of clinical examination and ED.
Results
MRN findings showed that the root was involved in 80% of cases, trunks in 70% of cases affecting the middle trunk in 40% of cases, the middle and posterior cord in 25%, lateral cord in 50%, and terminal branches on 10% of cases. Ten percent of cases were normal according to MRN, and 90% had abnormal findings in the form of preganglionic nerve root avulsion in 30% of cases, mild perineural edema surrounding C6/7 nerve roots in 20%, lower brachial trunk high signal in 10%, complicated with pseudo meningocele in 20%, and with increased shoulder muscle T2 signal intensity with muscle atrophy in 10%. There were minimal differences between clinical examination finding and MRN findings, with very good agreement between electromyography and nerve conduction (p value < 0.05, with sensitivity and specificity values of 94.44% and 100%, respectively).
Conclusion
MRN is important in differentiating different types of nerve injuries, nerve root avulsion, and nerve edema, playing an important role in differentiating the site of nerve injury, both preganglionic or postganglionic and planning for treatment of the cause of nerve injury, either medical or surgical.
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Viana GF, Midon M, Fonseca MW, Hataka A, Carandina L, Bueno LMC, Puoli Filho JNP, Machado VMDV. Assessment of qualitative and quantitative parameters of healthy thyroid gland in adult horses by magnetic resonance imaging. Anat Histol Embryol 2021; 50:839-848. [PMID: 34318942 DOI: 10.1111/ahe.12726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/19/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
In humans and pets, magnetic resonance imaging (MRI) provides important adjunctive anatomic information about the thyroid and its adjacent structures. To the best of our knowledge, however, no studies have been reported regarding the use of MRI for thyroid evaluation in horses. The aim of this study was to obtain qualitative and quantitative parameters of healthy thyroid gland in adult horses by MRI. Eleven horses were submitted to thyroid MRI evaluation. The healthy thyroid of these animals was ensured by normal examinations performed before (free thyroxine and ultrasound) and after (cytology) to MRI. It was concluded that the dorsal spin-echo T1-weighted, fast spin-echo T2-weighted, sagittal STIR and a three-dimensional T1-weighted gradient echo were the sequences that best characterized the thyroid lobes. Qualitatively, there was a significant variation in the elliptical format of some lobes considering the sagittal plane, which oscillated between rounded and flattened conformation. Excellent reproducibility of the quantitative thyroid parameters obtained was verified. The thyroid gland total volume mean of observers was 14.31 cm3 (±0.69). In relation with comparisons between quantitative parameters of left and right lobes, only differences regarding their respective lengths were observed. Thus, we can infer that the difference in some thyroid lobes format can be explained by the significant variation identified between left and right lobes lengths.
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Affiliation(s)
- Gustavo Fernandes Viana
- Department of Animal Reproduction and Veterinary Radiology, São Paulo State University (UNESP), Botucatu, Brazil
| | - Monica Midon
- Department of Veterinary Surgery and Anesthesiology, São Paulo State University (UNESP), Botucatu, Brazil
| | - Mariana Werneck Fonseca
- Department of Veterinary Surgery and Anesthesiology, São Paulo State University (UNESP), Botucatu, Brazil
| | - Alessandre Hataka
- Department of Veterinary Clinic, São Paulo State University (UNESP), Botucatu, Brazil
| | - Luciana Carandina
- Department of Animal Reproduction and Veterinary Radiology, São Paulo State University (UNESP), Botucatu, Brazil
| | - Laís Melício Cintra Bueno
- Department of Animal Reproduction and Veterinary Radiology, São Paulo State University (UNESP), Botucatu, Brazil
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Chao Z, Kim D, Kim HJ. Multiplanar reconstruction with incomplete data via enhanced fuzzy radial basis function neural networks. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2019.101766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Nerve imaging is an important component in the assessment of patients presenting with suspected peripheral nerve pathology. Although magnetic resonance neurography and ultrasound are the most commonly utilized techniques, several promising new modalities are on the horizon. Nerve imaging is useful in localizing the nerve injury, determining the severity, providing prognostic information, helping establish the diagnosis, and helping guide surgical decision making. The focus of this article is imaging of damaged nerves, focusing on nerve injuries and entrapment neuropathies.
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Affiliation(s)
- David A Purger
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sarada Sakamuri
- Department of Neurology and Neurological Sciences, 213 Quarry Road, MC 5979, Palo Alto, CA 94304, USA
| | - Nicholas F Hug
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sandip Biswal
- Department of Radiology, Stanford University, 300 Pasteur Drive, S-068B, Stanford, CA 94305, USA
| | - Thomas J Wilson
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, R293, Stanford, CA 94305, USA.
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Quantitative MR neurography of brachial plexus lesions based on diffusivity measurements. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Lichtenstein T, Sprenger A, Weiss K, Slebocki K, Cervantes B, Karampinos D, Maintz D, Fink GR, Henning TD, Lehmann HC. MRI biomarkers of proximal nerve injury in CIDP. Ann Clin Transl Neurol 2017; 5:19-28. [PMID: 29376089 PMCID: PMC5771316 DOI: 10.1002/acn3.502] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/17/2017] [Accepted: 10/17/2017] [Indexed: 12/30/2022] Open
Abstract
Objective To evaluate the utility of nerve diffusion tensor imaging (DTI), nerve cross‐sectional area, and muscle magnetic resonance imaging (MRI) multiecho Dixon for assessing proximal nerve injury in chronic inflammatory demyelinating polyneuropathy (CIDP). Methods In this prospective observational cohort study, 11 patients with CIDP and 11 healthy controls underwent a multiparametric MRI protocol with DTI of the sciatic nerve and assessment of muscle proton‐density fat fraction of the biceps femoris and the quadriceps femoris muscles by multiecho Dixon MRI. Patients were longitudinally evaluated by MRI, clinical examination, and nerve conduction studies at baseline and after 6 months. Results In sciatic nerves of CIDP patients, mean cross‐sectional area was significantly higher and fractional anisotropy value was significantly lower, compared to controls. In contrast, muscle proton‐density fat fraction was significantly higher in thigh muscles of patients with CIDP, compared to controls. MRI parameters showed high reproducibility at baseline and 6 months. Interpretation Advanced MRI parameters demonstrate subclinical proximal nerve damage and intramuscular fat accumulation in CIDP. Data suggest DTI and multiecho Dixon MRI might be useful in estimating axonal damage and neurogenic muscle changes in CIDP.
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Affiliation(s)
- Thorsten Lichtenstein
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany
| | - Alina Sprenger
- Department of Neurology University Hospital of Cologne Cologne Germany
| | - Kilian Weiss
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany.,Philips Healthcare Germany Hamburg Germany
| | - Karin Slebocki
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany
| | - Barbara Cervantes
- Cognitive Neuroscience Institute of Diagnostic and Interventional Radiology Technical University Munich Munich Germany
| | - Dimitrios Karampinos
- Cognitive Neuroscience Institute of Diagnostic and Interventional Radiology Technical University Munich Munich Germany
| | - David Maintz
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany
| | - Gereon R Fink
- Department of Neurology University Hospital of Cologne Cologne Germany.,Institute of Neuroscience and Medicine (INM-3) Research Centre Juelich Jülich Germany
| | - Tobias D Henning
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany.,Department of Neuroradiology Krankenhaus der Barmherzigen Brüder Trier Germany
| | - Helmar C Lehmann
- Department of Neurology University Hospital of Cologne Cologne Germany
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8
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Cervantes B, Kirschke JS, Klupp E, Kooijman H, Börnert P, Haase A, Rummeny EJ, Karampinos DC. Orthogonally combined motion- and diffusion-sensitized driven equilibrium (OC-MDSDE) preparation for vessel signal suppression in 3D turbo spin echo imaging of peripheral nerves in the extremities. Magn Reson Med 2017; 79:407-415. [DOI: 10.1002/mrm.26660] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Barbara Cervantes
- Department of Diagnostic and Interventional Radiology; Technische Universität München; Munich Germany
| | - Jan S. Kirschke
- Department of Neuroradiology; Technische Universität München; Munich Germany
| | - Elizabeth Klupp
- Department of Neuroradiology; Technische Universität München; Munich Germany
| | | | | | - Axel Haase
- Institute of Medical Engineering; Technische Universität München; Garching Germany
| | - Ernst J. Rummeny
- Department of Diagnostic and Interventional Radiology; Technische Universität München; Munich Germany
| | - Dimitrios C. Karampinos
- Department of Diagnostic and Interventional Radiology; Technische Universität München; Munich Germany
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The Anatomic Relationship of the Tibial Nerve to the Common Peroneal Nerve in the Popliteal Fossa: Implications for Selective Tibial Nerve Block in Total Knee Arthroplasty. Pain Res Manag 2017; 2017:7250181. [PMID: 28260964 PMCID: PMC5312044 DOI: 10.1155/2017/7250181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/12/2016] [Indexed: 11/18/2022]
Abstract
Background. A recently described selective tibial nerve block at the popliteal crease presents a viable alternative to sciatic nerve block for patients undergoing total knee arthroplasty. In this two-part investigation, we describe the effects of a tibial nerve block at the popliteal crease. Methods. In embalmed cadavers, after the ultrasound-guided dye injection the dissection revealed proximal spread of dye within the paraneural sheath. Consequentially, in the clinical study twenty patients scheduled for total knee arthroplasty received the ultrasound-guided selective tibial nerve block at the popliteal crease, which also resulted in proximal spread of local anesthetic. A sensorimotor exam was performed to monitor the effect on the peroneal nerve. Results. In the cadaver study, dye was observed to spread proximal in the paraneural sheath to reach the sciatic nerve. In the clinical observational study, local anesthetic was observed to spread a mean of 4.7 + 1.9 (SD) cm proximal to popliteal crease. A negative correlation was found between the excess spread of local anesthetic and bifurcation distance. Conclusions. There is significant proximal spread of local anesthetic following tibial nerve block at the popliteal crease with possibility of the undesirable motor blocks of the peroneal nerve.
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Ishikawa T, Asakura K, Mizutani Y, Ueda A, Murate KI, Hikichi C, Shima S, Kizawa M, Komori M, Murayama K, Toyama H, Ito S, Mutoh T. MR neurography for the evaluation of CIDP. Muscle Nerve 2016; 55:483-489. [DOI: 10.1002/mus.25368] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 07/21/2016] [Accepted: 08/04/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Tomomasa Ishikawa
- Department of Neurology; Fujita Health University School of Medicine; 1-98 Kutsukake-cho Toyoake Aichi 470-1192 Japan
| | - Kunihiko Asakura
- Department of Neurology; Fujita Health University School of Medicine; 1-98 Kutsukake-cho Toyoake Aichi 470-1192 Japan
| | - Yasuaki Mizutani
- Department of Neurology; Fujita Health University School of Medicine; 1-98 Kutsukake-cho Toyoake Aichi 470-1192 Japan
| | - Akihiro Ueda
- Department of Neurology; Fujita Health University School of Medicine; 1-98 Kutsukake-cho Toyoake Aichi 470-1192 Japan
| | - Ken-Ichiro Murate
- Department of Neurology; Fujita Health University School of Medicine; 1-98 Kutsukake-cho Toyoake Aichi 470-1192 Japan
| | - Chika Hikichi
- Department of Neurology; Fujita Health University School of Medicine; 1-98 Kutsukake-cho Toyoake Aichi 470-1192 Japan
| | - Sayuri Shima
- Department of Neurology; Fujita Health University School of Medicine; 1-98 Kutsukake-cho Toyoake Aichi 470-1192 Japan
| | - Madoka Kizawa
- Department of Neurology; Fujita Health University School of Medicine; 1-98 Kutsukake-cho Toyoake Aichi 470-1192 Japan
| | - Masako Komori
- Department of Radiology; Fujita Health University School of Medicine; Kutsukake-cho Toyoake Aichi Japan
| | - Kazuhiro Murayama
- Department of Radiology; Fujita Health University School of Medicine; Kutsukake-cho Toyoake Aichi Japan
| | - Hiroshi Toyama
- Department of Radiology; Fujita Health University School of Medicine; Kutsukake-cho Toyoake Aichi Japan
| | - Shinji Ito
- Department of Neurology; Fujita Health University School of Medicine; 1-98 Kutsukake-cho Toyoake Aichi 470-1192 Japan
| | - Tatsuro Mutoh
- Department of Neurology; Fujita Health University School of Medicine; 1-98 Kutsukake-cho Toyoake Aichi 470-1192 Japan
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Diagnostic Value and Surgical Implications of the 3D DW-SSFP MRI On the Management of Patients with Brachial Plexus Injuries. Sci Rep 2016; 6:35999. [PMID: 27782162 PMCID: PMC5080541 DOI: 10.1038/srep35999] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 10/07/2016] [Indexed: 01/09/2023] Open
Abstract
Three-dimensional diffusion-weighted steady-state free precession (3D DW-SSFP) of high-resolution magnetic resonance has emerged as a promising method to visualize the peripheral nerves. In this study, the application value of 3D DW-SSFP brachial plexus imaging in the diagnosis of brachial plexus injury (BPI) was investigated. 33 patients with BPI were prospectively examined using 3D DW-SSFP MR neurography (MRN) of brachial plexus. Results of 3D DW-SSFP MRN were compared with intraoperative findings and measurements of electromyogram (EMG) or somatosensory evoked potentials (SEP) for each injured nerve root. 3D DW-SSFP MRN of brachial plexus has enabled good visualization of the small components of the brachial plexus. The postganglionic section of the brachial plexus was clearly visible in 26 patients, while the preganglionic section of the brachial plexus was clearly visible in 22 patients. Pseudomeningoceles were commonly observed in 23 patients. Others finding of MRN of brachial plexus included spinal cord offset (in 16 patients) and spinal cord deformation (in 6 patients). As for the 3D DW-SSFP MRN diagnosis of preganglionic BPI, the sensitivity, the specificity and the accuracy were respectively 96.8%, 90.29%, and 94.18%. 3D DW-SSFP MRN of brachial plexus improve visualization of brachial plexus and benefit to determine the extent of injury.
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Bao H, Wang S, Wang G, Yang L, Hasan MU, Yao B, Wu C, Zhang X, Chen W, Chan Q, Wu L, Chhabra A. Diffusion-weighted MR neurography of median and ulnar nerves in the wrist and palm. Eur Radiol 2016; 27:2359-2366. [PMID: 27631109 DOI: 10.1007/s00330-016-4591-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/21/2016] [Accepted: 08/29/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate the feasibility of diffusion-weighted magnetic resonance neurography (DW-MRN) in the visualisation of extremity nerves in the wrist and palm. METHODS Thirty-two volunteers and 21 patients underwent imaging of the wrist and palm on a 3-T MR scanner. In all subjects, two radiologists evaluated the image quality on DW-MRN using a four-point grading scale. Kappa statistics were obtained for inter-observer performance. In volunteers, the chi-squared test was used to assess the differences in nerve visualisation on DW-MRN and axial fat-suppressed proton density weighted imaging (FS-PDWI). RESULTS In volunteers, the mean image quality scores for the median nerve (MN) and ulnar nerve (UN) were 3.71 ± 0.46 and 3.23 ± 0.67 for observer 1, and 3.70 ± 0.46 and 3.22 ± 0.71 for observer 2, respectively. The inter-observer agreement was excellent (k = 0.843) and good (k = 0.788), respectively. DW-MRN provided significantly improved visualisations of the second and the third common palmar digital nerves and three branches of UN compared with FS-PDWI (P < 0.05). In patients, the mean image quality scores for the two observers were 3.24 ± 0.62 and 3.10 ± 0.83, inter-observer performance was excellent (k = 0.842). CONCLUSIONS DW-MRN is feasible for improved visualisation of extremity nerves and their lesions in the wrist and palm with adequate image quality, thereby providing a supplementary method to conventional MR imaging. KEY POINTS • DW-MRN provides adequate image quality for wrist and palm neurography • DW-MRN performs similarly to FS-PDWI in nerve visualisation at the wrist • DW-MRN provides improved visualisation of small nerves in the palm • DW-MRN serves as a supplementary method to evaluate peripheral neuropathies.
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Affiliation(s)
- Hongjing Bao
- Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Shandong University, 324 Jingwu Rd, Jinan, 250021, Shandong, People's Republic of China
| | - Shanshan Wang
- Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Shandong University, 324 Jingwu Rd, Jinan, 250021, Shandong, People's Republic of China
| | - Guangbin Wang
- Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Shandong University, 324 Jingwu Rd, Jinan, 250021, Shandong, People's Republic of China.
| | - Li Yang
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Mansoor-Ul Hasan
- Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Shandong University, 324 Jingwu Rd, Jinan, 250021, Shandong, People's Republic of China
| | - Bin Yao
- Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Shandong University, 324 Jingwu Rd, Jinan, 250021, Shandong, People's Republic of China
| | - Chao Wu
- Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Shandong University, 324 Jingwu Rd, Jinan, 250021, Shandong, People's Republic of China
| | - Xu Zhang
- Department of Radiology, Shandong Chest Hospital, Jinan, 250021, Shandong, People's Republic of China
| | - Weibo Chen
- Philips Healthcare, Shanghai, People's Republic of China
| | - Queenie Chan
- Philips Healthcare, Shanghai, People's Republic of China
| | - Lebin Wu
- Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Shandong University, 324 Jingwu Rd, Jinan, 250021, Shandong, People's Republic of China
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Andreou A, Sohaib A, Collins DJ, Takahara T, Kwee TC, Leach MO, MacVicar DA, Koh DM. Diffusion-weighted MR neurography for the assessment of brachial plexopathy in oncological practice. Cancer Imaging 2015; 15:6. [PMID: 25934632 PMCID: PMC4417248 DOI: 10.1186/s40644-015-0041-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 04/14/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To evaluate diffusion-weighted MR neurography (DW-MRN) for visualizing the brachial plexus and for the assessment of brachial plexopathy. METHODS 40 oncological patients with symptoms of brachial plexopathy underwent 1.5 T MRI using conventional MR sequences and unidirectional DW-MRN. The images were independently reviewed by two radiologists. Anatomic visualization of the brachial plexus was scored using a 5 point scale on conventional MR sequences and then combined with DW-MRN. A brachial plexus abnormality was also scored using a 5 point scale and inter-observer agreement determined by kappa statistics. Diagnostic accuracy for brachial plexopathy assessed by conventional MRI alone versus conventional MRI combined with DW-MRN was compared by ROC analysis using reference standards. RESULTS DW-MRN significantly improved visualization of the brachial plexus compared with conventional MRI alone (P<0.001). When assessing brachial plexopathy, inter-observer agreement was moderate for conventional MRI (kappa=0.48) but good for conventional MRI with DW-MRN (kappa=0.62). DW-MRN combined with conventional MRI significantly improved diagnostic accuracy in one observer (P<0.05) but was similar in the other observer. CONCLUSION DW-MRN improved visualization of the brachial plexus. Combining DW-MRN with conventional MRI can improve inter-observer agreement and detection of brachial plexopathy in symptomatic oncological patients.
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Affiliation(s)
- Adrian Andreou
- Department of Radiology, Royal Marsden, Sutton, Surrey, UK.
| | - Aslam Sohaib
- Department of Radiology, Royal Marsden, Sutton, Surrey, UK.
| | - David J Collins
- CR UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Sutton, Surrey, UK.
| | - Taro Takahara
- Department of Radiology, University Medical Center, Utrecht, Netherlands.
| | - Thomas C Kwee
- Department of Radiology, University Medical Center, Utrecht, Netherlands.
| | - Martin O Leach
- CR UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Sutton, Surrey, UK.
| | | | - Dow-Mu Koh
- Department of Radiology, Royal Marsden, Sutton, Surrey, UK.
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Abstract
Management of brachial plexus injury is a demanding field of hand and upper extremity surgery. With currently available microsurgical techniques, functional gains are rewarding in upper plexus injuries. However, treatment options in the management of flail and anaesthetic limb are still evolving. Last three decades have witnessed significant developments in the management of these injuries, which include a better understanding of the anatomy, advances in the diagnostic modalities, incorporation of intra-operative nerve stimulation techniques, more liberal use of nerve grafts in bridging nerve gaps, and the addition of new nerve transfers, which selectively neurotise the target muscles close to the motor end plates. Newer research works on the use of nerve allografts and immune modulators (FK 506) are under evaluation in further improving the results in nerve reconstruction. Direct reimplantation of avulsed spinal nerve roots into the spinal cord is another area of research in brachial plexus reconstruction.
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Affiliation(s)
- Prem Singh Bhandari
- Department of Plastic Surgery, Command Hospital (NC), Panchkula, Haryana, India
| | - Sanjay Maurya
- Command Hospital (WC), Chandimandir Cantt, Panchkula, Haryana, India
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Ritter C, Wunderlich G, Macht S, Schroeter M, Fink GR, Lehmann HC. [Differential diagnostics of diseases of the brachial plexus]. DER NERVENARZT 2014; 85:176-188. [PMID: 24343110 DOI: 10.1007/s00115-013-3949-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Progressive, atrophic, asymmetrically distributed flaccid paresis of arm and hand muscles represents a frequent symptom of neuromuscular diseases that can be attributed to injury of the arm nerves, the plexus or the cervical roots. A timely and exact diagnosis is mandatory; however, the broad spectrum of differential diagnoses often represents a diagnostic challenge. A large variety of neuromuscular disorders need to be considered, encompassing autoimmune mediated inflammatory neuropathic conditions, such as multifocal motor neuropathy, as well as chronic degenerative and nerve compression disorders. This review provides an overview of the most frequent disorders of the upper plexus and cervical roots and summarizes the characteristic clinical features as well as electrodiagnostic and laboratory test results. In addition the diagnostic value of magnetic resonance imaging and sonography is discussed.
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Affiliation(s)
- C Ritter
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Wing L, Massoud TF. Trends in performance indicators of neuroimaging anatomy research publications: a bibliometric study of major neuroradiology journal output over four decades based on web of science database. Clin Anat 2014; 28:16-26. [PMID: 24431001 DOI: 10.1002/ca.22360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 11/04/2013] [Accepted: 11/15/2013] [Indexed: 11/11/2022]
Abstract
Quantitative, qualitative, and innovative application of bibliometric research performance indicators to anatomy and radiology research and education can enhance cross-fertilization between the two disciplines. We aim to use these indicators to identify long-term trends in dissemination of publications in neuroimaging anatomy (including both productivity and citation rates), which has subjectively waned in prestige during recent years. We examined publications over the last 40 years in two neuroradiological journals, AJNR and Neuroradiology, and selected and categorized all neuroimaging anatomy research articles according to theme and type. We studied trends in their citation activity over time, and mathematically analyzed these trends for 1977, 1987, and 1997 publications. We created a novel metric, "citation half-life at 10 years postpublication" (CHL-10), and used this to examine trends in the skew of citation numbers for anatomy articles each year. We identified 367 anatomy articles amongst a total of 18,110 in these journals: 74.2% were original articles, with study of normal anatomy being the commonest theme (46.7%). We recorded a mean of 18.03 citations for each anatomy article, 35% higher than for general neuroradiology articles. Graphs summarizing the rise (upslope) in citation rates after publication revealed similar trends spanning two decades. CHL-10 trends demonstrated that more recently published anatomy articles were likely to take longer to reach peak citation rate. Bibliometric analysis suggests that anatomical research in neuroradiology is not languishing. This novel analytical approach can be applied to other aspects of neuroimaging research, and within other subspecialties in radiology and anatomy, and also to foster anatomical education.
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Affiliation(s)
- Louise Wing
- Department of Radiology, John Radcliffe Hospital, Oxford, United Kingdom
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Sakai T, Miyagi R, Yamabe E, Fujinaga Y, N. Bhatia N, Yoshioka H. Diffusion-Weighted Imaging and Diffusion Tensor Imaging of Asymptomatic Lumbar Disc Herniation. THE JOURNAL OF MEDICAL INVESTIGATION 2014; 61:197-203. [DOI: 10.2152/jmi.61.197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Toshinori Sakai
- Department of Radiological Sciences, University of California
- Department of Orthopaedic Surgery, University of California
| | - Ryo Miyagi
- Department of Radiological Sciences, University of California
| | - Eiko Yamabe
- Department of Radiological Sciences, University of California
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Ohana M, Moser T, Moussaouï A, Kremer S, Carlier R, Liverneaux P, Dietemann JL. Current and future imaging of the peripheral nervous system. Diagn Interv Imaging 2014; 95:17-26. [DOI: 10.1016/j.diii.2013.05.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Eppenberger P, Andreisek G, Chhabra A. Magnetic resonance neurography: diffusion tensor imaging and future directions. Neuroimaging Clin N Am 2013; 24:245-56. [PMID: 24210323 DOI: 10.1016/j.nic.2013.03.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Magnetic resonance (MR) neurography has progressed in the past 2 decades because of rapid technological developments in both hardware and software. In addition to improvements in high-resolution anatomic pulse sequences, functional techniques are becoming feasible. This article presents the current state-of-the-art three-dimensional anatomic techniques, discusses the advantages of functional techniques being exploited, and portrays novel contrast types and molecular techniques that are under development and promise a bright future for this rapidly evolving technique.
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Affiliation(s)
- Patrick Eppenberger
- Department of Radiology, University Hospital Zurich, Ramistrasse 100, Zurich CH - 8091, Switzerland
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Diffusion-Weighted MR Neurography of Extremity Nerves With Unidirectional Motion-Probing Gradients at 3 T: Feasibility Study. AJR Am J Roentgenol 2013; 200:1106-14. [DOI: 10.2214/ajr.12.9213] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Groen GJ, Krediet AC, Moayeri N, Bruhn J, Geffen GJ. Brachial plexus sonoanatomy explained by multiplanar reformatting of digitized anatomy. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.eujps.2010.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Zhang Z, Meng Q, Li Z, Pan B, Regatte RR, Schweitzer ME. Simultaneous visualization of nerves and vessels of the lower extremities using magnetization-prepared susceptibility weighted magnetic resonance imaging at 3.0 T. Neurosurgery 2011; 70:1-7; discussion 7. [PMID: 21768913 DOI: 10.1227/neu.0b013e31822da57f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Identifying the extent of involvement of the vessel and nerve, particularly in regard to preoperative evaluation and precise localization of the tumor and its relation to the structures of the extremities, has important applications for advancing the treatment of lower extremity diseases. OBJECTIVE To review the technical feasibility of simultaneous visualization of nerves and vessels of the lower extremities by using magnetization-prepared susceptibility-weighted magnetic resonance (MR) imaging (MP-SWI) at 3.0T. METHODS Ten healthy volunteers and 10 patients were studied. Optimized MP-SWI, MR neurography (MRN) based on 3D diffusion-weighted steady-state free precession imaging and contrast-enhanced MR angiography (CE-MRA) sequences were performed for each subject. The means of signal-to-noise ratio (SNR)n, SNRv, SNRm, contrast-to-noise ratio (CNR)n,m and CNRv,m were calculated and the certainty of identifying nerves and vessels was determined. CNRn,m between MP-SWI and MRN, and CNRv,m between MP-SWI and CE-MRA were compared. RESULTS MP-SWI provides slightly poorer CNRv,m than CE-MRA, whereas MP-SWI provides a better CNRn,m than MRN. In thin-slice-thickness maximum-intensity projection arbitrary planes, the sciatic nerve and its branches were clearly identified (score 1 or 2 of 2) in 17 subjects (85%); the femoral artery and the main branches were identified (score 1 or 2 of 2) in all 20 subjects (100%). The nerves are isointense to slightly hypointense to muscle, and the vessels show a more obvious hyperintense signal than muscle in MP-SWI. CONCLUSION The proposed MP-SWI demonstrates the feasibility of simultaneously visualizing nerves and vessels of the lower extremities without using an exogenous contrast agent. It may enable straightforward localization of a disease process to a specific nerve and vessel.
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Affiliation(s)
- Zhongwei Zhang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Subtraction of unidirectionally encoded images for suppression of heavily isotropic objects (SUSHI) for selective visualization of peripheral nerves. Neuroradiology 2010; 53:109-16. [PMID: 20480155 PMCID: PMC3032219 DOI: 10.1007/s00234-010-0713-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 04/23/2010] [Indexed: 11/30/2022]
Abstract
Introduction The aim of this study was to introduce and assess a new magnetic resonance (MR) technique for selective peripheral nerve imaging, called “subtraction of unidirectionally encoded images for suppression of heavily isotropic objects” (SUSHI). Methods Six volunteers underwent diffusion-weighted MR neurography (DW-MRN) of the brachial plexus, and seven volunteers underwent DW-MRN of the sciatic, common peroneal, and tibial nerves at the level of the knee, at 1.5 T. DW-MRN images with SUSHI (DW-MRNSUSHI) and conventional DW-MRN images (DW-MRNAP) were displayed using a coronal maximum intensity projection and evaluated by two independent observers regarding signal suppression of lymph nodes, bone marrow, veins, and articular fluids and regarding signal intensity of nerves and ganglia, using five-point grading scales. Scores of DW-MRNSUSHI were compared to those of DW-MRNAP using Wilcoxon tests. Results Suppression of lymph nodes around the brachial plexus and suppression of articular fluids at the level of the knee at DW-MRNSUSHI was significantly better than that at DW-MRNAP (P < 0.05). However, overall signal intensity of brachial plexus nerves and ganglia at DW-MRNSUSHI was significantly lower than that at DW-MRNAP (P < 0.05). On the other hand, signal intensity of the sciatic, common peroneal, and tibial nerves at the level of the knee at DW-MRNSUSHI was judged as significantly better than that at DW-MRNAP (P < 0.05). Conclusion The SUSHI technique allows more selective visualization of the sciatic, common peroneal, and tibial nerves at the level of the knee but is less useful for brachial plexus imaging because signal intensity of the brachial plexus nerves and ganglia can considerably be decreased. Electronic supplementary material The online version of this article (doi:10.1007/s00234-010-0713-6) contains supplementary material, which is available to authorized users.
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Reliability, validity and diagnostic accuracy of palpation of the sciatic, tibial and common peroneal nerves in the examination of low back related leg pain. ACTA ACUST UNITED AC 2009; 14:623-9. [DOI: 10.1016/j.math.2008.12.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 12/02/2008] [Accepted: 12/14/2008] [Indexed: 12/21/2022]
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Walsh J, Hall T. Agreement and correlation between the straight leg raise and slump tests in subjects with leg pain. J Manipulative Physiol Ther 2009; 32:184-92. [PMID: 19362228 DOI: 10.1016/j.jmpt.2009.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 11/25/2008] [Accepted: 01/05/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The straight leg raise (SLR) and slump tests have traditionally been used to identify nerve root compression arising from disk herniation. However, they may be more appropriate as tests of lumbosacral neural tissue mechanosensitivity. The aim of this study was to determine agreement and correlation between the SLR and slump tests in a population presenting with back and leg pain. METHODS This was an observational, cross-sectional study design. Forty-five subjects with unilateral leg pain were recruited from an outpatient Back Pain Screening Clinic at a large teaching hospital in Ireland. The SLR and slump tests were performed on each side. In the event of symptom reproduction, the ankle was dorsiflexed. Reproduction of presenting symptoms, which were intensified by ankle dorsiflexion, was interpreted as a positive test. An inclinometer was used to measure range of motion (ROM). RESULTS There was substantial agreement between SLR and slump test interpretation (kappa = 0.69) with good correlation in ROM between the 2 tests (r = 0.64) on the symptomatic side. In subjects who had positive results, ROM for both tests was significantly reduced compared to ROM on the contralateral side and ROM in subjects who had negative results. CONCLUSIONS When the SLR and slump tests are interpreted as positive in the event of reproduction of presenting leg pain that are intensified by ankle dorsiflexion, these tests show substantial agreement and good correlation in the leg pain population. When interpreted in this way, these tests may be appropriate tests of neural tissue mechanosensitivity, but further criteria must be met before a definitive conclusion in relation to neural tissue mechanosensitivity may be drawn.
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Affiliation(s)
- Jeremy Walsh
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Morphological analysis in patients with sciatica: a magnetic resonance imaging study using three-dimensional high-resolution diffusion-weighted magnetic resonance neurography techniques. Spine (Phila Pa 1976) 2009; 34:E245-50. [PMID: 19333087 DOI: 10.1097/brs.0b013e318197162e] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective observational study of patients with sciatica. OBJECTIVE We investigated the effectiveness of 3-dimensional high-spatial resolution diffusion-weighted MR neurography based on steady state free precession (3-dimensional diffusion-weighted steady-state free precession [DW-SSFP]) in the diagnosis of sciatica. SUMMARY OF BACKGROUND DATA Patients with sciatica challenge a physician who desires a precise diagnosis for the etiology of the pain. Direct imaging of the sciatic nerve with high resolution and high contrast may contribute to accurate localization and help to find the causes of sciatica and provide reliable information to clinicians in treatment choice. Thus, we supposed that 3-dimensional DW-SSFP method have the ability to confirm the etiologies of sciatica. METHODS The 3-dimensional DW-SSFP sequence was performed on 137 patients with sciatica and 32 patients in control group. The postprocessing techniques were used to generate images of lumbosacral plexus and sciatic nerve, and the images acquired were assessed based on the presence or absence of nerve abnormality. The certainty of identifying the lumbosacral plexus and main branches from all cases was determined in each of the reconstruction planes for each case individually and assessed by using a 3-score scale. RESULTS All subjects were successfully performed. The sciatic nerve and its main branches were differentiated and a clear picture was obtained in all subjects. Compared with the control group, the presence of nerve root compression or increased T2 signal intensity changes can be observed in all patients. The mean score of certainty of identifying the sciatic nerve and main branches was 1.76 +/- 0.4, which indicate that the sciatic nerve and main branches can be identified with certainty. CONCLUSION The 3-dimensional DW-SSFP MRI with high spatial and sufficient contrast is an excellent technique to define the nature of sciatica and assists in prognostication and possibly in management.
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Takahara T, Hendrikse J, Yamashita T, Mali WPTM, Kwee TC, Imai Y, Luijten PR. Diffusion-weighted MR Neurography of the Brachial Plexus: Feasibility Study. Radiology 2008; 249:653-60. [PMID: 18796657 DOI: 10.1148/radiol.2492071826] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Taro Takahara
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
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Zhang Z, Song L, Meng Q, Li Z, Luo B, Pei Z, Zeng J. Segmented echo planar MR imaging of the brachial plexus with inversion recovery magnetization preparation at 3.0T. J Magn Reson Imaging 2008; 28:440-4. [PMID: 18666178 DOI: 10.1002/jmri.21304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the image quality of segmented echo planar MRI with inversion recovery magnetization preparation (seg-IR-EPI) to depict the anatomy and pathologic changes involving the brachial plexus. MATERIALS AND METHODS The coronal seg-IR-EPI sequence was performed on 30 healthy volunteers and 20 patients. Postprocessing techniques were used to generate images of brachial plexus and the images acquired were qualitatively evaluated by two experienced radiologists based on grading of the morphological images. Signal-to-noise ratios (SNRs) and nerve soft tissue contrast-to-noise-ratios (CNRs) were calculated and the normalized SNR (SNRn) and the normalized CNR (CNRn) were compared with the STIR TSE sequence. RESULTS Although seg-IR-EPI had more ghosting artifacts than STIR TSE, excellent general image appearance with minor blurring can be achieved with seg-IR-EPI. In all healthy volunteers the means of CNRn were significantly greater for seg-IR-EPI than for STIR-TSE, while the means of SNRn were significantly lower for seg-IR-EPI than for STIR-TSE. CONCLUSION In the present study the seg-IR-EPI sequence obtained uniform fat suppression and high-contrast T2-weighted images of brachial plexus. Our data suggest that the seg-IR-EPI sequence may provide high fidelity in evaluating brachial plexus.
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Affiliation(s)
- Zhongwei Zhang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
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Bard H, Demondion X, Vuillemin V. Les syndromes canalaires des régions glutéales et de la face latérale de la hanche. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.rhum.2007.02.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sakai T, Miyagi R, Yamabe E, Fujinaga Y, N. Bhatia N, Yoshioka H. <b>Diffusion-Weighted Imaging and Diffusion Tensor Imaging of Asymptomatic Lumbar Disc Herniation</b>. THE JOURNAL OF MEDICAL INVESTIGATION 2000. [DOI: 10.2152/jmi.40.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Toshinori Sakai
- Department of Radiological Sciences, University of California
- Department of Orthopaedic Surgery, University of California
| | - Ryo Miyagi
- Department of Radiological Sciences, University of California
| | - Eiko Yamabe
- Department of Radiological Sciences, University of California
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