Diffusion-weighted MR neurography of median and ulnar nerves in the wrist and palm
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To investigate the feasibility of diffusion-weighted magnetic resonance neurography (DW-MRN) in the visualisation of extremity nerves in the wrist and palm.
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).
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).
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.
• 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
KeywordsMR neurography Diffusion-weighted imaging Median nerve Ulnar nerve Wrist
diffusion-weighted magnetic resonance neurography
proton density weighted
fat suppressed proton density weighted imaging
carpal tunnel syndrome
diffusion-weighted whole-body imaging with background body signal suppression
number of excitations
The scientific guarantor of this publication is Guangbin Wang. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work was supported by the National Natural Science Foundation of China under Grant Nos. 81371534, 81171380. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent form was obtained from subjects or their parents in this study. This article has not been published elsewhere in whole or in part. Methodology: prospective, experimental, performed at one institution.
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