Advertisement

European Radiology

, Volume 27, Issue 6, pp 2359–2366 | Cite as

Diffusion-weighted MR neurography of median and ulnar nerves in the wrist and palm

  • Hongjing Bao
  • Shanshan Wang
  • Guangbin Wang
  • Li Yang
  • Mansoor-ul Hasan
  • Bin Yao
  • Chao Wu
  • Xu Zhang
  • Weibo Chen
  • Queenie Chan
  • Lebin Wu
  • Avneesh Chhabra
Magnetic Resonance

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

Keywords

MR neurography Diffusion-weighted imaging Median nerve Ulnar nerve Wrist 

Abbreviations

DW-MRN

diffusion-weighted magnetic resonance neurography

PDW

proton density weighted

FS-PDWI

fat suppressed proton density weighted imaging

CTS

carpal tunnel syndrome

MN

median nerve

UN

ulnar nerve

DWIBS

diffusion-weighted whole-body imaging with background body signal suppression

MPG

motion-probing gradient

NEX

number of excitations

Notes

Acknowledgments

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.

References

  1. 1.
    Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I (1999) Prevalence of carpal tunnel syndrome in a general population. JAMA 282:153–158CrossRefPubMedGoogle Scholar
  2. 2.
    Taylor CA, Braza D, Rice JB, Dillingham T (2008) The incidence of peripheral nerve injury in extremity trauma. Am J Phys Med Rehabil 87:381–385CrossRefPubMedGoogle Scholar
  3. 3.
    Tagliafico A, Panico N, Resmini E, Derchi LE, Ghio M, Martinoli C (2011) The role of ultrasound imaging in the evaluation of peripheral nerve in systemic sclerosis (scleroderma). Eur J Radiol 77:377–382CrossRefPubMedGoogle Scholar
  4. 4.
    Wein TH, Albers JW (2002) Electrodiagnostic approach to the patient with suspected peripheral polyneuropathy. Neurol Clin 20:503–526CrossRefPubMedGoogle Scholar
  5. 5.
    Ozben S, Acar H, Gunaydin S, Genc F, Ozer F, Ozben H (2012) The second lumbrical-interosseous latency comparison in carpal tunnel syndrome. J Clin Neurophysiol 29:263–267CrossRefPubMedGoogle Scholar
  6. 6.
    Kwee RM, Chhabra A, Wang KC, Marker DR, Carrino JA (2014) Accuracy of MRI in diagnosing peripheral nerve disease: a systematic review of the literature. AJR Am J Roentgenol 203:1303–1309CrossRefPubMedGoogle Scholar
  7. 7.
    Lacour-Petit MC, Lozeron P, Ducreux D (2003) MRI of peripheral nerve lesions of the lower limbs. Neuroradiology 45:166–170CrossRefPubMedGoogle Scholar
  8. 8.
    Freund W, Brinkmann A, Wagner F et al (2007) MR neurography with multiplanar reconstruction of 3D MRI datasets: an anatomical study and clinical applications. Neuroradiology 49:335–341CrossRefPubMedGoogle Scholar
  9. 9.
    Takahara T, Hendrikse J, Yamashita T et al (2008) Diffusion-weighted MR neurography of the brachial plexus: feasibility study. Radiology 249:653–660CrossRefPubMedGoogle Scholar
  10. 10.
    Chhabra A, Zhao L, Carrino JA et al (2013) MR neurography: advances. Radiol Res Pract 2013:809568PubMedPubMedCentralGoogle Scholar
  11. 11.
    Chhabra A, Soldatos T, Subhawong TK et al (2011) The application of three-dimensional diffusion-weighted PSIF technique in peripheral nerve imaging of the distal extremities. J Magn Reson Imaging 34:962–967CrossRefPubMedGoogle Scholar
  12. 12.
    Zhao L, Wang G, Yang L, Wu L, Lin X, Chhabra A (2013) Diffusion-weighted MR neurography of extremity nerves with unidirectional motion-probing gradients at 3 T: feasibility study. AJR Am J Roentgenol 200:1106–1114CrossRefPubMedGoogle Scholar
  13. 13.
    Kundel HL, Polansky M (2003) Measurement of observer agreement. Radiology 228:303–308CrossRefPubMedGoogle Scholar
  14. 14.
    Ghasemi-Rad M, Nosair E, Vegh A et al (2014) A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World J Radiol 6:284–300CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Sirasanagandla SR, Padavinangady A, Nayak SB, Jetti R (2015) Unusual communications between the cutaneous branches of ulnar nerve in the palm. J Clin Diagn Res 9:AD01–AD02Google Scholar
  16. 16.
    Shi Y, Zong M, Xu X, Zou Y, Feng Y, Liu W et al (2015) Diffusion tensor imaging with quantitative evaluation and fiber tractography of lumbar nerve roots in sciatica. Eur J Radiol 84:690–695CrossRefPubMedGoogle Scholar
  17. 17.
    Zhou Y, Narayana PA, Kumaravel M, Athar P, Patel VS, Sheikh KA (2014) High resolution diffusion tensor imaging of human nerves in forearm. J Magn Reson Imaging 39:1374–1383CrossRefPubMedGoogle Scholar
  18. 18.
    Ding WQ, Zhou XJ, Tang JB, Gu JH, Jin DS (2015) Three-dimensional display of peripheral nerves in the wrist region based on MR diffusion tensor imaging and maximum intensity projection post-processing. Eur J Radiol 84:1116–1127CrossRefPubMedGoogle Scholar
  19. 19.
    Lindberg PG, Feydy A, Le Viet D, Maier MA, Drapé JL (2013) Diffusion tensor imaging of the median nerve in recurrent carpal tunnel syndrome-initial experience. Eur Radiol 23:3115–3123CrossRefPubMedGoogle Scholar
  20. 20.
    Reinhold M, Ederer C, Henninger B, Eberwein A, Kremser C (2015) Diffusion-weighted magnetic resonance imaging for the diagnosis of patients with lumbar nerve root entrapment syndromes: results from a pilot study. Eur Spine J 24:319–326CrossRefPubMedGoogle Scholar
  21. 21.
    Chhabra A, Farahani SJ, Thawait GK, Wadhwa V, Belzberg AJ, Carrino JA (2016) Incremental value of magnetic resonance neurography of Lumbosacral plexus over non-contributory lumbar spine magnetic resonance imaging in radiculopathy: a prospective study. World J Radiol 28:109–116CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Hongjing Bao
    • 1
  • Shanshan Wang
    • 1
  • Guangbin Wang
    • 1
  • Li Yang
    • 2
  • Mansoor-ul Hasan
    • 1
  • Bin Yao
    • 1
  • Chao Wu
    • 1
  • Xu Zhang
    • 3
  • Weibo Chen
    • 4
  • Queenie Chan
    • 4
  • Lebin Wu
    • 1
  • Avneesh Chhabra
    • 5
  1. 1.Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong UniversityShandong UniversityJinanPeople’s Republic of China
  2. 2.Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan HospitalFudan UniversityShanghaiPeople’s Republic of China
  3. 3.Department of RadiologyShandong Chest HospitalJinanPeople’s Republic of China
  4. 4.Philips HealthcareShanghaiPeople’s Republic of China
  5. 5.UT Southwestern Medical CenterDallasUSA

Personalised recommendations