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Nakashima M, Kawai T, Matsumoto K, Kawaguchi T, Kitera N, Watanabe S, Itoh T, Hiwatashi A. Delineation of the brachial plexus by contrast-enhanced photon-counting detector CT and virtual monoenergetic images. Eur J Radiol 2025; 184:111964. [PMID: 39908938 DOI: 10.1016/j.ejrad.2025.111964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 01/11/2025] [Accepted: 01/30/2025] [Indexed: 02/07/2025]
Abstract
OBJECTIVES To improve the image quality of the brachial plexus in photon-counting detector CT (PCD-CT) using contrast media and virtual monoenergetic images (VMI). MATERIALS & METHODS We retrospectively analyzed contrast-enhanced neck PCD-CT images scanned in March-July 2023. Unenhanced and contrast-enhanced images were compared, and then 40-, 70-, and 100-keV VMIs were compared. The qualitative evaluation used a five-point Likert scale regarding overall image quality (IQ), sharpness, and noise. The quantitative evaluation used the standard deviation (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Freidman's test and one-way ANOVA were performed. RESULTS Forty patients (65 years ± 17, 21 males) were included. The median scores [interquartile range, IQR] for the unenhanced and contrast-enhanced groups were IQ, 3 [2,3] and 4 [3,4] (P < 0.001); sharpness, 3 [2,3] and 4 [3,4] (P < 0.001); and noise, 3 [3,4] and 3 [3,4] (P = 0.63). Mean ± SD scores were SD, 6.7 ± 1.4 and 6.7 ± 1.0 (P = 0.95); SNR, 5.1 ± 1.2 and 5.4 ± 1.4 (P = 0.04); and CNR, 4.8 ± 1.5 and 8.1 ± 2.3 (P < 0.001). The 40-, 70-, and 100-keV groups' IQ were 2 [2,3], 4 [3,4], and 3 [3,4]; their sharpness scores were 2 [2,3], 3 [3,4], and 3 [2,3] (all, P < 0.05). Those for noise were 2 [1-3], 3 [3,4], and 4 [3,4] (all, P < 0.001 except for 70-keV vs.100-keV: P = 0.16). The SDs were 13.1 ± 2.5, 7.5 ± 1.2, and 6.0 ± 1.1. The SNRs were 4.2 ± 1.9, 5.0 ± 1.2, and 5.7 ± 1.5 (all, P < 0.001). The CNRs were 8.7 ± 4.0, 6.8 ± 2.3, and 6.5 ± 2.3 (all, P < 0.001 except for 70-keV vs.100-keV: P = 0.51). CONCLUSION Contrast-enhanced PCD-CT and VMIs provided good delineation of the brachial plexus.
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Affiliation(s)
- Masahiro Nakashima
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Tatsuya Kawai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
| | - Kazuhisa Matsumoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Takatsune Kawaguchi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Nobuo Kitera
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Seita Watanabe
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Toshihide Itoh
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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Cheng T, Li F, Jiang X, Yu D, Wei J, Yuan Y, Xu H. Comparison of different acceleration factors of artificial intelligence-compressed sensing for brachial plexus MRI imaging: scanning time and image quality. BMC Med Imaging 2024; 24:309. [PMID: 39543482 PMCID: PMC11566112 DOI: 10.1186/s12880-024-01493-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 11/06/2024] [Indexed: 11/17/2024] Open
Abstract
BACKGROUND 3D brachial plexus MRI scanning is prone to examination failure due to the lengthy scan times, which can lead to patient discomfort and motion artifacts. Our purpose is to investigate the efficacy of artificial intelligence-assisted compressed sensing (ACS) in improving the acceleration efficiency and maintaining or enhancing the image quality of brachial plexus MR imaging. METHODS A total of 30 volunteers underwent 3D sampling perfection with application-optimized contrast using different flip angle evolution short time inversion recovery using a 3.0T MR scanner. The imaging protocol included parallel imaging (PI) and ACS employing acceleration factors of 4.37, 6.22, and 9.03. Radiologists evaluated the neural detail display, fat suppression effectiveness, presence of image artifacts, and overall image quality. Signal intensity and standard deviation of specific anatomical sites within the brachial plexus and background tissues were measured, with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) subsequently calculated. Cohen's weighted kappa (κ), One-way ANOVA, Kruskal-Wallis and pairwise comparisons with Bonferroni-adjusted significance level. P < 0.05 was considered statistically significant. RESULTS ACS significantly reduced scanning times compared to PI. Evaluations revealed differences in subjective scores and SNR across the sequences (P < 0.05), with no marked differences in CNR (P > 0.05). For subjective scores, ACS 9.03 were lower than the other three sequences in neural details display, image artifacts and overall image quality. There was no significant difference in fat suppression. For objective quantitative evaluation, SNR of right C6 root in ACS 6.22 and ACS 9.03 was higher than that in PI; SNR of left C6 root in ACS 4.37, ACS 6.22 and ACS 9.03 was higher than that in PI; SNR of medial cord in ACS 6.22, ACS 9.03 was higher than that in PI. CONCLUSION Compared with PI, ACS can shorten scanning time while ensuring good image quality.
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Affiliation(s)
- Tianxin Cheng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Beijing, 100050, China
| | - Feifei Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Beijing, 100050, China
- Department of Radiology, BaoShan Hospital of Traditional Chinese Medicine, Baoshan, Yunnan, China
| | - Xuetao Jiang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Beijing, 100050, China
- Department of Radiology, Zunyi First People's Hospital, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Dan Yu
- United Imaging Research Institute of Intelligent Imaging, Beijing, China
| | - Jie Wei
- Shanghai United Imaging Healthcare Co., Ltd., Shanghai, China
| | - Ying Yuan
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Beijing, 100050, China.
| | - Hui Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Beijing, 100050, China.
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Nakashima M, Kawai T, Matsumoto K, Kawaguchi T, Urano M, Kitera N, Itoh T, Hiwatashi A. Ultra-high-resolution photon-counting detector CT for visualization of the brachial plexus. Eur J Radiol 2024; 181:111810. [PMID: 39504796 DOI: 10.1016/j.ejrad.2024.111810] [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: 09/10/2024] [Accepted: 10/27/2024] [Indexed: 11/08/2024]
Abstract
OBJECTIVES To investigate the use of photon-counting detector CT (PCD-CT) to improve brachial plexus depiction. MATERIALS AND METHODS This retrospective study included patients who underwent neck CT from March to December 2023. To assess the optimal reconstruction condition in PCD-CT, the signal-to-noise ratios (SNRs) on images using various quantitative regular (Qr) kernels and strengths of quantum iterative reconstruction (QIR) were evaluated. Next, images obtained by ultra-high-resolution mode in PCD-CT (PCD-UHR), standard mode in PCD-CT (PCD-STD), and standard mode in energy-integrating detector CT (EID-STD) of 20 patients each were compared regarding brachial plexus depiction. A qualitative evaluation was performed using a 5-point Likert scale regarding sharpness, noise, and overall image quality. The standard deviations (SDs), SNRs, and contrast-to noise ratios (CNRs) were quantitatively evaluated. RESULTS Overall, 60 patients (mean age, 63 years ± 18; 30 males) were included. The SNRs for the Qr40 and QIR4 (means ± SDs) were 3.6 ± 1.1 and 4.1 ± 1.2, respectively, significantly higher than others (P < 0.05). The scores for overall image quality were 4 [4-5], 3 [3-4], and 2 [2-3], and those for sharpness were 4 [3-5], 3 [3-3], and 2 [1-3] for PCD-UHR, PCD-STD, and EID-STD, respectively (all, P < 0.05). Those for noise were 3 [3-4], 4 [3-4], and 2 [2-2], the SDs were 6.6 ± 1.6, 5.4 ± 0.8, and 8.8 ± 1.7, SNRs were 5.0 ± 1.4, 6,1 ± 1.2, and 3.5 ± 1.6, and CNRs were 5.6 ± 1.9, 7.9 ± 1.7, and 4.4 ± 1.8, respectively (between either of the PCD groups and EID-STD, P < 0.05). CONCLUSION PCD-CT showed superior delineation for brachial plexus to EID-CT.
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Affiliation(s)
- Masahiro Nakashima
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Tatsuya Kawai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
| | - Kazuhisa Matsumoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Takatsune Kawaguchi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Misugi Urano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | | | | | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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Gupta R, Herzog I, Phung L, Roth J, Weisberger J, Luthringer M, Lee ES, Ignatiuk A. Treatment of Brachial Plexus Injuries following Gunshot Injuries: A Systematic Review. Adv Orthop 2024; 2024:7708192. [PMID: 39247210 PMCID: PMC11379507 DOI: 10.1155/2024/7708192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 08/20/2024] [Indexed: 09/10/2024] Open
Abstract
Introduction Brachial plexus injuries (BPI) from gunshot injuries are uncommon but usually severe and can cause chronic pain, loss of function, and permanent nerve damage. Multiple surgical techniques including neurolysis, end-to-end suture repair, and graft repair have been described for the treatment of these injuries. However, surgical indication, timing, and technique for these injuries remain controversial. This systematic review aims to investigate the treatment modalities for patients with BPI due to gunshot-related injuries. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology was employed for this review. PubMed, Cochrane Reviews, Embase, and CINAHL databases were included. The following keywords constituted our search criteria: gun-shot-wounds, brachial plexus, traum∗, and management. Results A total of 90 studies were imported for screening, from which 9 papers met our final inclusion/exclusion criteria. The most common studies utilized in this review were retrospective chart reviews followed by case series. In total, there were 628 patients that suffered from gunshot wounds to the brachial plexus. Most patients underwent some form of delayed nerve repair consisting of neurolysis, end-to-end epineural repair, or graft repair with a sural or antebrachial cutaneous nerve graft. Several patients suffered from complications, with neuroma being the most common long-term complication that required reoperation. Conclusion The optimal timing for surgeries involving BPIs should be determined after examining the level of nerve damage, associated injuries, operative risks, and electrophysiological workup for indications of spontaneous regeneration. Early surgical interventions were indicated for patients presenting with associated vascular or thoracic injuries, compressive masses, and nerve transection by sharp instruments in most selected papers.
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Affiliation(s)
- Rohun Gupta
- Division of Plastic and Reconstructive Surgery St. Louis University School of Medicine, St. Louis, MO, USA
| | - Isabel Herzog
- Department of Plastic Surgery Rutgers New Jersey School of Medicine, Newark, NJ, USA
| | - Lauren Phung
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Jacquelyn Roth
- Department of Plastic Surgery Rutgers New Jersey School of Medicine, Newark, NJ, USA
| | - Joseph Weisberger
- Department of Plastic Surgery Rutgers New Jersey School of Medicine, Newark, NJ, USA
| | - Margaret Luthringer
- Department of Plastic Surgery Rutgers New Jersey School of Medicine, Newark, NJ, USA
| | - Edward S Lee
- Department of Plastic Surgery Rutgers New Jersey School of Medicine, Newark, NJ, USA
| | - Ashley Ignatiuk
- Department of Plastic Surgery Rutgers New Jersey School of Medicine, Newark, NJ, USA
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MacDonald IR, Farhat Z, Amoako-Tuffor Y, Maianski I, Erker C, Romao R, Moineddin R, Mata-Mbemba D. MR Imaging of Pediatric Neuroblastoma: Is Gadolinium Enhancement Necessary for Evaluation of Image-Defined-Risk Factors? Can Assoc Radiol J 2024; 75:404-411. [PMID: 38146213 DOI: 10.1177/08465371231218240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
Background: Pre-treatment stratification and outcomes of neuroblastoma patients often depend on the assessment of image-defined risk factors (IDRFs) on MR Imaging, usually using Gadolinium-contrast materials which are cautioned in pediatrics. We aimed to address whether gadolinium contrast-enhanced sequences are necessary to identify the presence/absence of IDRFs. Methods: Patients with neuroblastoma with MR imaging were retrospectively identified from 2005 to 2021. Ninety confirmed IDRFs were evaluated in 23 patients. Corresponding MR studies were anonymized, randomized, and independently evaluated by 3 fellowship-trained pediatric radiologists. Each radiologist assessed the studies twice. At the first reading, all enhanced sequences were omitted, while in the second reading, the full study with enhanced sequences were included. Consensus reading was obtained among readers. Inter- and intra-rater agreements using Kappa statistics (κ) as well as the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of non-enhanced MR in assessing IDRFs with respect to enhanced MR were calculated. Results: There were substantial (ĸ: 0.64-0.73) intra-reader agreements, and moderate to substantial (ĸ: 0.57-0.62) inter-reader agreements among radiologists in identifying IDRFs using non-enhanced MR. Non-enhanced MR had a sensitivity of 87.8% (95% CI [79-94]), specificity of 93% (89-96), PPV of 82.3 (73-89), NPV of 95.4 (92-98), and accuracy of 91.6 (88-94) in identifying IDRFs. However, 5/23 patients (21.7%) had a change in staging with the inclusion of contrast sequences. Conclusion: Although contrast sequences have a role in IDRF assessment, the majority can be adequately assessed on MR without gadolinium-contrast enhancement. Validation in a larger cohort is an important next step.
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Affiliation(s)
- Ian R MacDonald
- Department of Diagnostic Imaging, IWK Health Centre and Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Ziad Farhat
- Department of Diagnostic Imaging, IWK Health Centre and Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Yaw Amoako-Tuffor
- Department of Diagnostic Imaging, IWK Health Centre and Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Irit Maianski
- Department of Diagnostic Imaging, IWK Health Centre and Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Craig Erker
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, IWK Health Centre and Dalhousie University, Halifax, NS, Canada
| | - Rodrigo Romao
- Department of Pediatric General Surgery and Urology, IWK Health Centre and Dalhousie University, Halifax, NS, Canada
| | - Rahim Moineddin
- Departments of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Daddy Mata-Mbemba
- Department of Diagnostic Imaging, IWK Health Centre and Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
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Xu G, Zou X, Dong Y, Alhaskawi A, Zhou H, Ezzi SHA, Kota VG, Abdulla MHAH, Alenikova O, Abdalbary SA, Lu H. Advancements in autologous peripheral nerve transplantation care: a review of strategies and practices to facilitate recovery. Front Neurol 2024; 15:1330224. [PMID: 38523615 PMCID: PMC10959128 DOI: 10.3389/fneur.2024.1330224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Autologous peripheral nerve transplantation, a pioneering technique in nerve injury treatment, has demonstrated remarkable progress. We examine recent nursing strategies and methodologies tailored to various anatomical sites, highlighting their role in postoperative recovery enhancement. Encompassing brachial plexus, upper limb, and lower limb nerve transplantation care, this discussion underscores the importance of personalized rehabilitation plans, interdisciplinary collaboration, and innovative approaches like nerve electrical stimulation and nerve growth factor therapy. Moreover, the exploration extends to effective complication management and prevention strategies, encompassing infection control and pain management. Ultimately, the review concludes by emphasizing the advances achieved in autologous peripheral nerve transplantation care, showcasing the potential to optimize postoperative recovery through tailored and advanced practices.
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Affiliation(s)
- Guoying Xu
- Operating Theater, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang, China
| | - Xiaodi Zou
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | | | | | | | - Olga Alenikova
- Department of Neurology, Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
| | - Sahar Ahmed Abdalbary
- Department of Orthopedic Physical Therapy, Faculty of Physical Therapy, Nahda University in Beni Suef, Beni Suef, Egypt
| | - Hui Lu
- Operating Theater, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang, China
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Hu SX, Xiao Y, Peng WL, Zeng W, Zhang Y, Zhang XY, Ling CT, Li HX, Xia CC, Li ZL. Accelerated 3D MR neurography of the brachial plexus using deep learning-constrained compressed sensing. Eur Radiol 2024; 34:842-851. [PMID: 37606664 DOI: 10.1007/s00330-023-09996-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/20/2023] [Accepted: 06/02/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES To explore the use of deep learning-constrained compressed sensing (DLCS) in improving image quality and acquisition time for 3D MRI of the brachial plexus. METHODS Fifty-four participants who underwent contrast-enhanced imaging and forty-one participants who underwent unenhanced imaging were included. Sensitivity encoding with an acceleration of 2 × 2 (SENSE4x), CS with an acceleration of 4 (CS4x), and DLCS with acceleration of 4 (DLCS4x) and 8 (DLCS8x) were used for MRI of the brachial plexus. Apparent signal-to-noise ratios (aSNRs), apparent contrast-to-noise ratios (aCNRs), and qualitative scores on a 4-point scale were evaluated and compared by ANOVA and the Friedman test. Interobserver agreement was evaluated by calculating the intraclass correlation coefficients. RESULTS DLCS4x achieved higher aSNR and aCNR than SENSE4x, CS4x, and DLCS8x (all p < 0.05). For the root segment of the brachial plexus, no statistically significant differences in the qualitative scores were found among the four sequences. For the trunk segment, DLCS4x had higher scores than SENSE4x (p = 0.04) in the contrast-enhanced group and had higher scores than SENSE4x and DLCS8x in the unenhanced group (all p < 0.05). For the divisions, cords, and branches, DLCS4x had higher scores than SENSE4x, CS4x, and DLCS8x (all p ≤ 0.01). No overt difference was found among SENSE4x, CS4x, and DLCS8x in any segment of the brachial plexus (all p > 0.05). CONCLUSIONS In three-dimensional MRI for the brachial plexus, DLCS4x can improve image quality compared with SENSE4x and CS4x, and DLCS8x can maintain the image quality compared to SENSE4x and CS4x. CLINICAL RELEVANCE STATEMENT Deep learning-constrained compressed sensing can improve the image quality or accelerate acquisition of 3D MRI of the brachial plexus, which should be benefit in evaluating the brachial plexus and its branches in clinical practice. KEY POINTS •Deep learning-constrained compressed sensing showed higher aSNR, aCNR, and qualitative scores for the brachial plexus than SENSE and CS at the same acceleration factor with similar scanning time. •Deep learning-constrained compressed sensing at acceleration factor of 8 had comparable aSNR, aCNR, and qualitative scores to SENSE4x and CS4x with approximately half the examination time. •Deep learning-constrained compressed sensing may be helpful in clinical practice for improving image quality and acquisition time in three-dimensional MRI of the brachial plexus.
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Affiliation(s)
- Si-Xian Hu
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yi Xiao
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wan-Lin Peng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wen Zeng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yu Zhang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xiao-Yong Zhang
- Clinical Science, Philips Healthcare, Chengdu, Sichuan, China
| | - Chun-Tang Ling
- Clinical Science, Philips Healthcare, Chengdu, Sichuan, China
| | - Hai-Xia Li
- C&TS, Philips Healthcare, Guangzhou, Guangdong, China
| | - Chun-Chao Xia
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Zhen-Lin Li
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Felisaz PF, Napolitano A, Terrani S, Parisi C, Toto-Brocchi M, Cè M, Alessandrino F, Oliva G, Cellina M, Gerevini S. An optimized 1.5 Tesla MRI protocol of the brachial plexus. Neuroradiol J 2024; 37:43-53. [PMID: 37621183 PMCID: PMC10863567 DOI: 10.1177/19714009231196475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
PURPOSE Creating an effective MRI protocol for examining the brachial plexus poses significant challenges, and despite the abundance of protocols in the literature, there is a lack of reference standards for basic sequences and essential parameters needed for replication. The aim of this study is to establish a reproducible 1.5 T brachial plexus imaging protocol, including patient positioning, coil selection, imaging planes, and essential sequence parameters. METHODS We systematically investigated MRI sequences, testing each parameter through in vivo experiments, examining their effects on signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), visual quality scores, and acquisition time. Sequences were refined based on optimal quality and timing scores. The final protocol was tested on scanners from two other vendors for reliability. RESULTS The final protocol included a combination of 2D turbo-spin-echo and 3D SPACE T1, SPACE STIR, and VIBE DIXON sequences. Recommendations for imaging planes, phase encoding, field of view, TR, TE, resolution, number of slices, slice thickness, fat and blood suppression, and acceleration strategies are provided. The protocol was successfully translated to other vendor's scanners with comparable quality. CONCLUSION We present an optimized protocol detailing the essential parameters for reproducibility. Our comprehensive list of experiments describes the impact of each parameter on image quality and scan time, addressing common artifacts and potential solutions. This protocol can benefit both young radiologists new to the field and experienced professionals seeking to refine their existing protocols.
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Affiliation(s)
| | | | | | | | - Marco Toto-Brocchi
- Postgraduate School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Maurizio Cè
- Postgraduate School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Francesco Alessandrino
- Division of Abdominal Imaging, Department of Radiology, University of Miami Health System, Miami, FL, USA
| | - Giancarlo Oliva
- Radiology Department, Ospedale Fatebenefratelli e Oftalmico, Milano, Italy
| | - Michaela Cellina
- Radiology Department, Ospedale Fatebenefratelli e Oftalmico, Milano, Italy
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Kotb MA, Bedewi MA, Almalki DM, AlAseeri AA, Sandougah KJ, Soliman SB, Aldossary NM, Aboulela WH. Ultrasound assessment of the brachial plexus nerve root cross-sectional areas in asymptomatic patients with type 2 diabetes. Medicine (Baltimore) 2023; 102:e36806. [PMID: 38206708 PMCID: PMC10754578 DOI: 10.1097/md.0000000000036806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024] Open
Abstract
Type 2 diabetes mellitus (T2D) is one of the most common metabolic diseases and is often associated with cervical radiculoplexus neuropathies. Magnetic resonance imaging is the modality of choice for evaluating the brachial plexus, however, the use of ultrasound for its evaluation has increased and has been shown to be an additional reliable method. We aimed to compare the cross-sectional areas of the C5, C6, and C7 nerve roots of the brachial plexus, at the interscalene groove, in asymptomatic patients with T2D to that of an asymptomatic control cohort without T2D. A total of 25 asymptomatic patients with T2D were recruited from outpatient clinics. A total of 18 asymptomatic subjects without T2D were also recruited from hospital staff volunteers to form the control cohort. High-resolution ultrasound imaging of the bilateral C5, C6, and C7 nerve roots of the brachial plexus was performed in the short axis, at the level of the interscalene grooves. The nerve root cross-sectional areas were recorded and compared. In the patients with T2D, HbA1c and fasting blood glucose (FBG) levels were obtained as well as the duration of T2D in years and correlated with cross-sectional areas. The cross-sectional areas of C6 and C7 were significantly smaller in the T2D cohort. Additionally, HbA1c, and FBG levels as well as the duration of T2D were negatively correlated with the C5, C6, and C7 cross-sectional areas. Our study demonstrated smaller brachial plexus nerve root cross-sectional areas in asymptomatic patients with T2D which negatively correlated with HbA1c, and FBG levels as well as the duration of T2D.
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Affiliation(s)
- Mamdouh Ali Kotb
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz University, College of Medicine, Al-Kharj, Kingdom of Saudi Arabia
- Neurology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mohamed A. Bedewi
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz University, College of Medicine, Al-Kharj, Kingdom of Saudi Arabia
| | - Daifallah Mohamed Almalki
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz University, College of Medicine, Al-Kharj, Kingdom of Saudi Arabia
| | - Ali Abdullah AlAseeri
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz University, College of Medicine, Al-Kharj, Kingdom of Saudi Arabia
| | - Kholoud J. Sandougah
- Department of Medicine, College of Medicine, Al Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Steven B. Soliman
- Division of Musculoskeletal Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Nasser M. Aldossary
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz University, College of Medicine, Al-Kharj, Kingdom of Saudi Arabia
| | - Wael Hamed Aboulela
- Neurosurgery Department, Faculty of Medicine, Minia University, Minia, Egypt
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Chen R, Ran Y, Wu Y, Xu H, Niu J, Zhang Y, Cheng J. The value of the cinematic volume rendering technique: magnetic resonance imaging in diagnosing tumors associated with the brachial plexus. Eur J Med Res 2023; 28:569. [PMID: 38053185 DOI: 10.1186/s40001-023-01416-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/30/2023] [Indexed: 12/07/2023] Open
Abstract
PURPOSE To examine the diagnostic advantages and clinical application value of the cinematic volume rendering technique (cVRT) when evaluating the relationship between the brachial plexus, peripheral tumor lesions, and blood vessels. MATERIALS AND METHODS Seventy-nine patients with brachial plexus tumors between November 2012 and July 2022 were enrolled in our study. All patients underwent T1WI, T2WI, three-dimensional short recovery time reversal recovery fast spin-echo imaging (3D-STIR-SPACE), and the T1WI enhancement sequence. In addition, cVRT was used to render and obtain a three-dimensional model that clearly showed the location and tissue structure of the brachial plexus nerves and the tumor in all directions. RESULTS Seventy-one patients (mean age, 47.1 years; 33 males, 38 females) with tumors around the brachial plexus were included in the study. The brachial plexus nerve, surrounding tumor lesions, and vascular anatomy of all patients were well displayed with cVRT. The tumors of 37 patients manifested as unilateral or bilateral growths along the brachial plexus nerve and were fusiform, spherical, or multiple beaded; seven patients' tumors pushed against the brachial plexus nerve and were circular, lobular, or irregular; sixteen patients' tumors encircled the brachial plexus nerve and were spherical; and eleven patients' tumors infiltrated the brachial plexus nerve and had irregular morphology. The mass has a moderately uniform or uneven signal on T1WI and a high or mixed signal on T2WI. After enhancement, the signal was evenly or unevenly strengthened. CONCLUSIONS cVRT clearly showed the origin of tumors associated with the brachial plexus and their relationship with the nerves and peripheral blood vessels, providing reliable information for clinical diagnosis and treatment.
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Affiliation(s)
- Rui Chen
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuncai Ran
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanglei Wu
- MR Collaborations, Siemens Healthineers Ltd, Beijing, China
| | - Haowen Xu
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junxia Niu
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Mathew A, Panwar J, Shanmugasundaram D, Thomas BP. Will preoperative combined MRI and high-resolution ultrasonography redefine brachial plexus imaging? A comparative study of preoperative MRI versus combined MRI and high-resolution ultrasonography in assessing usable C5, C6 root-stumps for intra-plexal nerve grafting. Clin Radiol 2023; 78:e1023-e1031. [PMID: 37777386 DOI: 10.1016/j.crad.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/15/2023] [Accepted: 08/29/2023] [Indexed: 10/02/2023]
Abstract
AIM To compare the intraoperative findings with the preoperative imaging in detecting usable root stumps using magnetic resonance imaging (MRI) alone versus MRI combined with high-resolution ultrasonography (HRUS) in adults undergoing post-traumatic brachial plexus (BP) surgery. Further, when root stumps were present, the reliability of their measurements using both imaging methods was compared to their intraoperative length. MATERIALS AND METHODS A consecutive group of adults who were planned for post-traumatic BP surgery between July 2015 and April 2016 were evaluated prospectively. They underwent preoperative MRI and HRUS and the agreement (kappa value) between these imaging methods and their intraoperative findings in categorising roots were then compared. When stumps were present, the reliability of the extraforaminal measurements by each method were compared to their corresponding intraoperative stump length using intraclass correlation coefficients (ICC), and Bland-Altman plots. RESULTS Of the initial 60 patients, 48 patients with 82 roots were included in the study. Greater agreement was observed between HRUS and intraoperative findings in categorising BP root stumps (kappa value 0.70, SE 0.07) versus MRI and intraoperative findings (kappa value 0.42, SE 0.07). Similarly, there was a higher correlation between HRUS and intraoperative findings (ICC: 0.94, p<0.001) than that of MRI and intraoperative findings (ICC: 0.53, p<0.001) regarding stump length measurements. CONCLUSION Combining HRUS with MRI in the preoperative imaging of the adult BP injury can better predict the presence of usable nerve root stumps for intra-plexal nerve grafting. HRUS also gave reliable preoperative stump length measurements, and it was determined that a stump should be at least 1.3 cm to be deemed usable for nerve grafting.
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Affiliation(s)
- A Mathew
- Paul Brand Center for Hand Surgery, Christian Medical College, Vellore 632004, India
| | - J Panwar
- Department of Radiology, Christian Medical College, Vellore 632004, Tamil Nadu, India.
| | - D Shanmugasundaram
- Division of Epidemiology & Biostatistics, ICMR-National Institute of Epidemiology, Chennai, India
| | - B P Thomas
- Paul Brand Center for Hand Surgery, Christian Medical College, Vellore 632004, India
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12
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Payen M, Didier M, Vialle R, Lehericy S, Fitoussi F, Bachy M. MRI of brachial plexus using diffusion tensor imaging: a pilot study for the use of resolve sequence surgical and radiologic anatomy. Surg Radiol Anat 2023; 45:1567-1577. [PMID: 37884742 DOI: 10.1007/s00276-023-03255-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Clinical exam is the goldstandard for surgical indication. ENMG and conventional MRI are insufficient to understand the highly variable clinical presentation of brachial plexus (BP) lesions. DTI is based on motion of water molecules and can explore nerve function. PURPOSE This pilot study of healthy subjects aimed to develop RESOLVE sequence for BP exploration using diffusion MRI. The main objective was to provide complete precise information from DTI cartography associated with anatomical data. METHODS Six healthy volunteers were scanned using 3T PRISMA scanner with anatomic 3D STIR SPACE and RESOLVE diffusion sequences. Diffusion parametric maps of fractional anisotropy (FA) were extracted from RESOLVE acquisitions. A reproducible method for roots volumes and angles measurements was created using 3DSlicer. ROI were segmented on Mean B0 sequences. FA measurements were obtained with ROI on Mean B0 sequences. RESULTS RESOLVE sequence was adapted to the BP. Mean FA was 0.30. Angles measurements on 3D STIR SPACE sequences showed increasing values from proximal to distal roots with an 0.6 ICC. Volume measurements on anatomic sequences varied widely from one root to another but did not show any significant difference on laterality. CONCLUSIONS A new and reproducible method for BP exploration was developed, using MRI RESOLVE DTI sequences. Complete mapping was obtained but a low resolution of track density imaging did not allow to exploit distal nerves. Deterministic tractography principal limit was the lack of resolution. Extraction of diffusion, volumetric and angular parameters of the plexus roots, and scripts creation for image processing was adapted to the healthy BP.
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Affiliation(s)
- M Payen
- Clinique Chirurgicale Infantile, Hôpital Charles-Nicolle, CHU Rouen, 37 Boulevard Gambetta, 76038, Rouen, France.
- Department of Pediatric Orthopaedics, Sorbonne Université, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France.
- Clinical Research Group on Robotics and Surgical Innovations, GRC-33, Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France.
- The MAMUTH Hospital-University Federation for Innovative Therapies in Musculoskeletal Diseases-Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France.
| | - M Didier
- Paris Brain Institute-ICM, Center for NeuroImaging Research-CENIR, Paris, France
| | - R Vialle
- Department of Pediatric Orthopaedics, Sorbonne Université, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France
- Clinical Research Group on Robotics and Surgical Innovations, GRC-33, Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
- The MAMUTH Hospital-University Federation for Innovative Therapies in Musculoskeletal Diseases-Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
| | - S Lehericy
- Paris Brain Institute-ICM, Center for NeuroImaging Research-CENIR, Paris, France
- Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS, UMR 7225, Pitié-Salpêtrière Hospital, Paris, France
- Investigations and Therapeutics" (MOV'IT), ICM Team "Movement, Paris, France
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - F Fitoussi
- Department of Pediatric Orthopaedics, Sorbonne Université, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France
- Clinical Research Group on Robotics and Surgical Innovations, GRC-33, Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
- The MAMUTH Hospital-University Federation for Innovative Therapies in Musculoskeletal Diseases-Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
| | - M Bachy
- Department of Pediatric Orthopaedics, Sorbonne Université, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France
- Clinical Research Group on Robotics and Surgical Innovations, GRC-33, Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
- The MAMUTH Hospital-University Federation for Innovative Therapies in Musculoskeletal Diseases-Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
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13
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Pribowo MA, Harahap MIR, Fazharyasti V, Dwihapsari Y, Kartikasari Y, Sugiyanto. Non-contrast enhancement of brachial plexus magnetic resonance imaging with compressed sensing. Eur J Radiol 2023; 165:110890. [PMID: 37269572 DOI: 10.1016/j.ejrad.2023.110890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/03/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To observe the quality of brachial plexus (BP) images obtained from magnetic resonance imaging (MRI) with 3D T2 STIR SPACE sequence and compressed sensing (CS) and to compare the results with BP images from the same sequence without CS. METHODS In this study, compressed sensing was applied to acquire non-contrast BP images from ten healthy volunteers with 3D T2 STIR SPACE sequence to shorten acquisition time without sacrificing image quality. The acquisition time of scanning with CS was compared to that without CS. The quantitative signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated and compared using paired t-test to determine the quality of images with and without CS. The qualitative assessment by three experienced radiologists was performed using a scoring scale from 1 (poor) to 5 (excellent) and analyzed for interobserver agreement on image quality. RESULTS The increasing SNR and CNR of images with CS were found in nine regions of BP images (p < 0.001) with faster acquisition time. The result of paired t-test (p < 0.001) illustrates the significant difference between images with CS compared to images without CS. The assessment of observers also shows higher scores for images with CS compared to images without CS. CONCLUSIONS This study demonstrates that CS can effectively increase the visibility of images and image boundaries, SNR, and CNR of BP images obtained with 3D T2 STIR SPACE sequence with the good interobserver agreement and within clinically optimal acquisition time compared to images from similar sequence without CS.
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Affiliation(s)
- Muhammad Agus Pribowo
- Department of Radiology, Gatot Soebroto Army Hospital (RSPAD Gatot Soebroto), Jakarta 10410, Indonesia
| | | | - Vininta Fazharyasti
- Department of Radiology, Gatot Soebroto Army Hospital (RSPAD Gatot Soebroto), Jakarta 10410, Indonesia
| | - Yanurita Dwihapsari
- Department of Physics, Institut Teknologi Sepuluh Nopember (ITS), Surabaya 60111, Indonesia.
| | - Yeti Kartikasari
- Health Polytechnic of Semarang, Ministry of Health, Semarang 50239, Indonesia
| | - Sugiyanto
- Health Polytechnic of Semarang, Ministry of Health, Semarang 50239, Indonesia
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14
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Mandeville R, Deshmukh S, Tan ET, Kumar V, Sanchez B, Dowlatshahi AS, Luk J, See RHB, Leochico CFD, Thum JA, Bazarek S, Johnston B, Brown J, Wu J, Sneag D, Rutkove S. A scoping review of current and emerging techniques for evaluation of peripheral nerve health, degeneration and regeneration: part 2, non-invasive imaging. J Neural Eng 2023; 20:041002. [PMID: 37369193 DOI: 10.1088/1741-2552/ace217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/27/2023] [Indexed: 06/29/2023]
Abstract
Peripheral neuroregenerative research and therapeutic options are expanding exponentially. With this expansion comes an increasing need to reliably evaluate and quantify nerve health. Valid and responsive measures of the nerve status are essential for both clinical and research purposes for diagnosis, longitudinal follow-up, and monitoring the impact of any intervention. Furthermore, novel biomarkers can elucidate regenerative mechanisms and open new avenues for research. Without such measures, clinical decision-making is impaired, and research becomes more costly, time-consuming, and sometimes infeasible. Part 1 of this two-part scoping review focused on neurophysiology. In part 2, we identify and critically examine many current and emerging non-invasive imaging techniques that have the potential to evaluate peripheral nerve health, particularly from the perspective of regenerative therapies and research.
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Affiliation(s)
- Ross Mandeville
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Swati Deshmukh
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Ek Tsoon Tan
- Department of Radiology, Hospital for Special Surgery, New York, NY 10021, United States of America
| | - Viksit Kumar
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Benjamin Sanchez
- Department Electrical and Computer Engineering, University of Utah, Salt Lake City, UT 84112, United States of America
| | - Arriyan S Dowlatshahi
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Justin Luk
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Reiner Henson B See
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Carl Froilan D Leochico
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Global City, Taguig, The Philippines
- Department of Rehabilitation Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, The Philippines
| | - Jasmine A Thum
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Stanley Bazarek
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, United States of America
| | - Benjamin Johnston
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, United States of America
| | - Justin Brown
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Jim Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Darryl Sneag
- Department of Radiology, Hospital for Special Surgery, New York, NY 10021, United States of America
| | - Seward Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
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15
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Singh DK, Kumar N, Bhayana A, Altamash M, Sharma A, Agarwal A. A pentavalent approach for the evaluation of traumatic brachial plexopathy on MRI: correlation of macropattern and micropattern. Br J Radiol 2023; 96:20220913. [PMID: 36752595 PMCID: PMC10230398 DOI: 10.1259/bjr.20220913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
Macropattern analysis of traumatic brachial plexopathy (TBP) by Magnetic Resonance Imaging (MRI) encompasses localization of injured segments and determination of the severity of injury. The micropattern analysis implies the correlation of the MRI features of TBP with Sunderland's grading of the nerve injury, thereby guiding the management protocol. This review article presents a simplified novel pentavalent approach for the radiological anatomy of brachial plexus, MRI acquisition protocol for the evaluation of brachial plexus, cardinal imaging signs of TBP, and their correlation with Sunderland's microanatomical grading.
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Affiliation(s)
- Dharmendra Kumar Singh
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Nishith Kumar
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Aanchal Bhayana
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Mohd. Altamash
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Anuradha Sharma
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Anuj Agarwal
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Doi K, Marei AE, Hattori Y, Sakamoto S, Sonezaki S. Diagnostic Accuracy of Magnetic Resonance Imaging With 3-Dimensional T2-SPACE Techniques for Preganglionic Injury of the Brachial Plexus. J Hand Surg Am 2022; 47:953-961. [PMID: 36041945 DOI: 10.1016/j.jhsa.2022.06.023] [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: 11/13/2021] [Revised: 05/07/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE An accurate diagnosis of the site and severity of a brachial plexus injury is imperative for selecting the appropriate management. Conventional magnetic resonance imaging (MRI) does not allow for the precise interpretation of preganglionic injuries (pre-GIs), especially intravertebral canal injuries. We developed 4 MRI sequences of conventional 1.5-tesla 3-dimensional T2-weighted turbo spin echo sampling perfection with the application of optimized contrasts using different flip angles evolution (T2-SPACE) images to clearly visualize each component of the brachial plexus. The purpose of this study was to introduce basic normal and pathologic findings of our current MRI approach, focusing on its diagnostic accuracy for pre-GIs. METHODS We initially examined 119 patients with brachial plexus injuries who underwent surgical exploration by MRI using 4 sequences of the 1.5-tesla 3-dimensional T2-SPACE technique. We obtained coronal, transverse, coronal oblique, and coronal cuts of T2 short time inversion recovery. The images of 595 roots were interpreted by multiple-image synchronizing techniques of the 4 views to precisely interpret the presence of spinal cord edema, numbers of anterior and posterior rootlets, sites of ganglions, meningeal cysts, and the "black line sign" (displaced ruptured dura or bundles of ruptured rootlets). We assessed the accuracy, sensitivity, and specificity of these abnormal findings with regard to diagnosing pre-GIs by comparing surgical exploration. RESULTS The absence or decreased numbers of anterior and posterior rootlets and displacement of ganglions were definitive evidence of pre-GIs and the other findings, like spinal cord edema, meningeal cysts, and black line signs, were predictive signs. CONCLUSIONS The synchronizing techniques of the four 1.5-tesla 3-dimensional T2-SPACE images provided high diagnostic accuracy of pre-GIs. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- Kazuteru Doi
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Japan.
| | - Abdelhakim Ezzat Marei
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Japan; Department of Orthopaedic Surgery and Traumatology, Tanta University, Tanta, Egypt
| | - Yasunori Hattori
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Japan
| | - Sotetsu Sakamoto
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Japan
| | - Shichoh Sonezaki
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Japan
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17
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Nicholson CA, Nickless JT, Blomgren JA. Cervical Nerve Root Avulsion: A Case Report. Curr Sports Med Rep 2022; 21:362-365. [DOI: 10.1249/jsr.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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Hardie C, Brooks J, Wade R, Teh I, Bourke G. Diagnostic accuracy of magnetic resonance imaging for nerve injury in obstetric brachial plexus injury: protocol for systematic review and meta-analysis. Syst Rev 2022; 11:173. [PMID: 35987695 PMCID: PMC9392905 DOI: 10.1186/s13643-022-02037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 07/28/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Early and accurate clinical diagnosis of the extent of obstetric brachial plexus injury (OBPI) is challenging. The current gold standard for delineating the nerve injury is surgical exploration, and synchronous reconstruction is performed if indicated. Magnetic resonance imaging (MRI) is a non-invasive method of assessing the anatomy and severity of nerve injury in OBPI but the diagnostic accuracy is unclear. The primary objective of this review is to determine the diagnostic accuracy of MRI in comparison to surgical brachial plexus exploration for detecting root avulsion in children under 5 with OBPI. The secondary objectives are to determine its' diagnostic accuracy for detecting nerve abnormality and detecting pseudomeningocele(s) in this group. METHODS This review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).We will include studies reporting the accuracy of MRI (index test) compared to surgical exploration (reference standard) in detecting any of the three target conditions (root avulsion, any nerve abnormality and pseudomeningocele) in children under five with OBPI. Case reports and studies where the number of true positives, false positives, true negatives and false negatives cannot be derived will be excluded. We plan to search PubMed, Embase and CENTRAL for relevant studies from database inception to 15 June 2022. We will also search grey literature (medRxiv, bioRxiv and Google Scholar) and perform forward and backward citation chasing. Screening and full-text assessment of eligibility will be conducted by two independent reviewers, who will then both extract the relevant data. The QUADAS-2 tool will be used to assess methodological quality and risk of bias of included studies by two reviewers independently. The following test characteristics for the target conditions will be extracted: true positives, false positives, true negatives and false negatives. Estimates of sensitivity and specificity with 95% confidence intervals will be shown in forest plots for each study. If appropriate, summary sensitivities and specificities for target conditions will be obtained via meta-analyses using a bivariate model. DISCUSSION This study will aim to clarify the diagnostic accuracy of MRI for detecting nerve injury in OBPI and define its clinical role. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021267629.
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Affiliation(s)
- Claire Hardie
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - James Brooks
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
| | - Ryckie Wade
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Irvin Teh
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Grainne Bourke
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
- Department of Integrative Medical Biology, University of Umea, Umeå, Sweden
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Brogan DM, Osei DA, Colorado BS, Sneag DB, Van Voorhis A, Dy CJ. Team Approach: Management of Brachial Plexus Injuries. JBJS Rev 2022; 10:01874474-202204000-00005. [PMID: 35427254 DOI: 10.2106/jbjs.rvw.21.00222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Traumatic brachial plexus injuries are relatively rare but potentially devastating injuries with substantial functional, psychological, and economic consequences. » Prompt referral (ideally within 6 weeks of injury) to a center with a team of experts experienced in the diagnosis and management of these injuries is helpful to achieving optimal outcomes. » Preoperative and intraoperative decision-making to diagnose and plan reconstructive procedures is complex and must take into account a number of factors, including the time from injury, concomitant injuries, preservation of cervical nerve roots, and the availability of intraplexal and extraplexal donor nerves for nerve transfer. » A team approach is essential to ensure accurate localization of the pathology before surgery and to maximize rehabilitation after surgery, necessitating close contact between the surgical team, physiatrists, radiologists, and therapists.
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Affiliation(s)
- David M Brogan
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | | | - Berdale S Colorado
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | | | - Anna Van Voorhis
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri
| | - Christopher J Dy
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
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20
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Gürün E, Akdulum İ, Akyüz M, Oktar SÖ. Shear wave elastography evaluation of brachial plexus in multiple sclerosis. Acta Radiol 2022; 63:520-526. [PMID: 33730859 DOI: 10.1177/02841851211002828] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neuroinflammatory disease characterized by inflammation involving the peripheral nerves. Shear wave elastography (SWE) is potentially a method of choice for detecting peripheral nerve involvement. PURPOSE To compare the degree of thickening and nerve elasticity of brachial plexus (BP) nerve roots and evaluate the usefulness of sonoelastography in patients with clinically diagnosed MS without brachial plexopathy. MATERIAL AND METHODS Thirty-two patients with MS and 32 controls were included in the study. Bilateral C5, C6, and C7 mean nerve root diameters, and mean elasticity values in kiloPascal (kPa) were measured in the patient and control groups. The relationship between the age, height, and weight values and nerve diameter-elasticity values of the patient and control groups was compared. RESULTS The elasticity values of the C5 and C6 nerve roots were increased, and the nerve root thickness was decreased in the MS group compared to that in the control (P < 0.05). There was no difference between the C7 mean nerve root elasticity (kPa) and diameter measurements in the patient and control groups (P > 0.05). CONCLUSION Our study showed an increase in the BP nerve root elasticity values (kPa) in patients with MS compared to that of the control group and a decrease in diameter values thought to be related to the possible chronic atrophic process. The results are consistent with the demyelinating process of the peripheral nervous system (PNS) due to MS.
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Affiliation(s)
- Enes Gürün
- Department of Radiology, Gazi University, Ankara, Turkey
- Current affiliation: İskilip Atıf Hoca State Hospital, Çorum, Turkey
| | - İsmail Akdulum
- Department of Radiology, Gazi University, Ankara, Turkey
| | - Melih Akyüz
- Department of Radiology, Gazi University, Ankara, Turkey
- Current affiliation: Rush University Medical Center, Chicago, IL, USA
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21
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Szaro P, Geijer M, Ciszek B, McGrath A. Magnetic resonance imaging of the brachial plexus. Part 2: Traumatic injuries. Eur J Radiol Open 2022; 9:100397. [PMID: 35111891 PMCID: PMC8789590 DOI: 10.1016/j.ejro.2022.100397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/09/2022] [Accepted: 01/18/2022] [Indexed: 01/09/2023] Open
Abstract
The most common indications for magnetic resonance imaging (MRI) of the brachial plexus (BP) are traumatic injuries. The role of MRI of the BP has increased because of recent trends favoring earlier surgery. Determining preganglionic vs. postganglionic injury is essential, as different treatment strategies are required. Thus, MRI of the BP should be supplemented with cervical spine MRI to assess the intradural part of the spinal nerves, including highly T2-weighted techniques. Acute preganglionic injuries usually manifest as various combinations of post-traumatic pseudomeningocele, the absence of roots, deformity of nerve root sleeves, displacement of the spinal cord, hemorrhage in the spinal canal, presence of scars in the spinal canal, denervation of the back muscles, and syrinx. Spinal nerve root absence is more specific than pseudomeningocele on MRI. Acute postganglionic injuries can present as lesions in continuity or tears. The following signs indicate injury to the BP: side-to-side difference, swelling, partial, or total BP rupture. Injury patterns and localization are associated with the mechanism of trauma, which implies a significant role for MRI in the work-up of patients. The identification and description of traumatic lesions involving the brachial plexus need to be systematic and detailed. Using an appropriate MRI protocol, obtaining details about the injury, applying a systematic anatomical approach, and correlating imaging findings to relevant clinical data to make a correct diagnosis. Information about the presence or suspicion of root avulsion should always be provided.
Trauma is the most common indication for MRI of the brachial plexus. MRI of the brachial plexus should include cervical spine MRI. Spinal nerve root absence is seen in preganglionic injuries. Determining preganglionic vs. postganglionic injury is essential for treatment planning. Appropriate MRI rapport is crucial in communication with the clinician.
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22
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Bai Y, Wang Y, Ma C, Wu L, Zhou Q, Zhang C, Xia C. Application value of enhanced 3D STIR SPACE sequence in brachial plexus. Minerva Surg 2021; 77:73-76. [PMID: 33944522 DOI: 10.23736/s2724-5691.21.08905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Yupeng Bai
- Medical Image Center, The Third Affiliated Hospital of Anhui Medical University/Hefei No1. People's Hospital, Hefei, China
| | - Yueyue Wang
- Medical Image Center, Hefei Binhu Hospital, Hefei, China
| | - Changyue Ma
- Medical Image Center, The Third Affiliated Hospital of Anhui Medical University/Hefei No1. People's Hospital, Hefei, China
| | - Lingqiao Wu
- Medical Image Center, Hefei Binhu Hospital, Hefei, China
| | - Qian Zhou
- Medical Image Center, Hefei Binhu Hospital, Hefei, China
| | - Chunyan Zhang
- Medical Image Center, Hefei Binhu Hospital, Hefei, China
| | - Chunhua Xia
- Medical Image Center, The Third Affiliated Hospital of Anhui Medical University/Hefei No1. People's Hospital, Hefei, China -
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23
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Smith BW, Chang KWC, Parmar HA, Ibrahim M, Yang LJS. MRI evaluation of nerve root avulsion in neonatal brachial plexus palsy: understanding the presence of isolated dorsal/ventral rootlet disruption. J Neurosurg Pediatr 2021; 27:589-593. [PMID: 33711804 DOI: 10.3171/2020.9.peds20326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 09/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The evaluation, treatment, and prognosis of neonatal brachial plexus palsy (NBPP) continues to have many areas of debate, including the use of ancillary testing. Given the continued improvement in imaging, it is important to revisit its utility. Nerve root avulsions have historically been identified by the presence of pseudomeningoceles or visible ruptures. This "all-or-none" definition of nerve root avulsions has many implications for the understanding and management of NBPP, especially as characterization of the proximal nerve root as a potential donor remains critical. This study examined the ability of high-resolution MRI to more specifically define the anatomy of nerve root avulsions by individually examining the ventral and dorsal rootlets as they exit the spinal cord. METHODS This is a retrospective review of patients who had undergone brachial plexus protocol MRI for clinical evaluation of NBPP at a single institution. Each MR image was independently reviewed by a board-certified neuroradiologist, who was blinded to both established diagnosis/surgical findings and laterality. Each dorsal and ventral nerve rootlet bilaterally from C5 to T1 was evaluated from the spinal cord to its exit in the neuroforamen. Each rootlet was classified as avulsed, intact, or undeterminable. RESULTS Sixty infants underwent brachial plexus protocol MRI from 2010 to 2018. All infants were included in this study. Six hundred individual rootlets were analyzed. There were 49 avulsed nerve rootlets in this cohort. Twenty-nine (59%) combined dorsal/ventral avulsions involved both the ventral and dorsal rootlets, and 20 (41%) were either isolated ventral or isolated dorsal rootlet avulsions. Of the isolated avulsion injuries, 13 (65%) were dorsal only, meaning that the motor rootlets were intact. CONCLUSIONS A closer look at nerve root avulsions with MRI demonstrates a significant prevalence (approximately 41%) of isolated dorsal or ventral nerve rootlet disruptions. This finding implies that nerve roots previously labeled as "avulsed" but with only isolated dorsal (sensory) rootlet avulsion can yet provide donor fascicles in reconstruction strategies. A majority (99%) of the rootlets can be clearly visualized with MRI. These findings may significantly impact the clinical understanding of neonatal brachial plexus injury and its treatment.
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Abstract
Thoracic outlet syndrome (TOS) describes a complex disease process with three anatomic variations each with their own individual characteristics. Understanding the prevalence, diagnosis, and treatment of TOS is challenging for many providers. For this reason, the establishment of comprehensive care models and expert leadership by dedicated vascular surgeons with TOS experience has been invaluable.
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Affiliation(s)
- Kathryn L DiLosa
- Division of Vascular and Endovascular Surgery, University of California Davis Health, 2315 Stockton Boulevard, NAOB 5001, Sacramento, CA 95817
| | - Misty D Humphries
- Division of Vascular and Endovascular Surgery, University of California Davis Health, 2315 Stockton Boulevard, NAOB 5001, Sacramento, CA 95817.
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25
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Perumal AR, Anyamele UA, Bhogal RK, McCauley G, Teh I, Bourke G, Rankine JJ, Wade RG. Incidental findings associated with magnetic resonance imaging of the brachial plexus. Br J Radiol 2021; 94:20200921. [PMID: 33156721 PMCID: PMC7774680 DOI: 10.1259/bjr.20200921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The identification and management of incidental findings is becoming increasingly problematic, particularly in relation to brachial plexus imaging because the prevalence is unknown. Therefore, we aimed to estimate the prevalence of incidental findings in symptomatic patients undergoing MRI of the brachial plexus. METHODS This retrospective cohort study included all children and adults who underwent MRI over a 12-year period, in a tertiary care centre in the UK. An incidental finding was any abnormality which was not a direct injury to or disease-process of the brachial plexus. An "incidentaloma" was defined by the need for further investigation or treatment. Multivariable logistic regression was used to estimate the odds ratio (OR) of an "incidentaloma". To estimate which factors were associated with the incident rate ratio (IRR) of incidental findings, multivariable Poisson regression was used. RESULTS Overall, 502 scans (72%) reported incidental anomalies. Although the number of MRIs performed per annum increased by 23%, the prevalence of "incidentalomas" remained static (p = 0.766). Musculoskeletal incidental findings were the most prevalent (63%) and when identified, there were a median of 3 incidental anomalies per patient. Overall, 125 (18%) anomalies were "incidentalomas" which required further investigation or treatment. The odds of having further investigation or treatment was strongly related to the frequency of incidental findings [adjusted OR 1.16 (95% CI 1.08, 1.24)] and when a tumour was identified [adjusted OR 2.86 (95% CI 1.81, 4.53)]. The number of incidental findings recorded per scan increased when trainees co-reported with consultants [adjusted IRR 0.36 (95% CI 0.05, 0.67)] and in the presence of a tumour [adjusted IRR 0.39 (95% CI 0.28, 0.49)]. CONCLUSIONS The prevalence of clinically important incidental findings on brachial plexus MRI is lower than organ-specific imaging, but still 18% of scans identified an 'incidentaloma' which required further investigation or treatment. ADVANCES IN KNOWLEDGE This cohort study shows that approximately 1 in 5 symptomatic patients undergoing a brachial plexus MRI had a clinically important incidental findings, which required further investigation or treatment. This information can be used to inform patients consenting to clinical or research imaging.
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Affiliation(s)
- Antonia R Perumal
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK
| | | | - Rayna K Bhogal
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK
| | | | - Irvin Teh
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - James J Rankine
- Department of Radiology, Leeds Teaching Hospitals Trust, Leeds, UK
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Diffusion tensor imaging of the roots of the brachial plexus: a systematic review and meta-analysis of normative values. Clin Transl Imaging 2020; 8:419-431. [PMID: 33282795 PMCID: PMC7708343 DOI: 10.1007/s40336-020-00393-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023]
Abstract
Purpose Diffusion tensor magnetic resonance imaging (DTI) characterises tissue microstructure and provides proxy measures of myelination, axon diameter, fibre density and organisation. This may be valuable in the assessment of the roots of the brachial plexus in health and disease. Therefore, there is a need to define the normal DTI values. Methods The literature was systematically searched for studies of asymptomatic adults who underwent DTI of the brachial plexus. Participant characteristics, scanning protocols, and measurements of the fractional anisotropy (FA) and mean diffusivity (MD) of each spinal root were extracted by two independent review authors. Generalised linear modelling was used to estimate the effect of experimental conditions on the FA and MD. Meta-analysis of root-level estimates was performed using Cohen's method with random effects. Results Nine articles, describing 316 adults (1:1 male:female) of mean age 35 years (SD 6) were included. Increments of ten diffusion sensitising gradient directions reduced the mean FA by 0.01 (95% CI 0.01, 0.03). Each year of life reduced the mean MD by 0.03 × 10-3 mm2/s (95% CI 0.01, 0.04). At 3-T, the pooled mean FA of the roots was 0.36 (95% CI 0.34, 0.38; I 2 98%). The pooled mean MD of the roots was 1.51 × 10-3 mm2/s (95% CI 1.45, 1.56; I 2 99%). Conclusions The FA and MD of the roots of the brachial plexus vary according to experimental conditions and participant factors. We provide summary estimates of the normative values in different conditions which may be valuable to researchers and clinicians alike.
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Imaging of the spine and spinal cord: An overview of magnetic resonance imaging (MRI) techniques. Rev Neurol (Paris) 2020; 177:451-458. [PMID: 32800350 DOI: 10.1016/j.neurol.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/17/2020] [Indexed: 12/25/2022]
Abstract
This review will discuss conventional and advanced magnetic resonance (MRI) imaging techniques used to study the spine and spinal cord according to the anatomical structures and clinical indications. Clinical challenges that neuroradiologists may face are also discussed, such as the "when" and "where" concerning the use of each technique, and in which pathology or clinical scenario each technique is useful. Finally, some "tips and tricks" to overcome the challenges are provided with clinical examples.
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28
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Combine contrast-enhanced 3D T2-weighted short inversion time inversion recovery MR neurography with MR angiography at 1.5 T in the assessment of brachial plexopathy. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 34:229-239. [DOI: 10.1007/s10334-020-00867-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/20/2020] [Accepted: 07/08/2020] [Indexed: 12/21/2022]
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Abdolrazaghi H, Riyahi A, Zamenjany MR. Large venous hemangioma of brachial plexus. Ann Card Anaesth 2020; 23:218-220. [PMID: 32275040 PMCID: PMC7336981 DOI: 10.4103/aca.aca_73_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this report, we present a rare case of a vascular brachial plexus tumor. The patient was a 29-year-old woman with the chief complaint of progressive enlargement of a soft tissue mass in the left upper extremity, without any pain or sensory, motor, or neurologic deficits. The soft tissue mass had presented in the left deltopectoral groove eight years ago. However, the patient had not been evaluated in the past eight years and was only recently admitted to a referral hospital. After complete examination, she underwent surgery for a nerve sheath tumor of the brachial plexus.
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Affiliation(s)
- Hosseinali Abdolrazaghi
- Department of Hand and Reconstructive Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Azade Riyahi
- Department of Occupational Therapy, School of Rehabilitation, Arak University of Medical Science, Arak, Iran
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30
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Wade RG, Takwoingi Y, Wormald JCR, Ridgway JP, Tanner S, Rankine JJ, Bourke G. MRI for Detecting Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Systematic Review and Meta-Analysis of Diagnostic Accuracy. Radiology 2019; 293:125-133. [DOI: 10.1148/radiol.2019190218] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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31
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Echalier C, Teboul F, Dubois E, Chevrier B, Soumagne T, Goubier JN. The value of preoperative examination and MRI for the diagnosis of graftable roots in total brachial plexus palsy. HAND SURGERY & REHABILITATION 2019; 38:246-250. [DOI: 10.1016/j.hansur.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/19/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
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Acharya AM, Cherian BS, Bhat AK. Diagnostic accuracy of MRI for traumatic adult brachial plexus injury: A comparison study with surgical findings. J Orthop 2019; 17:53-58. [PMID: 31879474 DOI: 10.1016/j.jor.2019.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/11/2019] [Indexed: 01/09/2023] Open
Abstract
We studied the diagnostic accuracy of MRI in 35 adult patients with traumatic brachial plexus injury in comparison with intra operative findings. The overall sensitivity to detect root avulsions was 39% and specificity was 75%. MRI was more useful in the diagnosis of lower root avulsions. At trunk and division level injuries, the sensitivity was 87% but specificity was only 26%. It was not able to differentiate the type and extent of post-ganglionic injuries. The accuracy of pseudomeningocele as avulsion on surgical finding was 96% (27/28). Pseudomeningocele correlates well with root avulsions. Its presence warrants early referral and surgical exploration.
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Affiliation(s)
- A M Acharya
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal, Manipal Academy of Higher Education, India
| | - Blessin S Cherian
- Consultant Orthopaedic Surgeon, Department of Orthopaedics, Muthoot Hospital, College Road, Kozencherry, Pathanamthitta District, Kerala, 689641, India
| | - Anil K Bhat
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal, Manipal Academy of Higher Education, India
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Maruyama H, Fujiwara Y, Sakemoto T. [Optimization of Fat Suppression Technique and Imaging Parameters for MR Neurography Using 3D Turbo Spin Echo with Variable Refocusing Flip Angle at 3.0 T: Visualization of Brachial Plexus]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:143-150. [PMID: 30787220 DOI: 10.6009/jjrt.2019_jsrt_75.2.143] [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: 11/11/2022]
Abstract
Magnetic resonance neurography (MRN) has been used to evaluate abnormal conditions of entire nerves and nerve bundles. A fat-suppressed 3D turbo spin echo (TSE) sequence is one of the imaging techniques for MRN, which has been widely adopted at 1.5 T. However, MRN of the brachial plexus using a 3D TSE sequence with short-term inversion recovery (STIR) reduces the effect of fat suppression at 3.0 T. Moreover, the use of spectral pre-saturation with inversion recovery (SPIR) does not result in uniform fat suppression due to the inhomogeneity of the static magnetic field. On the other hand, it is well known that the visibility of the brachial plexus using a 3D TSE sequence greatly changes with the equivalent echo time (TEequiv). Therefore, we optimized the fat suppression technique and TEequiv so that the 3D TSE sequence, using a combination of STIR with SPIR and an optimal TEequiv (from 73 to 110 ms), achieved better visualization of the brachial plexus without residual fat.
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Affiliation(s)
- Hirotoshi Maruyama
- Department of Radiology, National Hospital Organization Kumamoto Saisyunso Hospital
| | - Yasuhiro Fujiwara
- Department of Medical Imaging, Faculty of Life Sciences, Kumamoto University
| | - Tsukasa Sakemoto
- Department of Radiology, National Hospital Organization Kumamoto Saisyunso Hospital
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Degree of Agreement between Electrodiagnostic Testing and Magnetic Resonance Imaging in the Evaluation of Brachial Plexopathy. Am J Phys Med Rehabil 2019; 98:545-548. [PMID: 30664530 DOI: 10.1097/phm.0000000000001139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Electrodiagnostic study (EDX) and magnetic resonance imaging (MRI) are commonly used in the diagnosis of brachial plexopathy, but the agreement between these 2 studies is unknown. The aim of this study was to evaluate the agreement of EDX and MRI in patients with brachial plexopathy. DESIGN The records of 69 patients with symptoms of brachial plexopathy who underwent EDX and MRI were reviewed. Based on the degree of agreement of EDX and MRI results, patients were classified as a "complete match," "partial match," or "mismatch." RESULTS Both studies yielded similar results for the majority of patients (63.2%). Among the enrolled patients, 26.4% were classified as a "complete match," 36.8% as "partial match," and 36.8% as "mismatch." However, only 1 test, either EDX or MRI, revealed abnormal findings in 21.1% of patients. CONCLUSIONS The agreement between EDX and MRI was high in patients with brachial plexopathy. However, only one of these tests, not both, revealed abnormal findings in several cases. Although both EDX and MRI were in accord with the diagnosis of brachial plexopathy in majority of cases, these 2 studies remain complementary diagnostic modalities for evaluating brachial plexopathies.
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Sneag DB, Mendapara P, Zhu JC, Lee SC, Lin B, Curlin J, Bogner EA, Fung M. Prospective respiratory triggering improves high‐resolution brachial plexus MRI quality. J Magn Reson Imaging 2018; 49:1723-1729. [DOI: 10.1002/jmri.26559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Darryl B. Sneag
- Department of Radiology and Imaging Hospital for Special Surgery New York New York USA
| | - Parrykumar Mendapara
- Department of Radiology and Imaging Hospital for Special Surgery New York New York USA
| | - Jacqui C. Zhu
- Department of Radiology and Imaging Hospital for Special Surgery New York New York USA
| | - Susan C. Lee
- Department of Radiology and Imaging Hospital for Special Surgery New York New York USA
| | - Bin Lin
- Department of Radiology and Imaging Hospital for Special Surgery New York New York USA
| | - Jahnavi Curlin
- Department of Radiology and Imaging Hospital for Special Surgery New York New York USA
| | - Eric A. Bogner
- Department of Radiology and Imaging Hospital for Special Surgery New York New York USA
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Mazal AT, Ashikyan O, Cheng J, Le LQ, Chhabra A. Diffusion-weighted imaging and diffusion tensor imaging as adjuncts to conventional MRI for the diagnosis and management of peripheral nerve sheath tumors: current perspectives and future directions. Eur Radiol 2018; 29:4123-4132. [PMID: 30535638 DOI: 10.1007/s00330-018-5838-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/29/2018] [Accepted: 10/17/2018] [Indexed: 12/21/2022]
Abstract
Peripheral nerve sheath tumors (PNSTs) account for ~ 5% of soft tissue neoplasms and are responsible for a wide spectrum of morbidities ranging from localized neuropathy to fulminant metastatic spread and death. MR imaging represents the gold standard for identification of these neoplasms, however, current anatomic MR imaging markers do not reliably detect or differentiate benign and malignant lesions, and therefore, biopsy or excision is required for definitive diagnosis. Diffusion-weighted MR imaging (DWI) serves as a useful tool in the evaluation and management of PNSTs by providing functional information regarding the degree of diffusion, while diffusion tensor imaging (DTI) aids in determining the directional information of predominant diffusion and has been shown to be particularly useful for pre-operative planning of these tumors by delineating healthy and pathologic fascicles. The article focuses on these important neurogenic lesions, highlighting the current utility of diffusion MR imaging and future directions including computerized radiomic analysis. KEY POINTS: • Anatomic MRI is moderately accurate in differentiating benign from malignant PNST. • Diffusion tensor imaging facilitates pre-operative planning of PNSTs by depicting neuropathy and tractography. • Radiomics will likely augment current observer-based diagnostic criteria for PNSTs.
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Affiliation(s)
- Alexander T Mazal
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75022, USA
| | - Oganes Ashikyan
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75022, USA
| | - Jonathan Cheng
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Lu Q Le
- Department of Dermatology and Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75022, USA.
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The Multidisciplinary Approach to the Diagnosis and Management of Nonobstetric Traumatic Brachial Plexus Injuries. AJR Am J Roentgenol 2018; 211:1319-1331. [DOI: 10.2214/ajr.18.19887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Stilwill SE, Mills MK, Hansford BG, Allen H, Mahan M, Moore KR, Hanrahan CJ. Practical Approach and Review of Brachial Plexus Pathology With Operative Correlation: What the Radiologist Needs to Know. Semin Roentgenol 2018; 54:92-112. [PMID: 31128744 DOI: 10.1053/j.ro.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sarah E Stilwill
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, UT.
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, UT.
| | - Barry G Hansford
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR.
| | - Hailey Allen
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, UT.
| | - Mark Mahan
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT.
| | - Kevin R Moore
- Intermountain Pediatric Imaging, Primary Children's Hospital, Medical Imaging Department, Salt Lake City, UT.
| | - Christopher J Hanrahan
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, UT.
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Matsumoto K, Yokota H, Mukai H, Masuda Y, Uno T, Miyati T. Merging images with different central frequencies reduces banding artifacts in balanced steady-state free precession magnetic resonance cisternography. J Appl Clin Med Phys 2018; 19:234-243. [PMID: 30288917 PMCID: PMC6236844 DOI: 10.1002/acm2.12468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/25/2018] [Accepted: 09/09/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of this study was to evaluate the utility of merged balanced steady‐state free precession (bSSFP) magnetic resonance cisternography images. Materials and Methods Twenty ears of 10 healthy volunteers (six men, four women; mean age ± standard deviation, 26.7 ± 1.6 yr) and 10 patients (two men, eight women; mean age, 46.3 ± 10.9 yr) with neoplasm around the sella turcica were included. Two different devices (A and B) were used to confirm the versatility of our method for MR devices with different local magnetic field homogeneity. Images with different central frequencies (±10, ±20, ±30, ±40, and ±50 Hz) were merged with the maximum magnitude of corresponding pixels from the images acquired using both devices. Two neuroradiologists visually graded the image quality of 11 sites in the inner ear and three sites around the sella turcica (scale: 0–2) and compared the quality with that of the corresponding basic image (0 Hz). Results The image quality was better in merged images of the vestibule, superior semicircular canal (SCC), posterior SCC, and horizontal SCC (P = 0.005 to 0.020 mainly at ±40 and ±50 Hz on devices A and B), as well as in merged images of the sella turcica and right cavernous sinus (±50 Hz, P = 0.003 and 0.020 on device B, respectively), than it was in the corresponding basic images. Conclusions The maximum magnitude merging of images with different central frequencies makes it possible to reduce banding artifacts on bSSFP images without the need for special pulse sequences and image processing programs.
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Affiliation(s)
- Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Chiba, Japan.,Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hajime Yokota
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroki Mukai
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takashi Uno
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tosiaki Miyati
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
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Klupp E, Cervantes B, Sollmann N, Treibel F, Weidlich D, Baum T, Rummeny EJ, Zimmer C, Kirschke JS, Karampinos DC. Improved Brachial Plexus Visualization Using an Adiabatic iMSDE-Prepared STIR 3D TSE. Clin Neuroradiol 2018; 29:631-638. [DOI: 10.1007/s00062-018-0706-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/03/2018] [Indexed: 12/12/2022]
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Silveira CRS, Vieira CGM, Pereira BM, Lopes E, Gerson G, Távora DGF, Chhabra A. Magnetic resonance neurography in the diagnosis of a retroperitoneal ganglioneuroma: Case report and literature review. Radiol Case Rep 2018; 13:380-385. [PMID: 29904477 PMCID: PMC5999826 DOI: 10.1016/j.radcr.2017.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/26/2017] [Indexed: 11/29/2022] Open
Abstract
Magnetic resonance neurography is a technique for identifying anatomy and pathologic lesions of nerves, and has emerged as a helpful technique for localizing lesions and elucidating the underlying etiology. Ganglioneuromas are highly differentiated benign tumors. This lesion is rare and exhibits undetermined symptoms, the features of using the magnetic resonance neurography are a great ally to determine its diagnosis. The authors illustrate a case of retroperitoneal ganglioneuroma emphasizing its image characteristics using magnetic resonance neurography with the diagnosis confirmed by histopathological examination.
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Affiliation(s)
| | | | - Brenda Machado Pereira
- São Carlos Imaging, Rua Otoni Façanha de Sá, 69, Dionísio Torres, Fortaleza, Ceará, Brazil
| | - Edson Lopes
- Neurosurgery Department, Geral Hospital of Fortaleza, Fortaleza, CE, Brazil
| | - Gunter Gerson
- Pathology Department, Federal University of Ceara, Fortaleza, CE, Brazil
| | | | - Avneesh Chhabra
- Radiology & Orthopaedic Surgery, UT Southwestern, Dallas, Texas
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42
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Wade RG, Takwoingi Y, Wormald JCR, Ridgway JP, Tanner S, Rankine JJ, Bourke G. Magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries: protocol for a systematic review of diagnostic accuracy. Syst Rev 2018; 7:76. [PMID: 29778092 PMCID: PMC5960500 DOI: 10.1186/s13643-018-0737-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 05/01/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Adult brachial plexus injuries (BPI) are becoming more common. The reconstruction and prognosis of pre-ganglionic injuries (root avulsions) are different to other types of BPI injury. Preoperative magnetic resonance imaging (MRI) is being used to identify root avulsions, but the evidence from studies of its diagnostic accuracy are conflicting. Therefore, a systematic review is needed to address uncertainty about the accuracy of MRI and to guide future research. METHODS We will conduct a systematic search of electronic databases alongside reference tracking. We will include studies of adults with traumatic BPI which report the accuracy of preoperative MRI (index test) against surgical exploration of the roots of the brachial plexus (reference standard) for detecting either of the two target conditions (any root avulsion or any pseudomeningocoele as a surrogate marker of root avulsion). We will exclude case reports, articles considering bilateral injuries and studies where the number of true positives, false positives, false negatives and true negatives cannot be derived. The methodological quality of the included studies will be assessed using a tailored version of the QUADAS-2 tool. Where possible, a bivariate model will be used for meta-analysis to obtain summary sensitivities and specificities for both target conditions. We will investigate heterogeneity in the performance of MRI according to field strength and the risk of bias if data permits. DISCUSSION This review will summarise the current diagnostic accuracy of MRI for adult BPI, identify shortcomings and gaps in the literature and so help to guide future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016049702 .
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Affiliation(s)
- Ryckie G. Wade
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK
| | - Yemisi Takwoingi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Justin C. R. Wormald
- Department of Plastic and Reconstructive Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - John P. Ridgway
- Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - Steven Tanner
- Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - James J. Rankine
- Department of Radiology, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - Grainne Bourke
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK
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43
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Wade RG, Itte V, Rankine JJ, Ridgway JP, Bourke G. The diagnostic accuracy of 1.5T magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries. J Hand Surg Eur Vol 2018; 43:250-258. [PMID: 28886666 DOI: 10.1177/1753193417729587] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Identification of root avulsions is of critical importance in traumatic brachial plexus injuries because it alters the reconstruction and prognosis. Pre-operative magnetic resonance imaging is gaining popularity, but there is limited and conflicting data on its diagnostic accuracy for root avulsion. This cohort study describes consecutive patients requiring brachial plexus exploration following trauma between 2008 and 2016. The index test was magnetic resonance imaging at 1.5 Tesla and the reference test was operative exploration of the supraclavicular plexus. Complete data from 29 males was available. The diagnostic accuracy of magnetic resonance imaging for root avulsion(s) of C5-T1 was 79%. The diagnostic accuracy of a pseudomeningocoele as a surrogate marker of root avulsion(s) of C5-T1 was 68%. We conclude that pseudomeningocoles were not a reliable sign of root avulsion and magnetic resonance imaging has modest diagnostic accuracy for root avulsions in the context of adult traumatic brachial plexus injuries. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ryckie G Wade
- 1 Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
- 2 Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK
| | - Vinay Itte
- 1 Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
- 3 Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - James J Rankine
- 4 Department of Radiology, Leeds Teaching Hospitals Trust, Leeds, UK
- 5 Leeds Musculoskeletal Biomedical Research Centre (LMBRC), Chapel Allerton Hospital, Leeds, UK
| | - John P Ridgway
- 5 Leeds Musculoskeletal Biomedical Research Centre (LMBRC), Chapel Allerton Hospital, Leeds, UK
- 6 Department of Medical Physics and Engineering, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Grainne Bourke
- 1 Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
- 2 Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK
- 3 Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
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Yokota H, Mukai H, Hattori S, Yamada K, Anzai Y, Uno T. MR Imaging of the Superior Cervical Ganglion and Inferior Ganglion of the Vagus Nerve: Structures That Can Mimic Pathologic Retropharyngeal Lymph Nodes. AJNR Am J Neuroradiol 2017; 39:170-176. [PMID: 29122764 DOI: 10.3174/ajnr.a5434] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/28/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE The superior cervical ganglion and inferior ganglion of the vagus nerve can mimic pathologic retropharyngeal lymph nodes. We studied the cross-sectional anatomy of the superior cervical ganglion and inferior ganglion of the vagus nerve to evaluate how they can be differentiated from the retropharyngeal lymph nodes. MATERIALS AND METHODS This retrospective study consists of 2 parts. Cohort 1 concerned the signal intensity of routine neck MR imaging with 2D sequences, apparent diffusion coefficient, and contrast enhancement of the superior cervical ganglion compared with lymph nodes with or without metastasis in 30 patients. Cohort 2 used 3D neurography to assess the morphology and spatial relationships of the superior cervical ganglion, inferior ganglion of the vagus nerve, and the retropharyngeal lymph nodes in 50 other patients. RESULTS All superior cervical ganglions had homogeneously greater enhancement and lower signal on diffusion-weighted imaging than lymph nodes. Apparent diffusion coefficient values of the superior cervical ganglion (1.80 ± 0.28 × 10-3mm2/s) were significantly higher than normal and metastatic lymph nodes (0.86 ± 0.10 × 10-3mm2/s, P < .001, and 0.73 ± 0.10 × 10-3mm2/s, P < .001). Ten and 13 of 60 superior cervical ganglions were hypointense on T2-weighted images and had hyperintense spots on both T1- and T2-weighted images, respectively. The latter was considered fat tissue. The largest was the superior cervical ganglion, followed in order by the retropharyngeal lymph node and the inferior ganglion of the vagus nerve (P < .001 to P = .004). The highest at vertebral level was the retropharyngeal lymph nodes, followed, in order, by the inferior ganglion of the vagus nerve and the superior cervical ganglion (P < .001 to P = .001). The retropharyngeal lymph node, superior cervical ganglion, and inferior ganglion of the vagus nerve formed a line from anteromedial to posterolateral. CONCLUSIONS The superior cervical ganglion and the inferior ganglion of the vagus nerve can be almost always differentiated from retropharyngeal lymph nodes on MR imaging by evaluating the signal, size, and position.
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Affiliation(s)
- H Yokota
- From Diagnostic Radiology and Radiation Oncology (H.Y., H.M., S.H., T.U.), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - H Mukai
- From Diagnostic Radiology and Radiation Oncology (H.Y., H.M., S.H., T.U.), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - S Hattori
- From Diagnostic Radiology and Radiation Oncology (H.Y., H.M., S.H., T.U.), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - K Yamada
- Department of Radiology (K.Y.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Y Anzai
- Department of Radiology (Y.A.), University of Utah School of Medicine Health Sciences, Salt Lake City, Utah
| | - T Uno
- From Diagnostic Radiology and Radiation Oncology (H.Y., H.M., S.H., T.U.), Graduate School of Medicine, Chiba University, Chiba, Japan
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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: 6.9] [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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46
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Hwang L, Dessouky R, Xi Y, Amirlak B, Chhabra A. MR Neurography of Greater Occipital Nerve Neuropathy: Initial Experience in Patients with Migraine. AJNR Am J Neuroradiol 2017; 38:2203-2209. [PMID: 28882864 DOI: 10.3174/ajnr.a5354] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/14/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging of peripheral nerves (MR neurography) allows improved assessment of nerve anatomy and pathology. The objective of this study was to evaluate patients with unilateral occipital neuralgia using MR neurography and to assess the differences in greater occipital nerve signal and size between the symptomatic and asymptomatic sides. MATERIALS AND METHODS In this case-control evaluation using MR neurography, bilateral greater occipital nerve caliber, signal intensity, signal-to-noise ratios, and contrast-to-noise ratios were determined by 2 observers. RESULTS Among 18 subjects with unilateral occipital migraines, the average greater occipital nerve diameter for the symptomatic side was significantly greater at 1.77 ± 0.4 mm than for the asymptomatic side at 1.29 ± 0.25 mm (P = .001). The difference in nerve signal intensity between the symptomatic and asymptomatic sides was statistically significant at 269.06 ± 170.93 and 222.44 ± 170.46, respectively (P = .043). The signal-to-noise ratios on the symptomatic side were higher at 15.79 ± 4.59 compared with the asymptomatic nerve at 14.02 ± 5.23 (P = .009). Contrast-to-noise ratios were significantly higher on the symptomatic side than on the asymptomatic side at 2.57 ± 4.89 and -1.26 ± 5.02, respectively (P = .004). Intraobserver performance was good to excellent (intraclass coefficient correlation, 0.68-0.93), and interobserver performance was fair to excellent (intraclass coefficient correlation, 0.54-0.81). CONCLUSIONS MR neurography can be reliably used for the diagnosis of greater occipital nerve neuropathy in patients with unilateral occipital migraines with a good correlation of imaging findings to the clinical presentation.
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Affiliation(s)
- L Hwang
- From the Departments of Plastic Surgery (L.H., B.A.)
| | - R Dessouky
- Radiology (R.D., Y.X., A.C.), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Radiology (R.D.), Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Y Xi
- Radiology (R.D., Y.X., A.C.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - B Amirlak
- From the Departments of Plastic Surgery (L.H., B.A.)
| | - A Chhabra
- Radiology (R.D., Y.X., A.C.), University of Texas Southwestern Medical Center, Dallas, Texas
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Gruber L, Loizides A, Löscher W, Glodny B, Gruber H. Focused high-resolution sonography of the suprascapular nerve: A simple surrogate marker for neuralgic amyotrophy? Clin Neurophysiol 2017; 128:1438-1444. [DOI: 10.1016/j.clinph.2017.04.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/18/2017] [Accepted: 04/30/2017] [Indexed: 01/24/2023]
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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: 108] [Impact Index Per Article: 13.5] [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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Raval SB, Britton CA, Zhao T, Krishnamurthy N, Santini T, Gorantla VS, Ibrahim TS. Ultra-high field upper extremity peripheral nerve and non-contrast enhanced vascular imaging. PLoS One 2017; 12:e0175629. [PMID: 28662061 PMCID: PMC5490941 DOI: 10.1371/journal.pone.0175629] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 03/29/2017] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to explore the efficacy of Ultra-high field [UHF] 7 Tesla [T] MRI as compared to 3T MRI in non-contrast enhanced [nCE] imaging of structural anatomy in the elbow, forearm, and hand [upper extremity]. MATERIALS AND METHOD A wide range of sequences including T1 weighted [T1] volumetric interpolate breath-hold exam [VIBE], T2 weighted [T2] double-echo steady state [DESS], susceptibility weighted imaging [SWI], time-of-flight [TOF], diffusion tensor imaging [DTI], and diffusion spectrum imaging [DSI] were optimized and incorporated with a radiofrequency [RF] coil system composed of a transverse electromagnetic [TEM] transmit coil combined with an 8-channel receive-only array for 7T upper extremity [UE] imaging. In addition, Siemens optimized protocol/sequences were used on a 3T scanner and the resulting images from T1 VIBE and T2 DESS were compared to that obtained at 7T qualitatively and quantitatively [SWI was only qualitatively compared]. DSI studio was utilized to identify nerves based on analysis of diffusion weighted derived fractional anisotropy images. Images of forearm vasculature were extracted using a paint grow manual segmentation method based on MIPAV [Medical Image Processing, Analysis, and Visualization]. RESULTS High resolution and high quality signal-to-noise ratio [SNR] and contrast-to-noise ratio [CNR]-images of the hand, forearm, and elbow were acquired with nearly homogeneous 7T excitation. Measured [performed on the T1 VIBE and T2 DESS sequences] SNR and CNR values were almost doubled at 7T vs. 3T. Cartilage, synovial fluid and tendon structures could be seen with higher clarity in the 7T T1 and T2 weighted images. SWI allowed high resolution and better quality imaging of large and medium sized arteries and veins, capillary networks and arteriovenous anastomoses at 7T when compared to 3T. 7T diffusion weighted sequence [not performed at 3T] demonstrates that the forearm nerves are clearly delineated by fiber tractography. The proper digital palmar arteries and superficial palmar arch could also be clearly visualized using TOF nCE 7T MRI. CONCLUSION Ultra-high resolution neurovascular imaging in upper extremities is possible at 7T without use of renal toxic intravenous contrast. 7T MRI can provide superior peripheral nerve [based on fiber anisotropy and diffusion coefficient parameters derived from diffusion tensor/spectrum imaging] and vascular [nCE MRA and vessel segmentation] imaging.
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Affiliation(s)
- Shailesh B. Raval
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pittsburgh, United States of America
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pittsburgh, United States of America
| | - Cynthia A. Britton
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pittsburgh, United States of America
| | - Tiejun Zhao
- Siemens Medical Solutions, New York, United States of America
| | - Narayanan Krishnamurthy
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pittsburgh, United States of America
| | - Tales Santini
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pittsburgh, United States of America
| | - Vijay S. Gorantla
- Department of Plastic Surgery, Pittsburgh, Pittsburgh, United States of America
- * E-mail: (TSI); (VSG)
| | - Tamer S. Ibrahim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pittsburgh, United States of America
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pittsburgh, United States of America
- * E-mail: (TSI); (VSG)
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50
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Mahbub ZB, Peters AM, Gowland PA. Presence of time-dependent diffusion in the brachial plexus. Magn Reson Med 2017. [PMID: 28626999 DOI: 10.1002/mrm.26733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE This work describes the development of a method to measure the variation of apparent diffusion coefficient (ADC) with diffusion time (Δ) in the brachial plexus, as a potential method of probing microstructure. METHODS Diffusion-weighted MRI with body signal suppression was used to highlight the nerves from surrounding tissues, and sequence parameters were optimized for sensitivity to change with diffusion time. A porous media-restricted diffusion model based on the Latour-Mitra equation was fitted to the diffusion time-dependent ADC data from the brachial plexus nerves and cord. RESULTS The ADC was observed to reduce at long diffusion times, confirming that diffusion was restricted in the nerves and cord in healthy subjects. T2 of the nerves was measured to be 80 ± 5 ms, the diffusion coefficient was found to vary from (1.5 ± 0.1) × 10-3 mm2 /s at a diffusion time of 18.3 ms to (1.0 ± 0.2) × 10-3 mm2 /s at a diffusion time of 81.3 ms. CONCLUSION A novel method of probing restricted diffusion in the brachial plexus was developed. Resulting parameters were comparable with values obtained previously on biological systems. Magn Reson Med 79:789-795, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Zaid B Mahbub
- Department of Arts & Sciences, Ahsanullah University of Science & Technology, Dhaka, Bangladesh.,Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, United Kingdom
| | - Andrew M Peters
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, United Kingdom
| | - Penny A Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, United Kingdom
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