3T MR neurography using three-dimensional diffusion-weighted PSIF: Technical issues and advantages

The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 601 North Caroline Street, Room 4214, Baltimore, MD 21287, USA.
Skeletal Radiology (Impact Factor: 1.51). 04/2011; 40(10):1355-60. DOI: 10.1007/s00256-011-1162-y
Source: PubMed


Three-dimensional (3D) diffusion-weighted reversed fast imaging with steady state precession (3D DW-PSIF) MR sequence has the potential to create nerve-specific images. The authors describe the technical issues and their initial experience with this imaging technique employed for peripheral MR neurography.

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    • "It should be noted that 3D DW PSIF is a sensitive sequence; it is prone to motion and ghosting artifacts. However, MIP reconstructions can enhance apparent SNR and be used to elegantly demonstrate nerves in multiple planes (Figure 4) [3, 6, 20]. Since it is a steady state sequence with both T1 and T2 contrasts, it shows neuropathy and mass lesions as abnormal T2 hyperintensity, with normal nerves appearing isointense to muscles, similar to other anatomic spin echo type sequences. "
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    ABSTRACT: High resolution and high field magnetic resonance neurography (MR neurography, MRN) is shown to have excellent anatomic capability. There have been considerable advances in the technology in the last few years leading to various feasibility studies using different structural and functional imaging approaches in both clinical and research settings. This paper is intended to be a useful seminar for readers who want to gain knowledge of the advancements in the MRN pulse sequences currently used in clinical practice as well as learn about the other techniques on the horizon aimed at better depiction of nerve anatomy, pathology, and potential noninvasive evaluation of nerve degeneration or regeneration.
    03/2013; 2013(7):809568. DOI:10.1155/2013/809568
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    ABSTRACT: To examine diagnostic accuracy of semiquantitative and qualitative magnetic resonance neurography criteria in common peroneal nerve (CPN) neuropathy. Institutional review board approval was obtained with a waiver of informed consent for this Health Insurance Portability and Accountability Act-compliant retrospective study. A review of 28 knees in 28 subjects (12 males and 16 females; age range, 13-84 years; mean [SD] age, 42 [20] years) who had undergone magnetic resonance neurography of the knee was performed. Thirteen patients who had a final diagnosis of CPN were classified as cases, and 15 patients who lacked a final diagnosis of CPN neuropathy were classified as controls. Morphological characteristics of the CPN, including nerve T2 signal intensity, nerve size, nerve course, fascicles morphology, regional muscle edema, and fatty infiltration, and an overall assessment of the CPN as being normal or abnormal were evaluated by 2 independent radiologists blinded to the clinical history. Overall sensitivity, specificity, and accuracy compared against our reference standards were expressed as percentages. Interobserver agreements were assessed using linear weighted κ statistics. Common peroneal nerve T2 signal abnormality had the highest sensitivity (77%) in identifying CPN neuropathy. Except for T2 signal abnormality, overall specificity for the nerve morphological parameters and muscle denervation change assessed was fairly high, ranging from 94% to 100%. The consensus accuracy ranged from 68% to 79% for the morphological characteristics assessed. The interobserver reproducibility was very good (k = 0.90 to 0.91) for assessment of regional muscle denervation changes and moderate (k = 0.46 to 0.59) for morphological CPN characteristics. Magnetic resonance neurography is a useful modality in supplementing the diagnosis of CPN. Using predefined classification criteria helps standardize the morphological criteria of CPN neuropathy diagnosis.
    Journal of computer assisted tomography 07/2012; 36(4):455-61. DOI:10.1097/RCT.0b013e31825dcfba · 1.41 Impact Factor
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