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Selective MR neurography-guided anterior femoral cutaneous nerve blocks for diagnosing anterior thigh neuralgia: anatomy, technique, diagnostic performance, and patient-reported experiences

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Abstract

Objective

To evaluate the clinical utility of selective magnetic resonance neurography-(MRN)-guided anterior femoral cutaneous nerve (AFCN) blocks for diagnosing anterior thigh neuralgia.

Materials and methods

Following institutional review board approval and informed consent, participants with intractable anterior thigh pain and clinically suspected AFCN neuralgia were included. AFCN blocks were performed under MRN guidance using an anterior groin approach along the medial sartorius muscle margin. Outcome variables included AFCN identification on MRN, technical success of perineural drug delivery, rate of AFCN anesthesia, complications, total procedure time, patient-reported procedural experiences, rate of positive diagnostic AFCN blocks, and positive subsequent treatment rate.

Results

Eighteen MRN-guided AFCN blocks (six unilateral and six bilateral blocks) were performed in 12 participants (6 women; age, 49 (30–65) years). Successful MRN identified the AFCN, successful perineural drug delivery, and AFCN anesthesia was achieved in all thighs. No complications occurred. The total procedure time was 19 (10–28) min. Patient satisfaction and experience were high without adverse MRI effects. AFCN blocks identified the AFCN as the symptom generator in 16/18 (89%) cases, followed by 14/16 (88%) successful treatments.

Conclusion

Our results suggest that selective MR neurography-guided AFCN blocks effectively diagnose anterior femoral cutaneous neuralgia and are well-tolerated.

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Funding

Danoob Dalili has received fellowship grant support from the BSSR and ESOR 2019.

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Authors and Affiliations

  1. Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, London, Epsom, KT18 7EG, UK

    Danoob Dalili

  2. Department of Diagnostic and Interventional Radiology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, London, Epsom, KT18 7EG, UK

    Danoob Dalili

  3. The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA

    Danoob Dalili & Shivani Ahlawat

  4. Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK

    Amanda Isaac

  5. School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK

    Amanda Isaac

  6. Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA

    Ali Rashidi

  7. Department of Radiology, New York University Grossman School of Medicine, New York, USA

    Jan Fritz

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  1. Danoob Dalili
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  2. Shivani Ahlawat
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  4. Ali Rashidi
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  5. Jan Fritz
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Corresponding author

Correspondence to Jan Fritz.

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Conflict of interest

Jan Fritz received institutional research support from Siemens AG, BTG International, Zimmer Biomed, DePuy Synthes, QED, and SyntheticMR; is a scientific advisor for Siemens AG, SyntheticMR, GE Healthcare, QED, BTG, ImageBiopsy Lab, Boston Scientific, and Mirata Pharma; and has shared patents with Siemens Healthcare, Johns Hopkins University, and NYU Grossman School of Medicine.

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Dalili, D., Ahlawat, S., Isaac, A. et al. Selective MR neurography-guided anterior femoral cutaneous nerve blocks for diagnosing anterior thigh neuralgia: anatomy, technique, diagnostic performance, and patient-reported experiences. Skeletal Radiol 51, 1649–1658 (2022). https://doi.org/10.1007/s00256-022-04014-8

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  • DOI: https://doi.org/10.1007/s00256-022-04014-8

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