Improved Brachial Plexus Visualization Using an Adiabatic iMSDE-Prepared STIR 3D TSE
The close proximity of blood vessels to the brachial plexus nerves can confound nerve visualization in conventional fat-suppressed 3D T2-weighted sequences. Vessel suppression can be accomplished by means of motion-sensitizing preparation. The aim of this study was to qualitatively and semi-quantitatively evaluate short tau inversion recovery (STIR) 3D turbo spin echo (TSE) in conjunction with an adiabatic T2 preparation incorporating motion sensitization for magnetic resonance neurography (MRN) of the brachial plexus in a clinical routine setting.
The MRN of the brachial plexus was performed in 22 patients (age 45.5 ± 20.3 years) with different clinical implications using the proposed improved motion-sensitized driven equilibrium (iMSDE) STIR 3D TSE and the STIR 3D TSE. Images were evaluated regarding image quality, overall artifacts, artifacts caused by vessel signal, signal homogeneity, visibility of small nerves and signal contrast. Furthermore, signal-to-noise ratios (aSNR), nerve muscle contrast to noise ratios (aNMCNR) and nerve vessel contrast to noise ratios (aNVCNR) were calculated and compared.
The incorporation of motion sensitization in the T2 preparation resulted in robust blood suppression across subjects, leading to significantly higher aNVCNRs (p < 0.001) and aNMCNRs (p < 0.05), increased conspicuousness of the nerves, better vessel suppression and image quality and less artifacts compared with STIR 3D TSE (p < 0.001).
The incorporation of the proposed adiabatic iMSDE-based motion sensitization was shown to provide robust blood suppression of vessels in close proximity to brachial plexus nerves. The use of STIR iMSDE 3D TSE can be considered for clinical MRN examinations of the brachial plexus.
KeywordsMR neurography Brachial plexus 3-D Imaging Fat suppression Vessel suppression
The present work was partially supported by Philips Healthcare and the European Union (ERC-StG 2014 iBack).
Conflict of interest
E. Klupp, B. Cervantes, N. Sollmann, F. Treibel, D. Weidlich, T. Baum, E.J. Rummeny, C. Zimmer, J.S. Kirschke and D.C. Karampinos declare that they have no competing interests.
- 1.Joint Task Force of the EFNS and the PNS. European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of multifocal motor neuropathy. Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society--first revision. J Peripher Nerv Syst. 2010;15:295–301.CrossRefGoogle Scholar
- 2.Joint Task Force of the EFNS and the PNS.European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of paraproteinemic demyelinating neuropathies. Report of a Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society--first revision. J Peripher Nerv Syst. 2010;15:185–95.CrossRefGoogle Scholar
- 3.Joint Task Force of the EFNS and the PNS. European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society--First Revision. J Peripher Nerv Syst. 2010;15:1–9.CrossRefGoogle Scholar
- 9.Hiwatashi A, Togao O, Yamashita K, Kikuchi K, Ogata H, Yamasaki R, Yoneyama M, Kira JI, Honda H. Evaluation of chronic inflammatory demyelinating polyneuropathy: 3D nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement imaging (3D SHINKEI). Eur Radiol. 2017;27:447–53.CrossRefPubMedGoogle Scholar
- 13.Viallon M, Vargas MI, Jlassi H, Lövblad KO, Delavelle J. High-resolution and functional magnetic resonance imaging of the brachial plexus using an isotropic 3D T2 STIR (Short Term Inversion Recovery) SPACE sequence and diffusion tensor imaging. Eur Radiol. 2008;18:1018–23.CrossRefPubMedGoogle Scholar
- 18.Cervantes B, Kirschke JS, Klupp E, Kooijman H, Börnert P, Haase A, Rummeny EJ, Karampinos DC. Orthogonally combined motion- and diffusion-sensitized driven equilibrium (OC-MDSDE) preparation for vessel signal suppression in 3D turbo spin echo imaging of peripheral nerves in the extremities. Magn Reson Med. 2018;79:407–415.CrossRefPubMedGoogle Scholar
- 20.Yoneyama M, Nakumara M, Okukari T, Tabuchi T, Takemura A, Obara M, Ogura J. High-resolution 3D volumetric nerve-sheath weighted RARE imaging (3D SHINKEI). In: Proceedings of the 19th annual meeting of ISMRM. 2011. p. 2721.Google Scholar
- 24.Weidlich D, Schlaeger S, Kooijman H, Börnert P, Kirschke JS, Rummeny EJ, Haase A, Karampinos DC. T2 mapping with magnetization-prepared 3D TSE based on a modified BIR-4 T2 preparation. NMR Biomed. Epub 2017 Aug 4.Google Scholar
- 25.Cervantes B. High-resolution DWI of the lumbar plexus using B1-insensitive velocity-compensated diffusion-prepared 3D TSE. In: Proceedings of the 24th annual meeting of ISMRM. 2016.Google Scholar