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Intravenous contrast does not improve detection of nerve lesions or active muscle denervation changes in MR neurography of the common peroneal nerve

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Abstract

Objective

To evaluate the effect of intravenous (IV) contrast on sensitivity, specificity, and accuracy of magnetic resonance (MR) neurography of the knee with attention to the common peroneal nerve (CPN) in identifying nerve lesions and active muscle denervation changes.

Materials and methods

A retrospective search for contrast-enhanced MR neurography cases evaluating the CPN at the knee was performed. Patients with electrodiagnostic testing (EDX) within 3 months of imaging were included and those with relevant prior surgery were excluded. Two radiologists independently reviewed non-contrast sequences and then 4 weeks later evaluated non-contrast and contrast sequences. McNemar’s tests were performed to detect a difference between non-contrast only and combined non-contrast and contrast sequences in identifying nerve lesions and active muscle denervation changes using EDX as the reference standard.

Results

Forty-four exams in 42 patients (2 bilateral) were included. Twenty-eight cases had common peroneal neuropathy and 29, 21, and 9 cases had active denervation changes in the anterior, lateral, and posterior compartment/proximal muscles respectively on EDX. Sensitivity, specificity, and accuracy of non-contrast versus combined non-contrast and contrast sequences for common peroneal neuropathy were 50.0%, 56.2%, and 52.3% versus 50.0%, 56.2%, and 52.3% for reader 1 and 57.1%, 50.0%, and 54.5% versus 64.3%, 56.2%, and 61.4% for reader 2. Sensitivity, specificity, and accuracy of non-contrast and combined non-contrast and contrast sequences in identifying active denervation changes for anterior, lateral, and posterior compartment muscles were not significantly different. McNemar’s tests were all negative.

Conclusion

IV contrast does not improve the ability of MR neurography to detect CPN lesions or active muscle denervation changes.

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Authors and Affiliations

  1. Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY, 10016, USA

    Steven P. Daniels

  2. Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA

    Andrew B. Ross & Michael J. Tuite

  3. Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th St., New York, NY, 10021, USA

    Darryl B. Sneag

  4. Department of Neurology, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA

    Stephanie N. Gardon

  5. Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA

    Geng Li

  6. Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA

    Amgad Hanna

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  1. Steven P. Daniels
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Correspondence to Steven P. Daniels.

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Conflict of interest

Dr. Daniels, Dr. Ross, Dr. Gardon, and Ms. Li have no conflicts of interest.

Dr. Sneag discloses that HSS has a research agreement with GE.

Dr. Hanna receives royalties from Springer and Thieme as a book author.

Dr. Tuite receives royalties from Elsevier as a book author.

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Daniels, S.P., Ross, A.B., Sneag, D.B. et al. Intravenous contrast does not improve detection of nerve lesions or active muscle denervation changes in MR neurography of the common peroneal nerve. Skeletal Radiol 50, 2483–2494 (2021). https://doi.org/10.1007/s00256-021-03812-w

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  • DOI: https://doi.org/10.1007/s00256-021-03812-w

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