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Routine knee MRI: how common are peripheral nerve abnormalities, and why does it matter?

Abstract

Objective

To evaluate the frequency, MRI appearance, and clinical significance of peripheral nerve abnormalities encountered on routine knee MRI.

Materials and methods

A retrospective review was performed to identify consecutive patients who underwent routine knee MRI from March 2015–2018 and had peripheral nerve abnormalities. MRIs were reviewed for the presence of tibial (TN) and common peroneal nerve (CPN) abnormalities (including hyperintensity, bulbous enlargement, discontinuity, architectural distortion, skeletal muscle denervation). The presence or absence of concomitant meniscal, cruciate, and collateral ligament tears was documented. Patient demographics and clinical outcomes were recorded. Descriptive statistics were reported.

Results

The search yielded 8125 MRIs, of which 50 knee MRIs (patient age (years): 44 + 19) had peripheral nerve abnormalities (hyperintensity (TN: 30%(15/50), CPN: 80%(40/50)), bulbous enlargement (TN: 10%(5/50), CPN: 30%(15/50)), discontinuity (TN: 0, CPN: 4%(2/50)), architectural distortion (TN: 4%(2/50), CPN: 18%(9/50)), and skeletal muscle denervation (TN: 14%(7/50), CPN: 28%(14/50)). Medial meniscus (TN: 12% (6/50), CPN: 36%(18/50)), ACL (TN: 4%(2/50), CPN: 32%(16/50)), PCL (TN: 2%(1/50), CPN: 20%(10/50)), and lateral meniscus (TN: 12%(6/50), CPN: 24%(12/50)) tears were frequently present. Of these, 32% (16/50) were treated for peripheral nerve injury (PNI), characterized as high-grade (n = 7/16) or low-grade (n = 9/16). Nerve discontinuity, architectural distortion, and denervation were encountered more in high-grade PNI than low-grade PNI. Five patients were recalled for follow-up imaging and operative management was performed in 36% of cases (18/50).

Conclusion

Although uncommon (frequency = 0.6%), peripheral nerve abnormalities (CPN more common than TN) are encountered on routine knee MRI and affect patient management, with 36% requiring surgical treatment.

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Correspondence to Danoob Dalili.

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Conflict of interest

Danoob Dalili has received fellowship grant support from the BSSR and ESOR 2019. Shivani Ahlawat has received support from Department of Defense 2018–2023 and Pfizer (2017–2018). Laura M. Fayad has received support from GERRAF 2008–10 and Siemens 2011–12. Amanda Isaac declares that she has no conflict of interest.

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Dalili, D., Isaac, A., Fayad, L.M. et al. Routine knee MRI: how common are peripheral nerve abnormalities, and why does it matter?. Skeletal Radiol 50, 321–332 (2021). https://doi.org/10.1007/s00256-020-03559-w

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Keywords

  • Peripheral nerve
  • MRI
  • Knee
  • Injury
  • Protocol