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.
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).
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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Pham M, Bäumer T, Bendszus M. Peripheral nerves and plexus: imaging by MR-neurography and high-resolution ultrasound. Curr Opin Neurol England. 2014;27:370–9.
Bendszus M, Stoll G. Technology insight: visualizing peripheral nerve injury using MRI. Nat Clin Pract Neurol England. 2005;1:45–53.
Chhabra A, Andreisek G, Soldatos T, Wang KC, Flammang AJ, Belzberg AJ, et al. MR neurography: past, present, and future. AJR Am J Roentgenol. United States. 2011;197:583–91.
Pham M, Oikonomou D, Hornung B, Weiler M, Heiland S, Bäumer P, et al. Magnetic resonance neurography detects diabetic neuropathy early and with Proximal Predominance. Ann Neurol. John Wiley and Sons Inc. 2015;78:939–48.
Kollmer J, Hund E, Hornung B, Hegenbart U, Schönland SO, Kimmich C, et al. In vivo detection of nerve injury in familial amyloid polyneuropathy by magnetic resonance neurography. Brain Oxford University Press. 2015;138:549–62.
Chhabra A, Carrino JA, Farahani SJ, Thawait GK, Sumner CJ, Wadhwa V, et al. Whole-body MR neurography: prospective feasibility study in polyneuropathy and Charcot-Marie-Tooth disease. J Magn Reson Imaging United States. 2016;44:1513–21.
Kwee RM, Chhabra A, Wang KC, Marker DR, Carrino JA. Accuracy of MRI in diagnosing peripheral nerve disease: a systematic review of the literature. AJR Am J Roentgenol United States. 2014;203:1303–9.
Reddy CG, Amrami KK, Howe BM, Spinner RJ. Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation. Neurosurg Focus United States. 2015;39:E8.
Morris BL, Grinde AS, Olson H, Brubacher JW, Schroeppel JP, Everist BM. Lariat sign: an MRI finding associated with common peroneal nerve rupture. Radiol Case Rep. Elsevier. 2018;13:743–6.
Tran TMA, Lim BG, Sheehy R, Robertson PL. Magnetic resonance imaging for common peroneal nerve injury in trauma patients: are routine knee sequences adequate for prediction of outcome? J Med Imaging Radiat Oncol. Australia. 2019;63:54–60.
Cao J, He B, Wang S, Zhou Z, Gao F, Xiao L, et al. Diffusion tensor imaging of tibial and common peroneal nerves in patients with Guillain-Barre syndrome: a feasibility study. J Magn Reson Imaging United States. 2019;49:1356–64.
Wu C, Wang G, Zhao Y, Hao W, Zhao L, Zhang X, et al. Assessment of tibial and common peroneal nerves in diabetic peripheral neuropathy by diffusion tensor imaging: a case control study. Eur Radiol Germany. 2017;27:3523–31.
Lee PP, Chalian M, Bizzell C, Williams EH, Rosson GD, Belzberg AJ, et al. Magnetic resonance neurography of common peroneal (fibular) neuropathy. J Comput Assist Tomogr United States. 2012;36:455–61.
Ahlawat S, Belzberg AJ, Fayad LM. Utility of magnetic resonance imaging for predicting severity of sciatic nerve injury. J Comput Assist Tomogr United States. 2018;42:580–7.
Noyes FR, Mooar LA, Moorman CT, McGinniss GH. Partial tears of the anterior cruciate ligament. Progression to complete ligament deficiency. J Bone Jt Surg - Ser B. 1989;71-B:825-833
De Smet AA, Norris MA, Yandow DR, Quintana FA, Graf BK, Keene JS. MR diagnosis of meniscal tears of the knee: importance of high signal in the meniscus that extends to the surface. AJR Am J Roentgenol United States. 1993;161:101–7.
Hong SH, Choi J-Y, Lee GK, Choi J-A, Chung HW, Kang HS. Grading of anterior cruciate ligament injury. J Comput Assist Tomogr. 2003;27:814-819
Landis JR, Koch GG. Landis amd Koch1977_agreement of categorical data. Biometrics. 1977;33:159–74.
Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. Elsevier B.V. 2016;15:155–63.
Husarik DB, Saupe N, Pfirrmann CWA, Jost B, Hodler J, Zanetti M. Elbow nerves: MR findings in 60 asymptomatic subjects--normal anatomy, variants, and pitfalls. Radiology. 2009/05/18. United States. 2009;252:148–56.
Kronlage M, Schwehr V, Schwarz D, Godel T, Harting I, Heiland S, et al. Prevalence of fascicular hyperintensities in peripheral nerves of healthy individuals with regard to cerebral white matter lesions. Eur Radiol Germany. 2019;29:3480–7.
Chappell KE, Robson MD, Stonebridge-Foster A, Glover A, Allsop JM, Williams AD, et al. Magic angle effects in MR neurography. Am J Neuroradiol. 2004;25:431–440
Woodmass JM, Romatowski NPJ, Esposito JG, Mohtadi NGH, Longino PD. A systematic review of peroneal nerve palsy and recovery following traumatic knee dislocation. Knee Surg Sports Traumatol Arthrosc Germany. 2015;23:2992–3002.
Niall DM, Nutton RW, Keating JF. Palsy of the common peroneal nerve after traumatic dislocation of the knee. J Bone Joint Surg (Br) England. 2005;87:664–7.
Moatshe G, Dornan GJ, Løken S, Ludvigsen TC, LaPrade RF, Engebretsen L. Demographics and injuries associated with knee dislocation: a prospective review of 303 patients. Orthop J Sport Med. 2017;5:2325967117706521.
Cho D, Saetia K, Lee S, Kline DG, Kim DH. Peroneal nerve injury associated with sports-related knee injury. Neurosurg Focus. United States. 2011;31:E11.
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
- Peripheral nerve