European Radiology

, Volume 18, Issue 9, pp 1953–1961 | Cite as

Upper extremity peripheral neuropathies: role and impact of MR imaging on patient management

  • Gustav Andreisek
  • Doris Burg
  • Ansgar Studer
  • Dominik Weishaupt
Magnetic Resonance

Abstract

To investigate the role of MR imaging (MRI) in the evaluation of peripheral nerve lesions of the upper extremities and to assess its impact on the patient management. Fifty-one patients with clinical evidence of radial, median, and/or ulnar nerve lesions and unclear or ambiguous clinical findings had MRI of the upper extremity at 1.5 T. MR images and clinical data were reviewed by two blinded radiologists and a group of three clinical experts, respectively, with regard to radial, median, and/or ulnar nerve, as well as muscle abnormalities. MRI and clinical findings were correlated using Spearman’s (p) rank correlation test. The impact of MRI on patient management was assessed by the group of experts and ranked as “major,” “moderate,” or “no” impact. The correlation of MRI and clinical findings was moderate for the assessment of the median/radial nerve and muscles (p = 0.51/0.51/0.63, respectively) and weak for the ulnar nerve (p = 0.40). The impact of MRI on patient management was assessed as “major” in 24/51 (47%), “moderate” in 19/51 (37%), and “no” in 8/51 (16%) patients. MRI in patients with upper extremity peripheral neuropathies and unclear or ambiguous clinical findings substantially influences the patient management.

Keywords

Peripheral nervous system Peripheral nerves Magnetic resonance imaging Upper extremity 

Notes

Acknowledgements

The authors thank Mrs. Anna Mueller-Gerber for her help in preparing the manuscript as well as Prof. Viktor Meyer for his thoughtful comments.

References

  1. 1.
    Day JW (2001) Electrodiagnosis in diseases of nerve and muscle: principles and practice. In: Kimura J (ed) Neuromuscul disord. Oxford University Press, OxfordGoogle Scholar
  2. 2.
    Koltzenburg M, Bendszus M (2004) Imaging of peripheral nerve lesions. Curr Opin Neurol 17:621–626PubMedCrossRefGoogle Scholar
  3. 3.
    McDonald CM, Carter GT, Fritz RC, Anderson MW, Abresch RT, Kilmer DD (2000) Magnetic resonance imaging of denervated muscle: comparison to electromyography. Muscle Nerve 23:1431–1434PubMedCrossRefGoogle Scholar
  4. 4.
    West GA, Haynor DR, Goodkin R et al (1994) Magnetic resonance imaging signal changes in denervated muscles after peripheral nerve injury. Neurosurgery 35:1077–1085, discussion 1085–1076PubMedCrossRefGoogle Scholar
  5. 5.
    Bendszus M, Wessig C, Reiners K, Bartsch AJ, Solymosi L, Koltzenberg M (2003) MR imaging in the differential diagnosis of neurogenic foot drop. AJNR Am J Neuroradiol 24:1283–1289PubMedGoogle Scholar
  6. 6.
    Jarvik JG, Yuen E, Kliot M (2004) Diagnosis of carpal tunnel syndrome: electrodiagnostic and MR imaging evaluation. Neuroimaging Clin N Am 14:93–102, DOI 10.1016/j.nic.2004.02.002 PubMedCrossRefGoogle Scholar
  7. 7.
    Wu HT, Schweitzer ME, Culp RW (2004) Potential MR signs of recurrent carpal tunnel syndrome: initial experience. J Comput Assist Tomogr 28:860–864PubMedCrossRefGoogle Scholar
  8. 8.
    Andreisek G, Crook DW, Burg D, Marincek B, Weishaupt D (2006) Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics 26:1267–1287, DOI 10.1148/rg.265055712 PubMedCrossRefGoogle Scholar
  9. 9.
    Beltran J, Rosenberg ZS (1994) Diagnosis of compressive and entrapment neuropathies of the upper extremity: value of MR imaging. AJR Am J Roentgenol 163:525–531PubMedGoogle Scholar
  10. 10.
    Ferdinand BD, Rosenberg ZS, Schweitzer ME et al (2006) MR imaging features of radial tunnel syndrome: initial experience. Radiology 240:161–168, DOI 10.1148/radiol.2401050028 PubMedCrossRefGoogle Scholar
  11. 11.
    Kim S, Choi JY, Huh YM et al (2007) Role of magnetic resonance imaging in entrapment and compressive neuropathy–what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity. Eur Radiol 17:509–522, DOI 10.1007/s00330–006–0180-y PubMedCrossRefGoogle Scholar
  12. 12.
    Demondion X, Bacqueville E, Paul C, Duquesnoy B, Hachulla E, Cotten A (2003) Thoracic outlet: assessment with MR imaging in asymptomatic and symptomatic populations. Radiology 227:461–468, DOI 10.1148/radiol.2272012111 PubMedCrossRefGoogle Scholar
  13. 13.
    Spinner RJ, Amadio PC (2003) Compressive neuropathies of the upper extremity. Clin Plast Surg 30:155–173 viPubMedCrossRefGoogle Scholar
  14. 14.
    Hems TE, Burge PD, Wilson DJ (1997) The role of magnetic resonance imaging in the management of peripheral nerve tumours. J Hand Surg [Br] 22:57–60Google Scholar
  15. 15.
    Murphey MD, Smith WS, Smith SE, Kransdorf MJ, Temple HT (1999) From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation. Radiographics 19:1253–1280PubMedGoogle Scholar
  16. 16.
    Toms AP, Anastakis D, Bleakney RR, Marshall TJ (2006) Lipofibromatous hamartoma of the upper extremity: a review of the radiologic findings for 15 patients. AJR Am J Roentgenol 186:805–811, DOI 10.2214/AJR.04.1717 PubMedCrossRefGoogle Scholar
  17. 17.
    Spratt JD, Stanley AJ, Grainger AJ, Hide IG, Campbell RS (2002) The role of diagnostic radiology in compressive and entrapment neuropathies. Eur Radiol 12:2352–2364, DOI 10.1007/s00330–001–1256–3 PubMedGoogle Scholar
  18. 18.
    Jarvik JG, Yuen E, Haynor DR et al (2002) MR nerve imaging in a prospective cohort of patients with suspected carpal tunnel syndrome. Neurology 58:1597–1602PubMedGoogle Scholar
  19. 19.
    May DA, Disler DG, Jones EA, Balkissoon AA, Manaster BJ (2000) Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls. Radiographics 20(Spec No):S295–S315PubMedGoogle Scholar
  20. 20.
    Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8:599–605PubMedCrossRefGoogle Scholar
  21. 21.
    Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res:78–83Google Scholar
  22. 22.
    Wessig C, Koltzenburg M, Reiners K, Solymosi L, Bendszus M (2004) Muscle magnetic resonance imaging of denervation and reinnervation: correlation with electrophysiology and histology. Exp Neurol 185:254–261PubMedCrossRefGoogle Scholar
  23. 23.
    Kundel HL, Polansky M (2003) Measurement of observer agreement. Radiology 228:303–308, DOI 10.1148/radiol.2282011860 PubMedCrossRefGoogle Scholar
  24. 24.
    Zou KH, Tuncali K, Silverman SG (2003) Correlation and simple linear regression. Radiology 227:617–622, DOI 10.1148/radiol.2273011499 PubMedCrossRefGoogle Scholar
  25. 25.
    Kruskal W (1978) Dickens on statistics. Science 199:1026, DOI 10.1126/science.199.4333.1026 PubMedCrossRefGoogle Scholar
  26. 26.
    Lacour-Petit MC, Lozeron P, Ducreux D (2003) MRI of peripheral nerve lesions of the lower limbs. Neuroradiology 45:166–170, DOI 10.1007/s00234-002-0932-6 PubMedGoogle Scholar
  27. 27.
    Grant GA, Goodkin R, Maravilla KR, Kliot M (2004) MR neurography: diagnostic utility in the surgical treatment of peripheral nerve disorders. Neuroimaging Clin N Am 14:115–133, DOI 10.1016/j.nic.2004.02.003 PubMedCrossRefGoogle Scholar
  28. 28.
    Weig SG, Waite RJ, McAvoy K (2000) MRI in unexplained mononeuropathy. Pediatr Neurol 22:314–317PubMedCrossRefGoogle Scholar
  29. 29.
    Skorpil M, Engstrom M, Nordell A (2007) Diffusion-direction-dependent imaging: a novel MRI approach for peripheral nerve imaging. Magn Reson Imaging 25:406–411, DOI 10.1016/j.mri.2006.09.017 PubMedCrossRefGoogle Scholar
  30. 30.
    Bendszus M, Stoll G (2003) Caught in the act: in vivo mapping of macrophage infiltration in nerve injury by magnetic resonance imaging. J Neurosci 23:10892–10896PubMedGoogle Scholar
  31. 31.
    Wessig C, Bendszus M, Stoll G (2007) In vivo visualization of focal demyelination in peripheral nerves by gadofluorine M-enhanced magnetic resonance imaging. Exp Neurol 204:14–19, DOI 10.1016/j.expneurol.2006.09.022 PubMedCrossRefGoogle Scholar
  32. 32.
    Britz GW, Haynor DR, Kuntz C et al (1996) Ulnar nerve entrapment at the elbow: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurgery 38:458–465, discussion 465PubMedCrossRefGoogle Scholar
  33. 33.
    Grant GA, Britz GW, Goodkin R, Jarvik JG, Maravilla K, Kliot M (2002) The utility of magnetic resonance imaging in evaluating peripheral nerve disorders. Muscle Nerve 25:314–331PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2008

Authors and Affiliations

  • Gustav Andreisek
    • 1
    • 5
  • Doris Burg
    • 2
    • 3
  • Ansgar Studer
    • 4
  • Dominik Weishaupt
    • 1
  1. 1.Institute for Diagnostic Radiology, Department of Medical RadiologyUniversity Hospital ZurichZurichSwitzerland
  2. 2.Division for Plastic, Hand- and Reconstructive Surgery, Department of SurgeryUniversity Hospital Zurich (Academic Medical Center)ZurichSwitzerland
  3. 3.MaurSwitzerland
  4. 4.Department of NeurologyUniversity Hospital ZurichZurichSwitzerland
  5. 5.Department of Medical Imaging, 5th Floor, Mount Sinai Hospital and the University Health NetworkUniversity of TorontoTorontoCanada

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