European Radiology

, Volume 26, Issue 5, pp 1235–1244

Impact of high resolution 3 tesla MR neurography (MRN) on diagnostic thinking and therapeutic patient management

  • Avneesh Chhabra
  • Allan J Belzberg
  • Gedge D Rosson
  • Gaurav K Thawait
  • M Chalian
  • Sahar J Farahani
  • Jaimie T Shores
  • Gene Deune
  • Shar Hashemi
  • Shrey K Thawait
  • Ty K Subhawong
  • John A Carrino
Musculoskeletal

Abstract

Objective

To evaluate the impact of magnetic resonance neurography (MRN) on diagnostic thinking and therapeutic choices in patients with suspected peripheral neuropathy.

Methods

IRB approval was obtained for this HIPAA-compliant study. Questionnaires were administered to six surgeons regarding the diagnosis and treatment in 85 patients suspected of having peripheral neuropathy, before (pretest) and after (posttest) MRN. Multiple outcome measures related to diagnostic confidence and surgical decision-making were assessed.

Results

The final cohort included 81 patients (30 men and 51 women, age 47 ± 17 years). The following changes were observed from pretest to posttest questionnaires: 23 % in nerve involvement (P < 0.05), 48 % in degree of confidence of nerve involvement (P < 0.01), 27 % in grade of injury (P < 0.05), 33 % in differential diagnosis (P < 0.05), 63 % in degree of confidence in need for surgery (P < 0.001), 41 % in timing of surgery (P < 0.01), 30 % in approach to surgery (P < 0.05), 58 % in degree of confidence in approach to surgery (P < 0.001), 30 % in estimated length of surgery (P < 0.05) and 27 % in length of incision (P < 0.05). The dichotomous decision regarding surgical or nonsurgical treatment changed from pro to con in 17 %.

Conclusion

MRN results significantly influenced the diagnostic thinking and therapeutic recommendations of peripheral nerve surgeons.

Key Points

• In patients with peripheral neuropathy, MRN significantly impacts diagnostic thinking.

• In patients with peripheral neuropathy, MRN significantly impacts therapeutic choices.

• 3-T MRN should be considered in presurgical planning of patients with peripheral neuropathy.

Keywords

Peripheral nerve injury MR neurography Decision-making Diagnostic approach Therapeutic management 

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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Avneesh Chhabra
    • 1
    • 2
  • Allan J Belzberg
    • 3
  • Gedge D Rosson
    • 4
  • Gaurav K Thawait
    • 2
  • M Chalian
    • 2
  • Sahar J Farahani
    • 2
  • Jaimie T Shores
    • 4
  • Gene Deune
    • 4
  • Shar Hashemi
    • 5
  • Shrey K Thawait
    • 2
  • Ty K Subhawong
    • 6
  • John A Carrino
    • 7
  1. 1.Department of RadiologySouthwestern Medical CenterDallasUSA
  2. 2.Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins HospitalBaltimoreUSA
  3. 3.Department of NeurosurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Department of Plastic SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  5. 5.Dellon InstituteTowsonUSA
  6. 6.Department of RadiologyUniversity of Miami Health SystemMiamiUSA
  7. 7.Department of Radiology and ImagingWeill Cornell Medical College, Hospital for Special SurgeryNew YorkUSA

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