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Prevalence of fascicular hyperintensities in peripheral nerves of healthy individuals with regard to cerebral white matter lesions

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Abstract

Objective

Detection and pattern analysis of fascicular nerve hyperintensities in the T2-weighted image are the backbone of magnetic resonance neurography (MRN) as they may represent lesions of various etiologies. The aim of this study was to assess the prevalence of fascicular nerve hyperintensities in healthy individuals with regard to a potential association with age or cerebral white matter lesions.

Methods

Sixty volunteers without peripheral nerve diseases between the age of 20 and 80 underwent MRN (high-resolution T2-weighted) of upper (median, ulnar, radial) and lower (sciatic, tibial) extremity nerves and a fluid-attenuated inversion recovery (FLAIR) sequence of the brain. Presence of peripheral nerve hyperintensities and degree of cerebral white matter lesions were independently rated by two blinded readers and related to each other and to age. T test with Welch’s correction was used for group comparisons. Spearman’s correlation coefficients were reported for correlation analyses.

Results

MR neurography revealed fascicular hyperintensities in 10 of 60 subjects (16.7%). Most frequently, they occurred in the sciatic nerve (8/60 subjects, 13.3%), less frequently in the tibial nerve at the lower leg and the median, ulnar, and radial nerves at the upper arm (1.7–5.0%). Mean age of subjects with nerve hyperintensities was higher than that of those without (60.6 years vs. 48.0 years, p = 0.038). There was only a weak correlation of nerve lesions with age and with cerebral white matter lesions, respectively.

Conclusion

Fascicular nerve hyperintensities may occur in healthy individuals and should therefore always be regarded in conjunction with the clinical context.

Key Points

• MR neurography may reveal fascicular hyperintensities in peripheral nerves of healthy individuals. Fascicular hyperintensities occur predominantly in the sciatic nerve and older individuals.

• Therefore, fascicular hyperintensities should only be interpreted as clearly pathologic in conjunction with the clinical context.

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Abbreviations

DWMH:

Deep white matter hyperintensitites

FLAIR:

Fluid-attenuated inversion recovery

FOV:

Field of view

MRN:

Magnetic resonance neurography

PVH:

Periventricular hyperintensities

SD:

Standard deviation

T2w:

T2-weighted

TE:

Echo time

TI:

Inversion time

TR:

Repetition time

TSE:

Turbo spin echo

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Moritz Kronlage, Véronique Schwehr, Daniel Schwarz, Tim Godel, Inga Harting, Sabine Heiland, Martin Bendszus & Philipp Bäumer

  2. Department of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Philipp Bäumer

Authors
  1. Moritz Kronlage
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  2. Véronique Schwehr
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  3. Daniel Schwarz
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  4. Tim Godel
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  5. Inga Harting
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  6. Sabine Heiland
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  7. Martin Bendszus
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  8. Philipp Bäumer
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Corresponding author

Correspondence to Moritz Kronlage.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Dr. Moritz Kronlage.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Diffusion tensor imaging, T2-relaxometry and nerve cross sectional area data of the same cohort have been published separately:

  1. 1.

    Kronlage M, Schwehr V, Schwarz D et al (2017) Magnetic Resonance Neurography: Normal Values and Demographic Determinants of Nerve Caliber and T2 Relaxometry in 60 healthy individuals. Clinical Neuroradiology. https://doi.org/10.1007/s00062-017-0633-5

  2. 2.

    Kronlage M, Schwehr V, Schwarz D et al (2018) Peripheral nerve diffusion tensor imaging (DTI): normal values and demographic determinants in a cohort of 60 healthy individuals. European Radiology 28:1801–1808

18 of 60 subjects were used in a control group for:

  1. 1.

    Kronlage M, Bäumer P, Pitarokoili K et al (2017) Large coverage MR neurography in CIDP: diagnostic accuracy and electrophysiological correlation. Journal of Neurology 264:1434–1443

  2. 2.

    Kronlage M, Pitarokoili K, Schwarz D et al (2017) Diffusion Tensor Imaging in Chronic Inflammatory Demyelinating Polyneuropathy: Diagnostic Accuracy and Correlation With Electrophysiology. Investigative Radiology 52:701–7075

  3. 3.

    Pitarokoili K, Kronlage M, Bäumer P et al (2018) High-resolution nerve ultrasound and magnetic resonance neurography as complementary neuroimaging tools for chronic inflammatory demyelinating polyneuropathy. Therapeutic Advances in Neurological Disorders 11:1756286418759974

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Kronlage, M., Schwehr, V., Schwarz, D. et al. Prevalence of fascicular hyperintensities in peripheral nerves of healthy individuals with regard to cerebral white matter lesions. Eur Radiol 29, 3480–3487 (2019). https://doi.org/10.1007/s00330-019-06145-4

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