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Bildgebung der Hand

Worauf sollte bei den Nerven geachtet werden?

Imaging of the hand

What should be considered regarding the nerves?

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Zusammenfassung

Hintergrund

Erkrankungen der peripheren Nerven an Hand und Handgelenk werden hauptsächlich durch Kompressionsneuropathien verursacht, während traumatische Nervenverletzungen und Tumoren deutlich seltener sind.

Fragestellung

Es sollen die Indikationen für ergänzende bildgebende Methoden und unterschiedliche Bildgebungsoptionen, insbesondere bei atypischer Symptompräsentation oder unklar verbleibender Symptomursache nach Abschluss der Standarddiagnostik, beleuchtet werden.

Material und Methoden

Die beiden bildgebenden Methoden, Magnetresonanz(MR)-Neurographie und Neurosonographie, werden vorgestellt und typische Befunde, aber auch Pitfalls, werden präsentiert.

Ergebnisse

Der diagnostische Goldstandard, bestehend aus Anamnese, klinisch-neurologischer Untersuchung und Elektrophysiologie, kann die Diagnose einer Neuropathie häufig sichern. Bildgebende Methoden, allen voran die MR-Neurographie sowie die Neurosonographie, erlangen jedoch zunehmende Bedeutung bei der Abklärung atypischer Neuropathien sowie zur Bestimmung der exakten Läsionslokalisation und -ausdehnung, insbesondere in der präoperativen Planung. Die technischen Fortschritte der letzten Jahre ermöglichen heute die hochauflösende Abbildung auch kleiner distaler Nervenendäste.

Schlussfolgerung

Die MR-Neurographie ermöglicht die hochauflösende Abbildung der peripheren Nerven an Hand und Handgelenk und kann die Diagnose einer Neuropathie sichern, die exakte Lokalisation einer Nervenläsion detektieren und Differenzialdiagnosen ausschließen. Die Neurosonographie ist eine zeit- und kosteneffiziente Alternativmethode.

Abstract

Background

Peripheral nerve disorders of the hand and wrist are most commonly caused by entrapment neuropathies, while traumatic nerve injuries and neoplasms are less common.

Objectives

The indication for additional imaging methods and different imaging options, especially in patients with atypical symptoms or remaining unclear etiology of symptoms after completion of standard diagnostics, are presented.

Materials and methods

The imaging methods magnetic resonance (MR) neurography and neurosonography are introduced, and typical findings as well as diagnostic pitfalls are presented.

Results

The diagnostic gold standard, which comprises a past medical history, neurologic examination and electrophysiology, can often establish the diagnosis. Imaging methods, especially MR neurography and neurosonography, are gaining increasing importance in the diagnostic workup of atypical neuropathies, as well as in the determination of the exact lesion location and spatial lesion extension, especially for surgical planning. Recent technical advances allow high-resolution depiction of small distal terminal nerve branches.

Conclusions

MR neurography allows for the high-resolution depiction of peripheral nerves of the hand and wrist. It can confirm the diagnosis of neuropathy, identify the exact lesion location, and rule out any differential diagnoses. Neurosonography is a time- and cost-efficient alternative diagnostic method.

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Authors and Affiliations

  1. Abteilung für Neuroradiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    Jennifer Kollmer &  Martin Bendszus

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  1. Jennifer Kollmer
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  2. Martin Bendszus
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Corresponding author

Correspondence to Jennifer Kollmer.

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Interessenkonflikt

J. Kollmer und M. Bendszus geben an, dass keine Interessenkonflikte bestehen.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Kollmer, J., Bendszus, M. Bildgebung der Hand. Radiologe 61, 375–381 (2021). https://doi.org/10.1007/s00117-021-00823-5

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  • DOI: https://doi.org/10.1007/s00117-021-00823-5

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