Look for the nerves! MR neurography adds essential diagnostic value to routine MRI in pediatric practice: a pictorial overview

J Neuroradiol. 2011 Jul;38(3):141-7. doi: 10.1016/j.neurad.2010.09.006. Epub 2011 Jan 12.

Abstract

Purpose: This study aimed to assess the feasibility of magnetic resonance (MR) neurography in children, and the potential roles of diffusion-weighted imaging (DWI) and fiber-tracking (FT) techniques.

Methods: Five pediatric patients (age range: 6-12 years) underwent magnetic resonance imaging (MRI) for various clinical indications: neurogenic bladder (case 1); persistent hand pain following minor trauma (case 2); progressive atrophy of the lower left extremity muscles (case 3); bilateral hip pain (case 4); and palpable left supraclavicular mass (case 5). All studies were performed using a 1.5-T Avanto MRI scanner (Siemens, Erlangen, Germany). The protocol included 3D T2-weighted STIR and SPACE imaging, T1-weighted fat-saturation post-gadolinium imaging and diffusion tensor imaging (DTI) with tractography. ADC (N×10(-3) mm(2)/s) and FA values were calculated from regions of interest (ROIs) centered on the nerves. Nerve-fiber tracks were calculated using a fourth-order Runge-Kutta algorithm (NeuroD software).

Results: MR neurography allowed satisfactory visualization of all neural structures, and FA and ADC measurements were feasible. The final diagnoses were Tarlov cysts, median-nerve compression, sciatic perineurioma, Charcot-Marie-Tooth disease and plexiform neurofibroma in a patient with NF-1.

Discussion: FA and ADC measurements are of little value because of the lack of normal reference values. Nerve-fiber tractography (FT) may be of value in the characterization of tumor pathology, and is also helpful in the planning of surgical treatments.

Conclusion: MR neurography is feasible in pediatric patients. However, a considerable amount of work has yet to be done to establish its role in the clinical management of the wide range of peripheral nerve diseases.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Anisotropy
  • Child
  • Contrast Media
  • Feasibility Studies
  • Female
  • Gadolinium
  • Humans
  • Image Interpretation, Computer-Assisted
  • Imaging, Three-Dimensional
  • Magnetic Resonance Imaging / methods*
  • Male
  • Peripheral Nervous System Diseases / diagnosis*

Substances

  • Contrast Media
  • Gadolinium