Pham Mirko, Bäumer Tobias, Bendszus Martin
aDepartment of Neuroradiology, Heidelberg University Hospital, Heidelberg bDepartment of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetic, University of Lübeck, Lübeck, Germany.
Curr Opin Neurol. 2014 Aug;27(4):370-9. doi: 10.1097/WCO.0000000000000111.
The purpose of this study is to review advances in magnetic resonance (MR)-neurography and nerve-ultrasound for the precise visualization and localization of nerve lesions not only in nerve trauma or mass lesions, but also in entrapment-related and spontaneously occurring intrinsic neuropathies. These advances may improve the understanding and classification of peripheral neuropathies.
Diagnostic studies of MR-neurography and high-resolution ultrasound in entrapment-neuropathies consistently report accurate determination and localization of symptomatic nerve entrapment. Additionally, the longitudinal sampling of nerve-T2-signal over larger areas of coverage has become technically feasible. With this approach, more complex patterns of spatial lesion dispersion in nonfocal neuropathies could be observed with reliable lesion image contrast at the level of individual nerve fascicles. Imaging detection of fascicular lesions allows for more accurate localization, because fascicular lesion types represent a specific pitfall for clinical-electrophysiological examinations. Fascicular hypoechogenicity of high-resolution ultrasound is the correlate of nerve-T2-signal lesions, but contrast is inferior and difficult to quantify. Therefore, nerve enlargement remains the main diagnostic criterion in high-resolution ultrasound. Diffusion-tensor-MR-neurography provides quantitative estimates of fiber structure, which were shown to correlate with aging and focal entrapment.
High-resolution nerve imaging with extended anatomical coverage is feasible and improves the topographic description of spatial lesion dispersion which is particularly relevant for the discrimination between focal and nonfocal neuropathies.
本研究旨在回顾磁共振（MR）神经成像和神经超声在精确可视化和定位神经病变方面的进展，这些病变不仅见于神经创伤或肿块性病变，还见于与卡压相关的和自发发生的原发性神经病。这些进展可能会增进对外周神经病的理解和分类。
在卡压性神经病中，MR神经成像和高分辨率超声的诊断研究一致报告了对有症状神经卡压的准确判定和定位。此外，在更大的覆盖区域对神经T2信号进行纵向采样在技术上已变得可行。通过这种方法，可以在单个神经束水平观察到非局灶性神经病中更复杂的空间病变分散模式，并具有可靠的病变图像对比度。对束状病变的成像检测有助于更准确地定位，因为束状病变类型是临床电生理检查的一个特殊陷阱。高分辨率超声的束状低回声与神经T2信号病变相关，但对比度较差且难以量化。因此，神经增粗仍然是高分辨率超声的主要诊断标准。扩散张量MR神经成像提供了纤维结构的定量估计，已证明其与衰老和局灶性卡压相关。
具有扩展解剖覆盖范围的高分辨率神经成像可行，且能改善对空间病变分散的地形学描述，这对于区分局灶性和非局灶性神经病尤为重要。
