Aggarwal Ankita, Srivastava Deep Narayan, Jana Manisha, Sharma Raju, Gamanagatti Shivanand, Kumar Atin, Kumar Vijay, Malhotra Rajesh, Goyal Vinay, Garg Kanwaljeet
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
World Neurosurg. 2017 Dec;108:185-200. doi: 10.1016/j.wneu.2017.08.054. Epub 2017 Aug 24.
Peripheral neuropathies refer to a group of disorders in which there is damage to the nerves of the peripheral nervous system. Electrophysiologic studies are the main stay for the diagnosis of peripheral neuropathies. However, direct visualization of the nerves is possible with exact localization of site of disease with high-resolution ultrasonography (USG) and 3-Tesla magnetic resonance imaging (MRI) scanner, and newer magnetic resonance (MR) sequences.
We performed a cross-sectional study including 55 patients and 64 nerves with upper limb peripheral neuropathies. All patients included underwent high-resolution focused USG of the nerves and MR neurography. A nerve conduction velocity study was performed for reference.
The diagnostic confidence of the turbo spin echo T2-weighted (T2W) MR sequence was seen to be highest, with a sensitivity of 95.31%, whereas it was 81.25% for USG. Continuity of the nerve in patients with traumatic neuropathy was seen in 65.7% and 62.86% (22/35) nerves on MRI and USG, respectively. T1-weighted and T2W MR sequences were seen to be equally effective in establishing the continuity of the nerve. Increase in the caliber/thickening was seen in 77% of cases on MRI and 73.8% of cases on USG. Neuroma formation was seen equally on both MR and USG in 60.66%. We consistently found low fractional anisotropy (FA) values at the site of disease.
USG is a sensitive technique to diagnose peripheral neuropathies and it should be used as a screening modality for focused MR to be performed later. Turbo spin echo T2W fast spin has the highest sensitivity to identify nerve disease and is comparable with nerve conduction studies. Among the newer sequences, diffusion tensor imaging should be performed to increase diagnostic confidence.
周围神经病变是指一组外周神经系统神经受损的疾病。电生理研究是诊断周围神经病变的主要手段。然而，使用高分辨率超声（USG）和3特斯拉磁共振成像（MRI）扫描仪以及更新的磁共振（MR）序列，可以直接观察神经并精确确定疾病部位。
我们进行了一项横断面研究，纳入了55例上肢周围神经病变患者和64条神经。所有患者均接受了神经的高分辨率聚焦USG检查和MR神经成像。同时进行神经传导速度研究作为参考。
涡轮自旋回波T2加权（T2W）MR序列的诊断置信度最高，敏感性为95.31%，而USG的敏感性为81.25%。在创伤性神经病变患者中，MRI和USG分别显示65.7%和62.86%（22/35）的神经神经连续性。T1加权和T2W MR序列在确定神经连续性方面同样有效。MRI显示77%的病例神经管径增加/增粗，USG显示73.8%的病例有此表现。60.66%的病例在MR和USG上均可见神经瘤形成。我们在疾病部位始终发现低分数各向异性（FA）值。
USG是诊断周围神经病变的一种敏感技术，应作为后续进行聚焦MR检查的筛查方式。涡轮自旋回波T2W快速自旋序列在识别神经疾病方面具有最高的敏感性，与神经传导研究相当。在更新的序列中，应进行扩散张量成像以提高诊断置信度。
