De Paepe Katja N, Higgins David M, Ball Iain, Morgan Veronica A, Barton Desmond P, deSouza Nandita M
The Institute of Cancer Research, Division of Radiotherapy and Imaging, Sutton, UK.
The Royal Marsden NHS Foundation Trust, Department of Radiology, London, UK.
Acta Radiol. 2020 Dec;61(12):1668-1676. doi: 10.1177/0284185120909337. Epub 2020 Mar 25.
Treatment of female pelvic malignancies often causes pelvic nerve damage. Magnetic resonance (MR) neurography mapping the female pelvic innervation could aid in treatment planning.
To depict female autonomic and somatic pelvic innervation using a modified 3D NerveVIEW sequence.
Prospective study in 20 female volunteers (n = 6 normal, n = 14 cervical pathology) who underwent a modified 3D short TI inversion recovery (STIR) turbo spin-echo (TSE) scan with a motion-sensitive driven equilibrium (MSDE) preparation radiofrequency pulse and flow compensation. Modifications included offset independent trapezoid (OIT) pulses for inversion and MSDE refocusing. Maximum intensity projections (MIP) were evaluated by two observers (Observer 1, Observer 2); image quality was scored as 2 = high, 1 = medium, or 0 = low with the sciatic nerve serving as a reference. Conspicuity of autonomic superior (SHP) and bilateral inferior hypogastric plexuses (IHP), hypogastric nerves, and somatic pelvic nerves (sciatic, pudendal) was scored as 2 = well-defined, 1 = poorly defined, or 0 = not seen, and inter-observer agreement was determined.
Images were of medium to high quality according to both observers agreeing in 15/20 (75%) of individuals. SHP and bilateral hypogastric nerves were seen in 30/60 (50%) of cases by both observers. Bilateral IHP was seen in 85% (34/40) by Observer 1 and in 75% (30/40) by Observer 2. Sciatic nerves were well identified in all cases, while pudendal nerves were seen bilaterally by Observer 1 in 65% (26/40) and by Observer 2 in 72.5% (29/40). Agreement between observers for scoring nerve conspicuity was in the range of 60%-100%.
Modified 3D NerveVIEW renders high-quality images of the female autonomic and pudendal nerves.
女性盆腔恶性肿瘤的治疗常导致盆腔神经损伤。磁共振（MR）神经成像对女性盆腔神经进行映射有助于治疗规划。
使用改良的3D NerveVIEW序列描绘女性自主神经和躯体盆腔神经。
对20名女性志愿者（n = 6名正常，n = 14名有宫颈病变）进行前瞻性研究，这些志愿者接受了改良的3D短TI反转恢复（STIR）快速自旋回波（TSE）扫描，采用运动敏感驱动平衡（MSDE）准备射频脉冲和血流补偿。改良包括用于反转和MSDE重新聚焦的偏移独立梯形（OIT）脉冲。由两名观察者（观察者1、观察者2）评估最大强度投影（MIP）；图像质量以坐骨神经为参考，评分为2 = 高，1 = 中，或0 = 低。自主神经上丛（SHP）、双侧下腹下丛（IHP）、下腹神经和躯体盆腔神经（坐骨神经、阴部神经）的清晰度评分为2 = 清晰，1 = 模糊，或0 = 未见，并确定观察者间的一致性。
根据两名观察者的评估，15/20（75%）的个体图像质量为中到高。两名观察者在30/60（50%）的病例中均观察到SHP和双侧下腹神经。观察者1在85%（34/40）的病例中观察到双侧IHP，观察者2在75%（30/40）的病例中观察到。在所有病例中坐骨神经均清晰可辨，观察者1在65%（26/40）的病例中双侧观察到阴部神经，观察者2在72.5%（29/40）的病例中观察到。观察者间对神经清晰度评分的一致性在范围为60%-100%。
改良的3D NerveVIEW可提供女性自主神经和阴部神经的高质量图像。
