Vanderbilt Institute for Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Ann Clin Transl Neurol. 2021 Feb;8(2):332-347. doi: 10.1002/acn3.51270. Epub 2021 Jan 6.
Management of peripheral nerve injuries requires physicians to rely on qualitative measures from patient history, electromyography, and physical exam. Determining a successful nerve repair can take months to years for proximal injuries, and the resulting delays in clinical decision-making can lead to a negative impact on patient outcomes. Early identification of a failed nerve repair could prevent permanent muscle atrophy and loss of function. This study aims to test the feasibility of performing diffusion tensor imaging (DTI) to evaluate injury and recovery following repair of wrist trauma. We hypothesize that DTI provides a noninvasive and reliable assessment of regeneration, which may improve clinical decision-making and alter the clinical course of surgical interventions.
Clinical and MRI measurements from subjects with traumatic peripheral nerve injury, carpal tunnel syndrome, and healthy control subjects were compared to evaluate the relationship between DTI metrics and injury severity.
Fractional anisotropy from DTI was sensitive to differences between damaged and healthy nerves, damaged and compressed nerves, and injured and healthy contralateral nerves. Longitudinal measurements in two injury subjects also related to clinical outcomes. Implications of other diffusion measures are also discussed.
DTI is a sensitive tool for wrist nerve injuries and can be utilized for monitoring nerve recovery. Across three subjects with nerve injuries, this study has shown how DTI can detect abnormalities between injured and healthy nerves, measure recovery, and determine if re-operation was successful. Additional comparisons to carpal tunnel syndrome and healthy nerves show that DTI is sensitive to the degree of impairment.
外周神经损伤的治疗需要医生依赖病史、肌电图和体格检查的定性测量结果。对于近端损伤，确定成功的神经修复可能需要数月至数年的时间，而由此导致的临床决策延迟可能会对患者的预后产生负面影响。早期发现神经修复失败可防止肌肉永久性萎缩和功能丧失。本研究旨在测试使用弥散张量成像（DTI）评估腕部创伤修复后损伤和恢复的可行性。我们假设 DTI 可提供一种非侵入性且可靠的再生评估方法，这可能会改善临床决策并改变手术干预的临床过程。
比较外伤性周围神经损伤、腕管综合征和健康对照受试者的临床和 MRI 测量结果，以评估 DTI 指标与损伤严重程度之间的关系。
DTI 的各向异性分数（fractional anisotropy）对受损和健康神经、受损和受压神经以及受伤和健康对侧神经之间的差异敏感。两名损伤受试者的纵向测量结果也与临床结果相关。其他扩散测量的影响也进行了讨论。
DTI 是腕部神经损伤的敏感工具，可用于监测神经恢复。在三名神经损伤受试者中，本研究展示了 DTI 如何检测受损和健康神经之间的异常、测量恢复情况，并确定是否需要再次手术。与腕管综合征和健康神经的进一步比较表明，DTI 对损伤程度敏感。
