From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, Room 2P-040, New York, NY 10021.
Radiology. 2021 Aug;300(2):246-259. doi: 10.1148/radiol.2021204039. Epub 2021 Jun 29.
As the frequency of orthopedic procedures performed each year in the United States continues to increase, evaluation of peripheral nerve injury (PNI) in the presence of pre-existing metallic hardware is in higher demand. Advances in metal artifact reduction techniques have substantially improved the capability to reduce the susceptibility effect at MRI, but few reports have documented the use of MR neurography in the evaluation of peripheral nerves in the presence of orthopedic hardware. This report delineates the challenges of MR neurography around metal given the high spatial resolution often required to adequately depict small peripheral nerves. It offers practical tips, including strategies for prescan assessment and protocol optimization, including use of more conventional two-dimensional proton density and T2-weighted fat-suppressed sequences and specialized three-dimensional techniques, such as reversed free-induction steady-state precession and multispectral imaging, which enable vascular suppression and metal artifact reduction, respectively. Finally, this article emphasizes the importance of real-time monitoring by radiologists to optimize the diagnostic yield of MR neurography in the presence of orthopedic hardware. © RSNA, 2021.
随着美国每年进行的骨科手术频率不断增加，对于存在先前存在的金属硬件的周围神经损伤 (PNI) 的评估需求也越来越高。金属伪影减少技术的进步极大地提高了在 MRI 中降低易感性效应的能力，但很少有报道记录了在存在骨科硬件的情况下使用磁共振神经成像术来评估周围神经。鉴于通常需要高空间分辨率来充分描绘小的周围神经，本报告阐述了围绕金属进行磁共振神经成像的挑战。它提供了实用技巧，包括预扫描评估和协议优化策略，包括使用更传统的二维质子密度和 T2 加权脂肪抑制序列以及专门的三维技术，例如反转自由进动稳态进动和多光谱成像，分别实现血管抑制和金属伪影减少。最后，本文强调了放射科医生实时监测的重要性，以优化存在骨科硬件时磁共振神经成像的诊断效果。
