Kang Jiamin, Wu Wenjun, Kong Xiangchuang, Su Yu, Liu Dingxi, Li Chungao, Gao Nan, Wang Youzhi, Zheng Chuansheng, Weng Yuxiong, Wang Lixia
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Radiology, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ther Adv Neurol Disord. 2024 Mar 26;17:17562864241239739. doi: 10.1177/17562864241239739. eCollection 2024.
Magnetic resonance imaging of peripheral nerves in the wrist and palm is challenging due to the small size, tortuous course, complex surrounding tissues, and accompanying blood vessels. The occurrence of carpal palmar lesions leads to edema, swelling, and mass effect, which may further interfere with the display and identification of nerves.
To evaluate whether contrast-enhanced magnetic resonance neurography (ceMRN) improves the visualization of the morphology and pathology of the median, ulnar nerves, and their small branches in the wrist and palm.
An observational study.
In total 57 subjects, including 36 volunteers and 21 patients with carpal palmar lesions, were enrolled and underwent ceMRN and non-contrast MRN (ncMRN) examination at 3.0 Tesla. The degree of vascular suppression, nerve visualization, diagnostic confidence, and lesion conspicuity was qualitatively assessed by two radiologists. Kappa statistics were obtained for inter-reader agreement. The signal-to-noise ratio, contrast ratio (CR), and contrast-to-noise ratio (CNR) of the median nerve were measured. The subjective ratings and quantitative measurements were compared between ncMRN and ceMRN.
The inter-reader agreement was excellent ( > 0.8) for all qualitative assessments and visualization assessment of each nerve segment. Compared with ncMRN, ceMRN significantly improved vascular suppression in volunteers and patients (both < 0.001). The ceMRN significantly enhanced nerve visualization of each segment (all < 0.05) and diagnostic confidence in volunteers and patients (both < 0.05). The ceMRN improved lesion conspicuity ( = 0.003) in patients. Quantitatively, ceMRN had significantly higher CRs of nerve subcutaneous fat, bone marrow, and vessels and CNR of nerve vessel than ncMRN (all < 0.05).
The ceMRN significantly improves the visualization of peripheral nerves and pathology in the wrist and palm by robustly suppressing the signals of fat, bone marrow, and especially vessels in volunteers and patients.
手腕和手掌周围神经的磁共振成像具有挑战性，原因在于神经尺寸小、走行迂曲、周围组织复杂以及伴有血管。腕掌部病变的出现会导致水肿、肿胀和占位效应，这可能进一步干扰神经的显示和识别。
评估对比增强磁共振神经造影（ceMRN）是否能改善手腕和手掌部正中神经、尺神经及其小分支的形态和病理可视化。
一项观察性研究。
共纳入57名受试者，包括36名志愿者和21名腕掌部病变患者，均在3.0特斯拉下接受ceMRN和非对比磁共振神经造影（ncMRN）检查。由两名放射科医生对血管抑制程度、神经可视化程度、诊断信心和病变清晰度进行定性评估。获得读者间一致性的Kappa统计量。测量正中神经的信噪比、对比率（CR）和对比噪声比（CNR）。比较ncMRN和ceMRN之间的主观评分和定量测量结果。
对于各神经节段的所有定性评估和可视化评估，读者间一致性均极佳（>0.8）。与ncMRN相比，ceMRN在志愿者和患者中均显著改善了血管抑制（均P<0.001）。ceMRN显著增强了各节段的神经可视化（均P<0.05）以及志愿者和患者的诊断信心（均P<0.05）。ceMRN改善了患者的病变清晰度（P = 0.003）。在定量方面，ceMRN的神经与皮下脂肪、骨髓和血管的CR以及神经与血管的CNR均显著高于ncMRN（均P<0.05）。
ceMRN通过有力抑制志愿者和患者体内脂肪、骨髓尤其是血管的信号，显著改善了手腕和手掌部周围神经及其病理的可视化。
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