van Vliet Eva, Raasveld Floris V, Liu Wen-Chih, Valerio Ian L, Eberlin Kyle R, Newman Erik T, Jarraya Mohamed, Simeone F Joseph, Husseini Jad S
Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Skeletal Radiol. 2025 May;54(5):979-991. doi: 10.1007/s00256-024-04779-0. Epub 2024 Sep 12.
The impact of time on neuroma growth and morphology on pain intensity is unknown. This study aims to assess magnetic resonance imaging (MRI) differences between symptomatic and non-symptomatic neuromas in oncological amputees, and whether time influences MRI-detected neuroma dimensions and their association with pain.
Oncological patients who underwent traditional extremity amputation were included. Post-amputation MRIs were assessed before decision for neuroma surgery. Chart review was performed for residual limb pain (numeric rating scale, 0-10) and the presence of neuropathic symptoms. Neuromas were classified as symptomatic or non-symptomatic, with neuroma size expressed as radiological neuroma-to-nerve-ratio (NNR).
Among 78 neuromas in 60 patients, the median NNR was 2.0, and 56 neuromas (71.8%) were symptomatic with a median pain score of 3.5. NNR showed no association with symptomatology or pain intensity but correlated with a longer time-to-neuroma-excision interval and a smaller nerve caliber. Symptomatic neuromas were associated with lower extremity amputation, T2 heterogeneity, and the presence of heterotopic ossification. Lower extremity amputation, T2 heterogeneity, perineural edema, and presence of heterotopic ossification were associated with more painful neuromas.
MRI features associated with symptomatic neuromas and pain intensity were identified. Awareness of the potential clinical significance of these imaging features may help in the interpretation of MRI exams and may aid clinicians in patient selection for neuroma surgery in oncological amputees.
时间对神经瘤生长、形态以及疼痛强度的影响尚不清楚。本研究旨在评估肿瘤截肢患者中有症状和无症状神经瘤之间的磁共振成像（MRI）差异，以及时间是否会影响MRI检测到的神经瘤大小及其与疼痛的关联。
纳入接受传统肢体截肢的肿瘤患者。在决定进行神经瘤手术前评估截肢后的MRI。对残肢疼痛（数字评分量表，0 - 10）和神经病变症状的存在情况进行病历审查。神经瘤分为有症状或无症状，神经瘤大小用放射学神经瘤与神经比率（NNR）表示。
在60例患者的78个神经瘤中，NNR中位数为2.0，56个神经瘤（71.8%）有症状，疼痛评分中位数为3.5。NNR与症状或疼痛强度无关联，但与神经瘤切除间隔时间较长和神经管径较小相关。有症状的神经瘤与下肢截肢、T2异质性以及异位骨化的存在有关。下肢截肢、T2异质性、神经周围水肿和异位骨化的存在与更疼痛的神经瘤有关。
确定了与有症状神经瘤和疼痛强度相关的MRI特征。了解这些影像特征的潜在临床意义可能有助于MRI检查的解读，并可能帮助临床医生在肿瘤截肢患者中选择神经瘤手术的患者。
