High-resolution sonography has a growing role in both the diagnosis and management of traumatic and atraumatic peripheral nerve pathology. Sonography not only affords a cost-effective and time-efficient approach to interrogating long segments of peripheral nerves but also possesses unique advantages in terms of its dynamic, real-time nature with few clinical contraindications and limitations. In this review, we will initially discuss imaging techniques and characteristics of normal neural sonohistology, then address specific features and pitfalls pertaining to the spectrum of post-traumatic peripheral nerve injury. Additionally, we will highlight the more common sonographic applications in the clinical work-up of patients presenting with symptoms of dynamic neural impingement and entrapment. Finally, illustrative and clinical features of the more frequently encountered peripheral neural neoplastic pathologies will be addressed.
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Traumatic injuries of the brain and spinal cord are a significant source of mortality and long-term disability. A recent systematic study in a rat model of spinal cord injury (SCI) indicates severe, destructive, and very protracted inflammation as the key mechanism initiated by the massive injury involving the white matter. Although the severe inflammation is localized and counteracted by astrogliosis, it has a damaging effect on the blood vessels in the surrounding spinal cord, leading to persistent vasogenic edema. To evaluate these injuries, imaging of the brain and spinal cord plays a crucial role in the acute trauma work-up, allowing clinicians to quickly identify abnormalities that require immediate medical or surgical intervention or to exclude them from the work-up. Recently, anti-inflammatory agents have been shown to inhibit and accelerate the elimination of post-SCI inflammation in preclinical studies, and an exciting potential has arisen for the use of anti-inflammatory drugs in clinical studies to achieve neuroprotection (i.e., inhibition of destruction caused by inflammation) and to inhibit vasogenic edema in SCI, traumatic brain injury, and stroke. In both subacute and chronic settings, imaging can be a guide to therapy and provide important prognostic information. In this review, we discuss the imaging work-up and evolving imaging findings of neurotrauma in the acute and chronic setting, including conventional and advanced imaging techniques. As neuroimaging is the primary mode of diagnostic analysis in neurotrauma, it is a critical component in future clinical trials evaluating neuroprotective therapies.
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