High-resolution Imaging of Neural Anatomy and Pathology of the Neck

Lee, Jeong Hyun; Cheng, Kai-Lung; Choi, Young Jun; Baek, Jung Hwan

doi:10.3348/kjr.2017.18.1.180

Cited by 37 publications

(23 citation statements)

References 22 publications

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“…The aim was to find a round, hypoechoic structure in axial view, surrounded by a slightly hyperechoic border which corresponds to the normal structure of the nerve. The vagus nerve was located in the carotid sheath, antero-laterally to the common carotid artery and dorsally to the internal jugular vein as it was described in former studies [15,16]. Individual fascicles were visible in the nerve, giving the structure a "honeycomb" appearance with two to five hypoechoic oval fascicles separated by hyperechoic epineurial tissue.…”

Section: High-resolution Ultrasound Examination Of the Nervesmentioning

confidence: 80%

Ultrasound appearance of peripheral nerves in the neck: vagus, hypoglossal and greater auricular

Curcean¹,

Rusu²,

Dudea³

2019

Medicine and Pharmacy Reports

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Background and aim. Information in ultrasonography about reference values of nerves, particularly of those located in the neck is limited. The aim of the study is to demonstrate the feasibility of direct visualization of the vagus, hypoglossal and greater auricular nerves, testing the method on healthy volunteers and estimate the reference values for two perpendicular diameters and cross-sectional area (CSA). Methods. A prospective study was carried out on 21 healthy volunteers (12 women and 9 men), recording their demographic characteristics. A 13 MHz transducer was used on a Hitachi EUB-8500 machine. The vagus nerve was measured at the bifurcation of common carotid artery (CCA) and at the intersection of the internal jugular vein with omohyoid muscle. The hypoglossal nerve was identified as it crosses the posterolateral border of the mylohyoid muscle in the submandibular space. The auricular nerve was identified on the superficial surface of the sternocleidomastoid muscle at 1 cm from its posterior margin. The mean CSA on axial scans, nerve width and thickness were determined. The side-to-side and gender differences of the estimated reference values and their correlations with the weight, height, and body mass index (BMI) were evaluated. Results. The mean ultrasound-estimated CSA was measured for the vagus nerve at CCA bifurcation (2.14 ± 0.79 on the left 2.86 ± 1.27 on the right), vagus nerve at the level of omohyoid muscle (2.10 ± 0.06 on the left and 2.43 ± 0.08 on the right), hypoglossal nerve (1.71 ± 0.08 on the left, 1.24 ± 0.06 on the right) and greater auricular nerve (0.90 ± 0.53 on the left and 0.79 ± 0.71 on the right). The vagus nerve was significantly larger on the right side compared to the left side. Larger hypoglossal nerve was observed in men compared to women. Significant correlations were observed between weight and CSA of the greater auricular nerve. Conclusion. Direct visualization of the vagus, greater auricular nerve and hypoglossal nerves is feasible. Reference values for the size of the studied nerves at specific anatomic landmarks were established. Side, gender and body weight differences of the nerves CSA were noted.

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Section: High-resolution Ultrasound Examination Of the Nervesmentioning

confidence: 80%

Ultrasound appearance of peripheral nerves in the neck: vagus, hypoglossal and greater auricular

Curcean¹,

Rusu²,

Dudea³

2019

Medicine and Pharmacy Reports

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“…In addition, conventional MRI can only capture restricted regions of the peripheral nerve trunks, and therefore, it may be insufficient for identifying CIDP (11). The limited field of view (FOV) and insufficient background suppression of signals from the venous plexus, lymph node, and perineural muscles undermine the visualization of the peripheral nerves (13)(14)(15) and impair the quality of images to visualize the nerve branches. As a result, the evidence of pathology in smaller nerves may be missed, and the distribution and true incidence of abnormally involved peripheral nerves may be underestimated.…”

Section: Mri Techniquementioning

confidence: 99%

Use of Magnetic Resonance Neurography for Evaluating the Distribution and Patterns of Chronic Inflammatory Demyelinating Polyneuropathy

Kong

et al. 2020

Korean J Radiol

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Objective: To evaluate the distribution and characteristics of peripheral nerve abnormalities in chronic inflammatory demyelinating polyneuropathy (CIDP) using magnetic resonance neurography (MRN) and to examine the diagnostic efficiency. Materials and Methods: Thirty-one CIDP patients and 21 controls underwent MR scans. Three-dimensional sampling perfections with application-optimized contrasts using different flip-angle evolutions and T1-/T2-weighted turbo spinecho sequences were performed for neurography of the brachial and lumbosacral (LS) plexus and cauda equina, respectively. Clinical data and scores of the inflammatory Rasch-built overall disability scale (I-RODS) in CIDP were obtained. Results: The bilateral extracranial vagus (n = 11), trigeminal (n = 12), and intercostal nerves (n = 10) were hypertrophic. Plexus hypertrophies were observed in the brachial plexus of 19 patients (61.3%) and in the LS plexus of 25 patients (80.6%). Patterns of hypertrophy included uniform hypertrophy (17 [54.8%] brachial plexuses and 21 [67.7%] LS plexuses), and multifocal fusiform hypertrophy (2 [6.5%] brachial plexuses and 4 [12.9%] LS plexuses) was present. Enlarged and/or contrast-enhanced cauda equina was found in 3 (9.7%) and 13 (41.9%) patients, respectively. Diameters of the brachial and LS nerve roots were significantly larger in CIDP than in controls (p < 0.001). The largest AUC was obtained for the L5 nerve. There were no significant differences in the course duration, I-RODS score, or diameter between patients with and without hypertrophy. Conclusion: MRN is useful for the assessment of distribution and characteristics of the peripheral nerves in CIDP. Compared to other regions, LS plexus neurography is more sensitive for CIDP.

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“…Lee et al (29) reported that 73% of superior cervical ganglion could be identified in medial to internal carotid artery and lateral to longus capitis muscle at the C2-C3 level using 3T magnetic resonance imaging (MRI) (29). Typical location and intraganglionic hypointensity on a T2-weighted image and a contrast enhanced T1-weighted image could be utilized as imaging clues for differentiating superior cervical ganglion from retropharyngeal metastatic lymphadenopathy (29,30). The inferior cervical ganglion with or without fusion to the thoracic ganglia is located between C7 and T1 (8).…”

Section: Discussionmentioning

confidence: 99%

Characteristics of the Middle Cervical Sympathetic Ganglion: A Systematic Review and Meta-Analysis

et al. 2018

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Background: Understanding the characteristics of the middle cervical sympathetic ganglion (MCSG) may minimize procedure-related complications and maximize efficacy during surgery or ultrasound (US)-guided procedures. The location and detection rate of the MCSG were variable in small population studies. Therefore, a large population study or meta-analysis could give more information about the MCSG. Objectives: We aim to review the published literature and evaluate the anatomical features of the MCSG, including the detection rate, location, size, and a normal variation, and to review the clinical relevance of MCSG for procedures including, US-guided ganglion block, ethanol ablation (EA), or radiofrequency ablation (RFA). Study Design: A systematic review and meta-analysis. The Ovid-MEDLINE and EMBASE databases were searched to find the detection rate, location, and other characteristics of the MCSG. Setting: The pooled proportions for the detection rate of the MCSG were assessed using the DerSimonian-Laird random-effects model. Methods: Heterogeneity among the studies was determined using a chi-square analysis for the pooled estimates and inconsistency index (I2 ). In order to reduce the heterogeneity, sensitivity analyses were performed. Results: A review of 542 studies identified 8 eligible studies, with 273 MCSGs included in the meta-analysis. The pooled proportion for the detection rate of the MCSG was 50.4% (95% confidence interval [CI], 34.5–66.4%). Considerable heterogeneity among the studies was observed (I2 = 94.9%). In the sensitivity analysis, when excluding one study, heterogeneity was reduced with a recalculated pooled proportion of 44.2% (95% CI, 32.1–56.2%; I2 = 86.0%). The location of the MCSG is usually posterior to the carotid sheath and anterior to the longus colli muscle at the level of the C3–C7 vertebrae. There was a variant where the cervical sympathetic trunk was located at the posterior wall of the carotid sheath and was adherent to the sheath. The size of the MCSG is as follows: the width, length, and height ranges were 3.8–6.3 mm, 6.3–10.5 mm, and 1.7–2.1 mm, respectively. A specific type of MCSG, referred to as the “double middle cervical ganglion”, consisting of 2 ganglia, was demonstrated in 3 studies with a detection rate of 2.9–10%. Limitations: This meta-analysis included a relatively small number of studies. Significant heterogeneity was also present in the detection rate of MCSG in these studies. There was a lack of concentrated information about the MCSG, because the majority of the included studies focused on the entire cervical sympathetic chain, not only MCSG primarily. Improving complication rates might be limited due to the approximate 50% detection rate. Conclusion: Understanding the characteristics and variations of the MCSG could minimize complications and maximize efficacy during surgery and US-guided procedures. Key words: Middle cervical sympathetic ganglion, cervical sympathetic trunk, cervical sympathetic chain, ultrasound, nerve block, ethanol ablation, radiofrequency ablation, thyroid, Horner syndrome, meta-analysis

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High-resolution Imaging of Neural Anatomy and Pathology of the Neck

Cited by 37 publications

References 22 publications

Ultrasound appearance of peripheral nerves in the neck: vagus, hypoglossal and greater auricular

Ultrasound appearance of peripheral nerves in the neck: vagus, hypoglossal and greater auricular

Use of Magnetic Resonance Neurography for Evaluating the Distribution and Patterns of Chronic Inflammatory Demyelinating Polyneuropathy

Characteristics of the Middle Cervical Sympathetic Ganglion: A Systematic Review and Meta-Analysis

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