Multimodal magnetic resonance imaging of peripheral nerves: Establishment and validation of brachial and lumbosacral plexi measurements in 163 healthy subjects

Su, Xiaoyun; Kong, Xiaoni; Dingxi, Liu; Kong, Xiaodong; Alwalid, Osamah; Wang, Jing; Shu, Shenglei; Zheng, Chuansheng

doi:10.1016/j.ejrad.2019.05.017

Cited by 15 publications

(22 citation statements)

References 35 publications

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“…Within the MRI-explored group, the results of the ICC values indicated a moderate, good and excellent reliability, demonstrating the reproducibility of the measurements and the MRI reliability in determining the reference values for the two studied nerves. From this point of view, a similar result (intrareader consistency 0.990 for the lumbosacral plexus) was obtained in another study, performed exclusively with MRI on a large number of subjects, which targeted multimodal measurements at the level of the brachial and lumbosacral plexus [ 21 ].…”

Section: Discussionsupporting

confidence: 69%

Ultrasound and magnetic resonance imaging evaluation of the femoral and sciatic nerves. A study of healthy volunteers

Rusu¹,

Curcean²,

Dudea

2020

Medicine and Pharmacy Reports

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Background and aims. The study describes the femoral (FN) and sciatic nerves (SN), explored using ultrasound (US) and magnetic resonance imaging (MRI). The aims of the study are: to establish US / MRI correlations and define reference values: for the anteroposterior (AP) and mediolateral (ML) diameters and cross-sectional area (CSA) of the two nerves respectively, in well-defined anatomical measuring sites; to analyze the intraobserver variation; to define the value with least variability; to determine differences between the right-left and male-female reference values. Methods. A prospective study was carried out on 24 healthy volunteers (11 men and 13 women). MRI scans were performed using a 1.5T system. To visualize both nerves (FN and SN), a single 3D T2 weighted acquisition was performed, in the coronal plane, with a wide FOV. For ultrasonographic examinations, a Hitachi EUB-8500 ultrasound machine, equipped with a 13 MHz linear transducer was used. The measurements were performed at well-defined anatomical locations. The mean reference values of the AP, ML diameters and CSA were calculated for femoral and sciatic nerves, both on MRI and US. The correlations between the values determined by the two techniques were analyzed. The intra-observer variation was calculated by measuring the nerves at the same anatomical location at two separate time points. Results. Wilcoxon matched-pairs signed rank test indicated a non-significant difference (p> 0.05) for the femoral and sciatic nerves, on both sides, except the femoral nerve ML diameter on MRI (p= 0.014). The mean MRI and US reference values for the femoral nerve were calculated between the psoas and iliac muscles: FNAPMRI 4.533 ± 0.486, FNAPUS 4.800 ± 1.237, FNMLMRI 6.172 ± 1.203, FNMLUS 7.685 ± 3.338, FNCSAMRI 24.811 ± 3.394, FNCSAUS 26.285 ± 17.608. The mean MRI and US measurements for the sciatic nerve were determined under the buttock, at the level of the ischial tuberosity: SNAPMRI 5.500 ± 1.201, SNAPUS 5.975 ± 1.312, SNMLMRI 10.375 ± 2.272, SNMLUS 13.500 ± 1.661, SNCSAMRI 50.625 ± 15.373, SNCSAUS 53.631 ± 15.847. The MRI and US differences between right and left sides, both for the femoral and sciatic nerves were insignificant. In selected cases, Wilcoxon paired test indicated differences between subjects, according to their gender, both on MRI and US. Conclusion. Reference values for the femoral and sciatic nerves at specific anatomical sites were identified. Side to side variation and gender related differences add to current knowledge on nerve size in young Caucasian population.

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Section: Discussionsupporting

confidence: 69%

Ultrasound and magnetic resonance imaging evaluation of the femoral and sciatic nerves. A study of healthy volunteers

Rusu¹,

Curcean²,

Dudea

2020

Medicine and Pharmacy Reports

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“…After reviewing 27 full texts, 15 were excluded (Supplementary materials) and 9 articles (of 9 unique studies) were included [18,[21][22][23][24][25][26][27][28] (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

“…ten estimates of the FA (one from each spinal root, bilaterally) taken from the same individual will be highly correlated and without adjustment, the sample-level estimates will have falsely small variances. Seven studies [21][22][23][24][25]28] provided no information about missing data and so the risk of bias is unclear. Two studies [21,23] were judged to be at high risk of bias in the measurement of FA and MD because a bespoke region of interest was used to calculate the FA and the number of diffusion sensitising gradients used was not described [21].…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

“…Two studies [21,23] were judged to be at high risk of bias in the measurement of FA and MD because a bespoke region of interest was used to calculate the FA and the number of diffusion sensitising gradients used was not described [21]. Three studies [24,25,28] were at unclear risk of bias in the measurement of FA and MD because information was lacking about preprocessing, tensorial reconstruction or how the estimates of the FA and MD were derived from images (e.g. region of interest size and position).…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

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Diffusion tensor imaging of the roots of the brachial plexus: a systematic review and meta-analysis of normative values

Wade

Whittam

Teh

et al. 2020

Clin Transl Imaging

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Purpose Diffusion tensor magnetic resonance imaging (DTI) characterises tissue microstructure and provides proxy measures of myelination, axon diameter, fibre density and organisation. This may be valuable in the assessment of the roots of the brachial plexus in health and disease. Therefore, there is a need to define the normal DTI values. Methods The literature was systematically searched for studies of asymptomatic adults who underwent DTI of the brachial plexus. Participant characteristics, scanning protocols, and measurements of the fractional anisotropy (FA) and mean diffusivity (MD) of each spinal root were extracted by two independent review authors. Generalised linear modelling was used to estimate the effect of experimental conditions on the FA and MD. Meta-analysis of root-level estimates was performed using Cohen’s method with random effects. Results Nine articles, describing 316 adults (1:1 male:female) of mean age 35 years (SD 6) were included. Increments of ten diffusion sensitising gradient directions reduced the mean FA by 0.01 (95% CI 0.01, 0.03). Each year of life reduced the mean MD by 0.03 × 10–3 mm2/s (95% CI 0.01, 0.04). At 3-T, the pooled mean FA of the roots was 0.36 (95% CI 0.34, 0.38; I2 98%). The pooled mean MD of the roots was 1.51 × 10–3 mm2/s (95% CI 1.45, 1.56; I2 99%). Conclusions The FA and MD of the roots of the brachial plexus vary according to experimental conditions and participant factors. We provide summary estimates of the normative values in different conditions which may be valuable to researchers and clinicians alike.

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“…A clear limitation of qualitative assessment of brachial plexus MRI as it is used nowadays is its low interrater reliability [8,9]. Few studies have explored the feasibility and use of a quantitative MRI assessment and only in small groups of patients and healthy controls [9,[22][23][24][25]. Estimates of the upper limit of normal for cervical nerve root size in healthy controls ranged between 4 and 5 mm.…”

Section: Discussionmentioning

confidence: 99%

Quantitative assessment of brachial plexus MRI for the diagnosis of chronic inflammatory neuropathies

et al. 2020

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Objective This study aimed at developing a quantitative approach to assess abnormalities on MRI of the brachial plexus and the cervical roots in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) and to evaluate interrater reliability and its diagnostic value. Methods We performed a cross-sectional study in 50 patients with CIDP, 31 with MMN and 42 disease controls. We systematically measured cervical nerve root sizes on MRI bilaterally (C5, C6, C7) in the coronal [diameter (mm)] and sagittal planes [area (mm2)], next to the ganglion (G0) and 1 cm distal from the ganglion (G1). We determined their diagnostic value using a multivariate binary logistic model and ROC analysis. In addition, we evaluated intra- and interrater reliability. Results Nerve root size was larger in patients with CIDP and MMN compared to controls at all predetermined anatomical sites. We found that nerve root diameters in the coronal plane had optimal reliability (intrarater ICC 0.55–0.87; interrater ICC 0.65–0.90). AUC was 0.78 (95% CI 0.69–0.87) for measurements at G0 and 0.81 (95% CI 0.72–0.91) for measurements at G1. Importantly, our quantitative assessment of brachial plexus MRI identified an additional 10% of patients that showed response to treatment, but were missed by nerve conduction (NCS) and nerve ultrasound studies. Conclusion Our study showed that a quantitative assessment of brachial plexus MRI is reliable. MRI can serve as an important additional diagnostic tool to identify treatment-responsive patients, complementary to NCS and nerve ultrasound.

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Multimodal magnetic resonance imaging of peripheral nerves: Establishment and validation of brachial and lumbosacral plexi measurements in 163 healthy subjects

Cited by 15 publications

References 35 publications

Ultrasound and magnetic resonance imaging evaluation of the femoral and sciatic nerves. A study of healthy volunteers

Ultrasound and magnetic resonance imaging evaluation of the femoral and sciatic nerves. A study of healthy volunteers

Diffusion tensor imaging of the roots of the brachial plexus: a systematic review and meta-analysis of normative values

Quantitative assessment of brachial plexus MRI for the diagnosis of chronic inflammatory neuropathies

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