(mentions CMT) Look for the nerves! MR neurography adds essential diagnostic val

January 15, 2011

J Neuroradiol. 2011 Jan 11

Look for the nerves! MR neurography adds essential diagnostic value to routine

MRI in pediatric practice: A pictorial overview.

Merlini L, Vargas MI, Anooshiravani M, Viallon M, Joël F, Hanquinet S.

Unit of Pediatric Radiology, Geneva University Hospital HUG, 6, Willy-Donzé,

1205 Geneva, Switzerland.

Abstract

PURPOSE: This study aimed to assess the feasibility of magnetic resonance (MR)

neurography in children, and the potential roles of diffusion-weighted imaging

(DWI) and fiber-tracking (FT) techniques.

METHODS: Five pediatric patients (age range: 6-12 years) underwent magnetic

resonance imaging (MRI) for various clinical indications: neurogenic bladder

(case 1); persistent hand pain following minor trauma (case 2); progressive

atrophy of the lower left extremity muscles (case 3); bilateral hip pain (case

4); and palpable left supraclavicular mass (case 5). All studies were performed

using a 1.5-T Avanto MRI scanner (Siemens, Erlangen, Germany). The protocol

included 3D T2-weighted STIR and SPACE imaging, T1-weighted fat-saturation

post-gadolinium imaging and diffusion tensor imaging (DTI) with tractography.

ADC (N×10(-3) mm(2)/s) and FA values were calculated from regions of interest

(ROIs) centered on the nerves. Nerve-fiber tracks were calculated using a

fourth-order Runge-Kutta algorithm (NeuroD software).

RESULTS: MR neurography allowed satisfactory visualization of all neural

structures, and FA and ADC measurements were feasible. The final diagnoses were

Tarlov cysts, median-nerve compression, sciatic perineurioma,

Charcot-Marie-Tooth disease and plexiform neurofibroma in a patient with NF-1.

DISCUSSION: FA and ADC measurements are of little value because of the lack of

normal reference values. Nerve-fiber tractography (FT) may be of value in the

characterization of tumor pathology, and is also helpful in the planning of

surgical treatments.

CONCLUSION: MR neurography is feasible in pediatric patients. However, a

considerable amount of work has yet to be done to establish its role in the

clinical management of the wide range of peripheral nerve diseases.

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