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Peripheral nerve magnetic resonance imaging
Yongsheng Chen1, E Mark Haacke2, Jun Li1,3,4,5
1Department of Neurology, Wayne State University School of Medicine, Detroit, MI, 48201, USA.
Abstract:
Magnetic resonance imaging (MRI) has been used extensively in revealing pathological changes in the central nervous system. However, to date, MRI is very much underutilized in evaluating the peripheral nervous system (PNS). This underutilization is generally due to two perceived weaknesses in MRI: first, the need for very high resolution to image the small structures within the peripheral nerves to visualize morphological changes; second, the lack of normative data in MRI of the PNS and this makes reliable interpretation of the data difficult. This article reviews current state-of-the-art capabilities in in vivo MRI of human peripheral nerves. It aims to identify areas where progress has been made and those that still require further improvement. In particular, with many new therapies on the horizon, this review addresses how MRI can be used to provide non-invasive and objective biomarkers in the evaluation of peripheral neuropathies. Although a number of techniques are available in diagnosing and tracking pathologies in the PNS, those techniques typically target the distal peripheral nerves, and distal nerves may be completely degenerated during the patient's first clinic visit. These techniques may also not be able to access the proximal nerves deeply embedded in the tissue. Peripheral nerve MRI would be an alternative to circumvent these problems. In order to address the pressing clinical needs, this review closes with a clinical protocol at 3T that will allow high-resolution, high-contrast, quantitative MRI of the proximal peripheral nerves.
Insights
Magnetic resonance imaging (MRI) shows promise for evaluating the peripheral nervous system (PNS). This review highlights advancements and proposes a protocol for high-resolution peripheral nerve MRI to aid in diagnosing neuropathies.
Area of Science:
- Neuroimaging
- Peripheral Nervous System (PNS) Evaluation
- Medical Diagnostics
Background:
- Magnetic resonance imaging (MRI) is underutilized for peripheral nervous system (PNS) assessment due to resolution and normative data limitations.
- Current PNS imaging techniques often focus on distal nerves, which may be severely degenerated by the time of clinical evaluation.
- Proximal nerves, deeply embedded, are also challenging to access with existing methods.
Purpose of the Study:
- To review the current capabilities of in vivo MRI for human peripheral nerves.
- To identify areas of progress and areas needing further development in peripheral nerve MRI.
- To explore MRI's potential as a non-invasive biomarker for peripheral neuropathies, especially with emerging therapies.
Main Methods:
- Review of current state-of-the-art in vivo MRI techniques for human peripheral nerves.
- Analysis of limitations in current MRI for PNS evaluation, including resolution and normative data.
- Development of a clinical protocol for high-resolution, quantitative MRI of proximal peripheral nerves at 3T.
Main Results:
- Significant advancements have been made in MRI technology for peripheral nerve imaging.
- Challenges remain in achieving sufficient resolution and establishing normative data for reliable PNS MRI interpretation.
- Peripheral nerve MRI offers a potential alternative to overcome limitations of current distal and proximal nerve imaging techniques.
Conclusions:
- Peripheral nerve MRI is a developing field with the potential to significantly improve the evaluation of peripheral neuropathies.
- Further research and technological advancements are needed to overcome current limitations.
- A proposed 3T clinical protocol aims to provide high-resolution, quantitative imaging of proximal peripheral nerves to meet clinical needs.
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