High-Resolution US vs MR Neurography for Diagnosis of Upper Extremity Peripheral Nerve Disorders

Background High-resolution imaging methods contribute important pathomorphological information in diagnosing peripheral nerve disorders, but their diagnostic roles remain unclear due to limited clinical evidence. Purpose To investigate the diagnostic performance of high-resolution nerve US (HRUS) and MR neurography (MRN). Materials and Methods This prospective observational, single-center cohort study included 800 patients referred for clinically suspected peripheral neuropathy of the upper extremity from November 2015 to February 2022. All patients underwent both HRUS and MRN, performed and interpreted independently by experienced neuroradiologists. Accuracy, sensitivity, and specificity of HRUS and MRN in diagnosing peripheral neuropathy correctly were calculated in reference to the final diagnosis, based on compound results of clinical, electrophysiological, imaging, and surgical/histopathological findings and compared by means of the McNemar's test and X²-Testing. Results In total 800 patients (431 male, 369 female; mean age 47.8 ± 16.5 years) were included. Overall, MRN provided higher accuracy (85.4% [95%CI: 82.7%, 87.8%] vs. 70.6% [95%CI: 67.3%, 73.8%], P<.001) and sensitivity (91.6% [95%CI: 89.1%,93.7%] vs. 68.7% [95%CI: 64.8%,72.3%], P<.001), while HRUS achieved higher specificity (76.0% [95%CI: 69.4%,81.9%] vs. 66.2% [95%CI: 59.1%,72.8%], P<.001) for diagnosing peripheral neuropathy correctly. Conclusion For diagnosing peripheral neuropathies of the upper extremity, MRN achieved higher accuracy and sensitivity while HRUS achieved higher specificity. See also the editorial by Deshmukh in this issue.