Imaging Diagnosis of Pelvic Nerve Syndromes

Pelvic pain syndromes are common and often neuropathic, with pudendal neuralgia being the most recognized. However, other nerves from the sacral and lumbar plexus-including the iliohypogastric, ilioinguinal, genitofemoral, and posterior femoral cutaneous branches-may also contribute to pelvic and genital neuropathic pain. Diagnosis is challenging due to complex pelvic neuroanatomy and overlapping etiologies. MR neurography plays a key role in evaluating affected nerves and musculoskeletal structures, with advanced sequences improving vascular suppression and nerve conspicuity. While ultrasound and CT mainly guide interventions, MR-ultrasound fusion imaging and MR neurography-guided perineural injections provide more accurate, image-guided treatment strategies.