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High-resolution ultrasound vs. MR neurography in upper extremity neuropathies: exploratory analysis of perceived
Merle Brunnée1, Olivia Foesleitner1, Marietta Kirchner2
1Department of Neuroradiology, Medical Faculty, Heidelberg University and Heidelberg University Hospital, Heidelberg, Germany.
Objectives:
High-resolution nerve ultrasound (HRUS) and magnetic resonance neurography (MRN) are the imaging modalities of choice for evaluating peripheral neuropathies. This study aimed to identify predictors and practice-patterns of perceived additional diagnostic value in clinical routine for the two modalities in patients with suspected upper extremity neuropathies.
Materials And Methods:
This retrospective exploratory subanalysis was conducted within a prospective, observational, single-center study of 800 patients referred for HRUS and MRN between November 2015 and February 2022 for suspected upper extremity neuropathy. Patients were included where one modality demonstrated perceived additional diagnostic value over the other, defined as the detection of clinically relevant lesions missed by the other or by providing additional significant diagnostic information. Predictors of perceived additional diagnostic value were assessed using uni- and multivariable logistic regression and a classification regression tree (CART) model.
Results:
Of the entire cohort (800 patients), 275 (34.4%) demonstrated perceived additional diagnostic value of one modality. MRN provided additional diagnostic value in 261 cases (94.9%) and HRUS in 14 (5.1%). Additional diagnostic value of MRN was predicted by proximal nerve lesions (proximal only: OR 5.72, 95% CI: 3.42-9.56; proximal-peripheral combined: OR 4.59, 95% CI: 2.31-9.09), multi-anatomical region-involvement (OR 1.81, 95% CI: 1.14-2.87), and multi-nerve involvement (OR 1.65, 95% CI: 1.03-2.63). HRUS added value mainly when MRN was limited by metal artifacts.
Conclusion:
Proximal nerve lesion location, multi-regional involvement and multi-nerve pathology were found to favor MRN. On the other hand, HRUS proved particularly beneficial in the presence of metal implants.
Key Points:
Question Which predictors can be identified to guide the choice of preferred imaging modality-high-resolution ultrasound or MR neurography-in suspected upper extremity peripheral neuropathies? Findings Proximal nerve lesion location, multi-regional involvement and multi-nerve pathology were found to favor MR neurography, while HRUS proved beneficial in the presence of metal implants. Clinical relevance Our results provide an exploratory imaging rationale for patient-tailored diagnostic strategies in peripheral neuropathy care.
