AANEM News Express

AANEM News Express

Science News: Imaging of the Peripheral Nerve: Concepts and Future Direction of Magnetic Resonance Neurography and Ultrasound

Submitted by Rebecca O'Bryan, MD
Edited by Francisco Gomez, MD

Imaging of the Peripheral Nerve: Concepts and Future Direction of Magnetic Resonance Neurography and Ultrasound.
Holzgrefe RE, Wagner ER, Singer AD, Daly CA. J Hand Surg Am. 2019 Dec;44(12):1066-1079. doi: 10.1016/j.jhsa.2019.06.021. Epub 2019 Oct 2.

This review article provides an overview of the most current concepts in peripheral nerve imaging in the context of nerve injury and compressive neuropathies. It goes into some detail with regards to the application of each modality (ultrasound and magnetic resonance neurography), and then provides direction about imaging choices based on the clinical picture. It also puts into context the usefulness given the availability of electro-diagnostics. In the context of compressive neuropathies, recommendation is to utilize ultrasound in the setting of recurrent pathology, atypical presentations, when the diagnosis is unclear, and in patients who cannot tolerate electro-diagnostics. MRN is the imaging modality of choice in traumatic nerve lesion, brachial plexus injuries, and nerve tumors. Emerging imaging modalities are also reviewed (sonoelastography, diffusion tensor imaging and tractography, 3D volume neurography and cinematic rendering, microneurography, and contrast agents).

Comments: AANEM members are already utilizing ultrasound and MRN technology to supplement electrodiagnostic evaluation. This article provides a fairly comprehensive review of these modalities and also reviews state of the art, emerging imaging strategies for our patients with peripheral nerve pathology.

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