Läsionen peripherer Nerven: MR-Neurografie als innovative Ergänzung zur Elektrodiagnostik

C. Wessig; M. Bendszus; K. Reiners; M. Pham

doi:10.1055/s-0032-1324371

Handchirurgie · Mikrochirurgie · Plastische Chirurgie, Table of Contents

Handchir Mikrochir Plast Chir 2012; 44(03): 155-162
DOI: 10.1055/s-0032-1324371

Originalarbeit

Läsionen peripherer Nerven: MR-Neurografie als innovative Ergänzung zur Elektrodiagnostik

Lesions of the Peripheral Nerves: MR Neurography as an Innovative Supplement to Electrodiagnostics

Authors

C. Wessig

¹Neurologische Klinik, Universitätsklinikum Würzburg
M. Bendszus

²Abteilung für Neuroradiologie, Universitätsklinikum HeidelbergHeidelberg
K. Reiners

¹Neurologische Klinik, Universitätsklinikum Würzburg
M. Pham

²Abteilung für Neuroradiologie, Universitätsklinikum HeidelbergHeidelberg

Abstract

Zusammenfassung

Die Diagnostik peripherer Nervenschädigungen beruht bislang vor allem auf neurophysiologischen Untersuchungsverfahren. Technische Fortschritte im Bereich der Magnetresonanztomografie (MRT) ermöglichen zunehmend, die Magnetresonanz (MR)-Neurografie auch in der Abklärung von Erkrankungen des peripheren Nervensystems einzusetzen. Anhand experimenteller Untersuchungen wird dargestellt, wie die MR-Neurografie axonale und entmarkende Läsionen peripherer Nerven sichtbar machen kann. Im klinischen Einsatz kann die MR-Neurografie in Kombination mit neurophysiologischen Verfahren die Diagnosefindung bei fokalen Nervenläsionen im Rahmen von Engpass-Syndromen, traumatischen oder anderen Läsionen verbessern. Sie leistet insbesondere einen wertvollen Beitrag zur exakten Lokalisationsdiagnostik in Körperregionen, die der Elektrodiagnostik schwer zugänglich sind. Aber auch bei Polyneuropathien können durch die MR-Neurografie neue pathophysiologische Erkenntnisse gewonnen werden, wie anhand der diabetischen Neuropathie erläutert wird.

Abstract

The diagnostic work-up of peripheral neuropathies largely depends on neurophysiological investigations. Recently, progress in magnetic resonance imaging (MRI) has lead to new perspectives in the diagnostics of disorders of the peripheral nervous system (PNS). Experimental data show how MR neurography visualises axonal and demyelinating lesions of the PNS. In clinical use, difficult cases of focal nerve compression, traumatic or inflammatory lesions can be solved by the combination of MR neurography and neurophysiology. In particular, the localisation of nerve lesions can be improved by MR techniques. Furthermore, MR neurography enables new insights in the pathophysiology of neuropathies which will be shown for diabetic polyneuropathy.

Schlüsselwörter

Magnetresonanz-Neurografie - klinische Neurophysiologie - peripheren Nervensystem - axonale Läsionen - Demyelination

Key words

magnetic resonance neurography - clinical neurophysiology - peripheral nervous system - axonal lesion - demyelination

Full Text

References

Literatur
1 Stewart JD. Peripheral nerve fascicles: Anatomy and clinical relevance. Muscle Nerve 2003; 28: 525-541
2 Stull MA, Moser Jr RP, Kransdorf MJ et al. MR appearance of peripheral nerve sheath tumors. Skel Radiol 1991; 20: 9-14
3 Söderlund V, Göranson H, Bauer HC. MR imaging of benign peripheral nerve sheath tumors. Acta Radiol 1994; 35: 282-286
4 Beekman R, Visser LH, Verhagen WI. Ultrasonography in ulnar neuropathy at the elbow: a critical review. Muscle Nerve 2011; 43: 627-635
5 Titelbaum DS, Frazier JL, Grossman RI et al. Wallerian degeneration and inflammation in rat peripheral nerve detected by in vivo MR imaging. AJNR Am J Neuroradiol 1989; 10: 741-746
6 Howe FA, Filler AG, Bell BA et al. Magnetic resonance neurography. Magn Reson Med 1992; 28: 328-338
7 Cudlip SA, Howe FA, Griffiths JR et al. Magnetic resonance neurography of peripheral nerve following experimental crush injury, and correlation with functional deficit. J Neurosurg 2002; 96: 755-775
8 Does MD, Snyder RE. Multiexponential T2 relaxation in degenerating peripheral nerve. Magn Reson Med 1996; 35: 207-213
9 Britz GW, Haynor DR, Kuntz C et al. Carpal tunnel syndrome: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurgery 1995; 37: 1097-1103
10 Britz GW, Haynor DR, Kuntz C et al. Ulnar nerve entrapment at the elbow: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurgery 1996; 38: 458-465
11 Horch RE, Allmann KH, Laubenberger J et al. Median nerve compression can be detected by magnetic resonance imaging of the carpal tunnel. Neurosurgery 1997; 41: 76-82
12 Wilder-Smith EP, Seet RC, Lim EC. Diagnosing carpal tunnel syndrome – clinical criteria and ancillary tests. Nat Clin Pract Neurol 2006; 2: 366-374
13 Bendszus M, Wessig C, Solymosi L et al. MRI of peripheral nerve degeneration and regeneration: correlation with electrophysiology and histology. Exp Neurol 2004; 188: 171-177
14 Van Es HW, Van den Berg LH, Franssen H et al. Magnetic resonance imaging of the brachial plexus in patients with multifocal motor neuropathy. Neurology 1997; 48: 1218-1224
15 Wessig C, Bendszus M, Stoll G. In vivo visualization of focal demyelination in peripheral nerves by gadofluorine M-enhanced magnetic resonance imaging. Exp Neurol 2007; 204: 14-19
16 Bendszus M, Stoll G. Caught in the act: in vivo mapping of macrophage infiltration in nerve injury by magnetic resonance imaging. J Neurosci 2003; 23: 10892-10896
17 Bäumer P, Dombert T, Staub F et al. Ulnar neuropathy at the elbow: MR neurography – nerve T2 signal increase and calibre. Radiology 2011; 260: 199-206
18 Bendszus M, Rieckmann P, Perez J et al. Painful vascular compression syndrome of the sciatic nerve caused by gluteal varicosities. Neurology 2003; 61: 985-987
19 Hu MH, Wu KW, Jian YM et al. Vascular compression syndrome of sciatic nerve caused by gluteal varicosities. Ann Vasc Surg 2010; 24 (1134.e1) (1134.e4) -
20 Moser T, Scheiber-Nogueira MC, Nogueira TS et al. Pudendal nerve compression by pelvic varices: successful treatment with transcatheter ovarian vein embolisation. J Neurol Neurosurg Psychiatry 2006; 77: 88
21 Yamamoto N, Koyano K. Neurovascular compression of the common peroneal nerve by varicose veins. Eur J Vasc Endovasc Surg 2004; 28: 335-338
22 Thomas PK. Diabetic sensorimotor neuropathy: Treatment. In: Gries FA. ed. Textbook of diabetic neuropathy. Stuttgart, New York: Thieme; 2003: 208-214
23 Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature 2001; 414: 813-820
24 Pham M, Oikonomou D, Bäumer P et al. Proximal neuropathic lesions in distal symmetric diabetic polyneuropathy: findings of high-resolution magnetic resonance neurography. Diabetes Care 2011; 34: 721-723
25 Zochodne D. Nerve and ganglion blood flow in diabetes: An appraisal. In: Tomlinson DR. ed. Neurobiology of diabetic neuropathy. Elsevier; 2002: 161-202
26 Pham M, Sommer C, Wessig C et al. Magnetic resonance neurography for the diagnosis of extrapelvic sciatic endometriosis. Fertil Steril 2010; 94 (351.e11) 351.e-14
27 Pham M, Wessig C, Brinkhoff J et al. MR neurography of sciatic nerve injection injury. J Neurol 2011; 258: 1120-1125
28 Filler AG, Howe FA, Hayes CE et al. Magnetic resonance neurography. Lancet 1993; 341: 659-661
29 Grant GA, Britz GW, Goodkin R et al. The utility of magnetic resonance imaging in evaluating peripheral nerve disorders. Muscle Nerve 2002; 25: 314-331
30 Kuwabara S, Nakajima M, Matsuda S et al. Magnetic resonance imaging at the demyelinative foci in chronic inflammatory demyelinating polyneuropathy. Neurology 1997; 48: 874-877
31 Cellerini M, Salti S, Desideri V et al. MR imaging of the cauda equine in hereditary motor sensory neuropathies: correlations with sural nerve biopsies. Am J Neuroradiol 2000; 21: 1793-1798
32 Liao JP, Waclawik AJ. Nerve root hypertrophy in CMT type 1A. Neurology 2004; 62: 783
33 Shy ME, Lupski JR, Chance PF et al. Hereditary motor and sensory neuropathies: An overview of clinical, genetic, electrophysiologic, and pathologic features. In: Peripheral Neuropathy. edited by Dyck PJ, Thomas PK. 4^th edition Elsevier Saunders; Philadelphia: 2005: 1623-1658
34 Harding AE, Thomas PK. The clinical features of hereditary motor and sensory neuropathy types I and II. Brain 1980; 103: 259-280
35 Wessig C, Jestaedt L, Sereda MW et al. Gadofluorine M-enhanced magnetic resonance nerve imaging: Comparison between acute inflammatory and chronic degenerative demyelination in rats. Exp Neurol 2008; 210: 137-143
36 Shabas D, Gerard G, Rossi D. Magnetic resonance imaging examination of denervated muscle. Comput Radiol 1987; 11: 9-13
37 Uetani M, Hayashi K, Matsunaga N et al. Denervated skeletal muscle: MR imaging. Radiology 1993; 189: 511-515
38 Bendszus M, Wessig C, Reiners K et al. MR imaging in the differential diagnosis of neurogenic foot drop. Am J Neuroradiol 2003; 24: 1283-1289
39 Wessig C, Koltzenburg M, Reiners K et al. Muscle magnetic resonance imaging of denervation and reinnervation: correlation with electrophysiology and histology. Exp Neurol 2004; 185: 254-261
40 Kästel T, Heiland S, Bäumer P et al. Magic angle effect: a relevant artifact in MR neurography at 3T?. AJNR Am J Neuroradiol 2011; 821-827