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Diagnostic Signs of Motor Neuropathy in MR Neurography: Nerve Lesions and Muscle Denervation

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Abstract

Objective

To investigate the diagnostic contribution of T2-w nerve lesions and of muscle denervation in peripheral motor neuropathies by magnetic resonance neurography (MRN).

Methods

Fifty-one patients with peripheral motor neuropathies underwent high-resolution MRN by large coverage axial T2-w sequences of the upper arm, elbow, and forearm. Images were evaluated by two blinded readers for T2-w signal alterations of median, ulnar, and radial nerves, and for denervation in respective target muscle groups.

Results

All 51 patients displayed nerve lesions in at least one of three nerves, and 43 out of 51 patients showed denervation in at least one target muscle group of these nerves. In 21 out of 51 patients, the number of affected nerves matched the number of affected target muscle groups. In the remaining 30 patients, T2-w lesions were encountered more frequently than target muscle group denervation. In 153 nerve-muscle pairs, 72 showed denervation, but only one had increased muscle signal without a lesion in the corresponding nerve.

Conclusions

MRN-based diagnosis of peripheral motor neuropathies is more likely by visualization of peripheral nerve lesions than by denervation in corresponding target muscles. Increased muscular T2-w signal without concomitant nerve lesions should raise suspicion of an etiology other than peripheral neuropathy.

Key Points

• In peripheral neuropathy, T2-w nerve lesions are more frequent than muscle denervation.

• Muscle denervation almost never occurs without detectable lesions in corresponding nerves.

• MRN-aided diagnosis of peripheral motor neuropathy should focus primarily on nerve lesions.

• Increased muscular T2-w signal intensity without concomitant nerve lesions indicates other aetiology.

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Acknowledgments

The scientific guarantor of this publication is Dr. med. Philipp Bäumer, Department of Neuroradiology, Heidelberg University Hospital, Germany. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Daniel Schwarz, Mirko Pham, Martin Bendszus & Philipp Bäumer

  2. Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany

    Markus Weiler

  3. Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Markus Weiler

  4. Section of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany

    Sabine Heiland

Authors
  1. Daniel Schwarz
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  2. Markus Weiler
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  3. Mirko Pham
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  4. Sabine Heiland
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  5. Martin Bendszus
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  6. Philipp Bäumer
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Corresponding author

Correspondence to Philipp Bäumer.

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Supplementary Table 1

Clinical data for all patients. Detailed overview of clinical and demographic data of the patient collective. The functional specification of the symptom is followed by the respective MRC grading in brackets. Symptoms are listed in ascending MRC grading order. Muscles are abbreviated as follows: M. brachioradialis (BR), extensor carpi radialis (longus and brevis) (ECR), extensor digitorum communis (EDC), extensor indicis (EI), extensor carpi ulnaris (ECU), pronator teres (PT), flexor carpi ulnaris (FCU), flexor digitorum profundus (FDP), flexor carpi radialis (FCR), pronator quadratus (PQ), flexor pollicis longus (FPL), flexor pollicis brevis (FPB), abductor pollicis brevis (APB), opponens pollicis (OP), abductor digiti minimi (ADM), interosseous dorsalis (IDM). Electrophysiological abbreviations are: motor unit action potential (MUAP), compound muscle action potential (CMAP), sensory nerve action potential (SNAP), distal motor latency (dml), proximal motor latency (pml), sensory evoked potentials (SEP). The following (sixth) column states the corresponding diagnosis, and the seventh column lists the respective interval of time between onset of clinical symptoms and MR neurography. The penultimate column informs about additional MR sequences performed that were not routinely included in the protocol of the study. The last column shows the assigned group of every patient after evaluation of acquired images. At the bottom, the total numbers of male and female patients, the mean age, and the median and mean time delay between onset of clinical symptoms and MR neurography are given. (JPEG 4850 kb)

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Schwarz, D., Weiler, M., Pham, M. et al. Diagnostic Signs of Motor Neuropathy in MR Neurography: Nerve Lesions and Muscle Denervation. Eur Radiol 25, 1497–1503 (2015). https://doi.org/10.1007/s00330-014-3498-x

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  • DOI: https://doi.org/10.1007/s00330-014-3498-x

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