Imag­­ing of peripheral nerves us­­ing dif­fusion tensor imag­­ing and MR tractography

Authors: I. Humhej 1;  I. Ibrahim 2;  M. Sameš 1;  J. Tintěra 2;  D. Hořínek 3;  I. Čižmář 4
Authors‘ workplace: Neurochirurgická klinika FZS UJEP, Krajská zdravotní a. s., Masarykova nemocnice v Ústí nad Labem o. z. 1;  Základna radiodiagnostiky a intervenční radiologie, IKEM, Praha 2;  Neurochirurgická klinika dětí a dospělých 2. LF UK a FN Motol, Praha 3;  Traumatologická klinika LF UP a FN Olomouc 4
Published in: Cesk Slov Neurol N 2018; 81(4): 420-426
Category: Original Paper
doi: 10.14735/amcsnn2018csnn.eu3


Development of an examination protocol for investigation of functional integrity and microstructural damage of peripheral nerves (PN) at dif­ferent locations us­­ing dif­fusion tensor imag­­ing (DTI). Consequently, we want to implement this protocol into clinical practice.

Subjects and methods: We investigated 15 healthy volunteers and 15 patients with a 3T MRI, scan­ner us­­ing the DTI method. We attempted to visualize the brachial plexus, lumbosacral plexus and the course of PN in the limbs of healthy volunteers. In patients, we focused on the examination of damaged parts of the PN to display these pathologies.

Results: We managed to obtain a valid visualization of the brachial plexus, lumbosacral plexus and the course of PN in the limbs us­­ing DTI. Throughout the study, we encountered some limitations of this method, particularly motion artifacts which interfered with the quality of nerve structure imag­­ing and problems in dif­ferentiat­­ing nerve fibers from muscle fibers. These technical problems could be reduced to a certain extent us­­ing adequate coils, optimiz­­ing imag­­ing protocols and data proces­s­­ing methodology.

Conclusion: Despite some technical limitations, this paper demonstrates the pos­sibility of obtain­­ing a valid display of PN in dif­ferent locations us­­ing the DTI method. DTI is an additional non-invasive imag­­ing technique provid­­ing valuable information useful in the decision-mak­­ing dia­gnostic and therapeutic process for various PN pathologies. Technological advances and further improvements of MRI techniques in the future are likely to result in a wider use of this technique in clinical practice.

Key words:
magnetic resonance imaging – diffusion tensor imaging – MR tractography – peripheral nerves – brachial plexus – lumbo­sacral plexus

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­ script met the ICMJE “uniform requirements” for biomedical papers.


1. Jeon T, Fung MM, Koch KM et al. Peripheral nerve dif­fusion tensor imaging: overview, pitfal­ls, and future directions. J Magn Reson Imag­­ing 2017; 47(5): 1171– 1189. doi: 10.1002/ jmri.25876.

2. Bas­ser PJ, Mattiel­lo J, LeBihan D. MR dif­fusion tensor spectroscopy and imaging. Biophys J 1994; 66(1): 259– 267. doi: 10.1016/ S0006-3495(94)80775-1.

3. Keřkovský M, Šprláková-Puková A, Kašpárek T et al.Dif­fusion tensor imaging –  současné možnosti MRzobrazení bílé hmoty mozku. Cesk Slov Neurol N 2010; 73/ 106(2): 136– 142.

4. Ibrahim I, Tintěra J. Teoretické základy pokročilých metod magnetické rezonance na poli neurověd. Ces Radiol 2013; 67(1): 9– 19.

5. Mori S, Crain BJ, Chacko VP et al. Three- dimensional track­­ing of axonal projections in the brain by magnetic resonance imaging. Ann Neurol 1999; 45(2): 265– 269.

6. Berman J. Dif­fusion MR tractography as a tool for surgical plan­ning. Magn Reson Imag­­ing Clin N Am 2009; 17(2): 205– 214. doi: 10.1016/ j.mric.2009.02.002.

7. Zolal A, Sameš M, Vachata P et al. Použití DTI traktografie v neuronavigaci při operacích mozkových nádorů: kazuistiky. Cesk Slov Neurol N 2008; 71/ 104(3): 352– 357.

8. Takagi T, Nakamura M, Yamada M et al. Visualization of peripheral nerve degeneration and regeneration: monitor­­ing with dif­fusion tensor tractography. Neuroimage 2009; 44(3): 884– 892. doi: 10.1016/ j.neuroimage.2008.09.022.

9. Lehmann HC, Zhang J, Mori S et al. Dif­fusion tensor imag­­ing to as­sess axonal regeneration in peripheral nerves. Exp Neurol 2010; 223(1): 238– 244. doi: 10.1016/ j.expneurol.2009.10.012.

10. Morisaki S, Kawai Y, Umeda M et al. In vivo as­ses­sment of peripheral nerve regeneration by dif­fusion tensor imaging. J Magn Reson Imag­­ing 2011; 33(3): 535– 542. doi: 10.1002/ jmri.22442.

11. Boyer RB, Kelm ND, Riley DC et al. 4.7-T dif­fusion tensor imag­­ing of acute traumatic peripheral nerve injury. Neurosurg Focus 2015; 39(3): E9. doi: 10.3171/ 2015.6.FOCUS1590.

12. Jambawalikar S, Baum J, Button T et al. Dif­fusion tensor imag­­ing of peripheral nerves. Skeletal Radiol 2010; 39(11): 1073– 1079. doi: 10.1007/ s00256-010-0974-5.

13. Hiltunen J, Suortti T, Arvela S et al. Dif­fusion tensor imag­­ing and tractography of distal peripheral nerves at 3 T. Clin Neurophysiol 2005; 116(10): 2315– 2323. doi: 10.1016/ j.clinph.2005.05.014.

14. Zhou Y, Kumaravel M, Patel VS et al. Dif­fusion tensor imag­­ing of forearm nerves in humans. J Magn Reson Imag­­ing 2012; 36(4): 920– 927. doi: 10.1002/ jmri.23709.

15. Skorpil M, Engström M, Nordell A. Dif­fusion-direction-dependent imaging: a novel MRI approach for peripheral nerve imaging. Magn Reson Imag­­ing 2007; 25(3): 406– 411. doi: 10.1016/ j.mri.2006.09.017.

16. Simon NG, Lagopoulos J, Gal­lagher T et al. Peripheral nerve dif­fusion tensor imag­­ing is reliable and reproducible. J Magn Reson Imag­­ing 2016; 43(4): 962– 969. doi: 10.1002/ jmri.25056.

17. Chenevert TL, Brunberg JA, Pipe JG. Anistropic dif­fusion in human white matter: demonstration with MR techniques in vivo. Radiology 1990; 177(2): 401– 405.

18. Bam­mer R, Fazekas F, Augustin M et al. Dif­fusion-weighted MR imag­­ing of the spinal cord. AJNR Am J Neuroradiol 2000; 21(3): 587– 591.

19. Song T, Chen WJ, Yang B et al. Dif­fusion tensor imag­­ing in the cervical spinal cord. Eur Spine J 2011; 20(3): 422– 428. doi: 10.1007/ s00586-010-1587-3.

20. Skorpil M, Karls­son M, Nordell A. Peripheral nerve dif­fusion tensor imaging. Magn Reson Imag­­ing 2004; 22(5): 743– 745. doi: 10.1016/ j.mri.2004.01.073.

21. Kwon BC, Koh SH, Hwang SY. Optimal parameters and location for dif­fusion-tensor imag­­ing in the dia­gnosis of carpal tun­nel syndrome: a prospective matched case-control study. AJR Am J Roentgenol 2015; 204(6): 1248– 1254. doi: 10.2214/ AJR.14.13371.

22. Guggenberger R, Markovic D, Eppenberger P et al. As­ses­sment of median nerve with MR neurography by us­­ing dif­fusion-tensor imaging: normative and pathologic dif­fusion values. Radiology 2012; 265(1): 194– 203. doi: 10.1148/ radiol.12111403.

23. Naraghi A, da Gama Lobo L, Menezes R et al. Dif­fusion tensor imag­­ing of the median nerve before and after carpal tun­nel release in patients with carpal tun­nel syndrome: feasibility study. Skeletal Radiol2013; 42(10): 1403– 1412. doi: 10.1007/ s00256-013-1670-z.

24. Hiltunen J, Kirveskari E, Num­minen J et al. Pre- and post-operative dif­fusion tensor imag­­ing of the median nerve in carpal tun­nel syndrome. Eur Radiol 2012; 22(6): 1310– 1319. doi: 10.1007/ s00330-012-2381-x.

25. Breitenseher JB, Kranz G, Hold A et al. MR neurography of ulnar nerve entrapment at the cubital tun­nel: a dif­fusion tensor imag­­ing study. Eur Radiol 2015; 25(7): 1911– 1918. doi: 10.1007/ s00330-015-3613-7.

26. Iba K, Wada T, Tamakawa M et al. Dif­fusion-weighted magnetic resonance imag­­ing of the ulnar nerve in cubital tun­nel syndrome. Hand Surg 2010; 15(1): 11– 15. doi: 10.1142/ S021881041000445X.

27. Magill ST, Brus-Ramer M, Weinstein PR et al. Neurogenic thoracic outlet syndrome: cur­rent dia­gnostic criteria and advances in MRI dia­gnostics. Neurosurg Focus 2015; 39(3): E7. doi: 10.3171/ 2015.6.FOCUS15219.

28. Gal­lagher TA, Simon NG, Kliot M. Dif­fusion tensor imag­­ing to visualize axons in the sett­­ing of nerve injury and recovery. Neurosurg Focus 2015; 39(3): E10. doi: 10.3171/ 2015.6.FOCUS15211.

29. Gasparotti R, Lodoli G, Meoded A et al. Feasibility of dif­fusion tensor tractography of brachial plexus injuries at 1.5 T. Invest Radiol 2013; 48(2): 104– 112. doi: 10.1097/ RLI.0b013e3182775267.

30. Ho MJ, Manoliu A, Kuhn FP et al. Evaluation of reproducibility of dif­fusion tensor imag­­ing in the brachial plexus at 3.0 T. Invest Radiol 2017; 52(8): 482– 487. doi: 10.1097/ RLI.0000000000000363.

31. Tagliafico A, Calabrese M, Puntoni M et al. Brachial plexus MR imaging: accuracy and reproducibility of DTI-derived measurements and fibre tractography at 3.0-T. Eur Radiol 2011; 21(8): 1764– 1771. doi: 10.1007/ s00330-011-2100-z.

32. Budzik JF, Verclytte S, Lefebvre G et al. As­ses­sment of reduced field of view in dif­fusion tensor imag­­ing of the lumbar nerve roots at 3 T. Eur Radiol 2013; 23(5): 1361– 1366. doi: 10.1007/ s00330-012-2710-0.

33. van der Jagt PK, Dik P, Froel­­ing M et al. Architectural configuration and microstructural properties of the sacral plexus: a dif­fusion tensor MRI and fiber tractography study. Neuroimage 2012; 62(3): 1792– 1799. doi: 10.1016/ j.neuroimage.2012.06.001.

34. Shi Y, Zong M, Xu X et al. Dif­fusion tensor imag­­ing with quantitative evaluation and fiber tractography of lumbar nerve roots in sciatica. Eur J Radiol 2015; 84(4): 690– 695. doi: 10.1016/ j.ejrad.2015.01.006.

35. Kanamoto H, Eguchi Y, Oikawa Y et al. Visualization of lumbar nerves us­­ing reduced field of view dif­fusion tensor imag­­ing in healthy volunteers and patients with degenerative lumbar disorders. Br J Radiol 2017; 90(1080): 20160929. doi: 10.1259/ bjr.20160929.

36. Schmidt M, Kasprian G, Amann G et al. Dif­fusion tensor tractography for the surgical management of peripheral nerve sheath tumors. Neurosurg Focus 2015; 39(3): E17. doi: 10.3171/ 2015.6.FOCUS15228.

37. Cage TA, Yuh EL, Hou SW et al. Visualization of nerve fibers and their relationship to peripheral nerve tumors by dif­fusion tensor imaging. Neurosurg Focus 2015; 39(3): E16. doi: 10.3171/ 2015.6.FOCUS15235.

38. Chhabra A, Thakkar RS, Andreisek G et al. Anatomic MR imag­­ing and functional dif­fusion tensor imag­­ing of peripheral nerve tumors and tumorlike conditions. AJNR Am J Neuroradiol 2013; 34(4): 802– 807. doi: 10.3174/ ajnr.A3316.

39. Heckel A, Weiler M, Xia A et al. peripheral nerve dif­fusion tensor imaging: as­ses­sment of axon and myelin sheath integrity. PLoS One 2015; 10(6): e0130833. doi: 10.1371/ journal.pone.0130833.

40. Kronlage M, Pitarokoili K, Schwarz D et al. Dif­fusion tensor imag­­ing in chronic inflam­matory demyelinat­­ing polyneuropathy: dia­gnostic accuracy and cor­relation with electrophysiology. Invest Radiol 2017; 52(11): 701– 707. doi: 10.1097/ RLI.0000000000000394.

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