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Post-Cubital Tunnel Release: How Much 3T Mr Neurography Adds?
Majid Chalian; Neda Faridian-Aragh, MD; Allan J. Belzberg; John A. Carrino; Eric Wlliams; Avneesh Chhabra
The Johns Hopkins Hospital, Baltimore, MD, USA
Purpose: To describe 3T MR Neurography (MRN) findings in symptomatic post-cubital tunnel release (PCTR) patients.
Materials and Methods: In this HIPPA compliant study, MRN of 12 PCTR patients (6 Males/6 Females; mean age 51 +/- 10 yrs) were evaluated. Subjects had pain, sensory or motor deficits and positive Tinel`s sign. Neurosensory testing, electeromyography (EMG), and re-operation reports were available and used as reference standards. Qualitative and semi-quantitative MRN criteria were used for ulnar nerve (UN) evaluation and regional muscles. Two blinded musculoskeletal radiologists evaluated the findings independently and consensus was obtained.
Results: UN T2 hyperintensity was moderate in 25% (3/12) and severe in 75% (9/12) of cases. Nerve size was normal and enlarged in 50% (6/12) of cases, each. Mean nerve/vessel SI was 1.28+/-0.64. Nerve course deviation reported in 50% (6/12), fascicular abnormality in 58% (7/12), neuroma in 8% (1/12) and muscle denervation changes in 75% (9/12) of cases. MRN was true positive in 83% (10/12) and false positive in 17% (2/12). Focal fibrosis was the cause of re-entrapment in 75% (9/12) cases.
Conclusion: In PCTR cases, 3T MRN is a useful technique for the assessment of nerve re-entrapment.
Clinical Relevance: There is relative paucity of literature on MR evaluation of symptomatic PCTR patients. This study suggests that 3T MRN should be incorporated in the diagnostic/follow-up algorithm of such patients.
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