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High resolution 3 Tesla MR Neurography- Impact On Patient Management
Avneesh Chhabra, MD; Eric H. Williams, MD; Allan J. Belzberg; Gedge D. Rosson; E. Gene Deune, MD, MBA; John Eng; J.A. Carrino, MD
Johns Hopkins University, Baltimore, MD, USA
Purpose: To evaluate how high resolution, high field MR Neurography impacts physicians diagnostic thinking and patient management decisions, if it is added to the current standard of care, including the combination of physicial exam, quantitative neurosensory testing (QNS), and electromyography (EMG).
Methods and Materials: Prospective Multireader (ongoing) Study in 82 patients with suspected and not known injured or entrapped peripheral nerves. Survey questionnaires were performed before and after MRN and the measures included, presence or absence of nerve injury, diagnostic confidence, degree of nerve injury, differential diagnosis, decision whether to pursue surgery, timing of surgical intervention, surgical approach, confidence in approach, and estimated length of surgery. Normally distributed variables were compared between groups using the Wilcoxon signed-rank test. The McNemar test was used for the categorical variables. The differences were considered statistically significant with probability values < 0.05.
Results: 4/82 surveys were ineligible due to lack of completeness. Before MRN, these other modalities were available to clinicians- 33/78-EMG; 16/78-QNS; 15/78-Both; 14/78-None. Changes were seen in all categories of the surveys with statistical significance seen in differential diagnosis (33%), surgeon decision against the surgery (17%), confidence in need for surgery- 24/50 (48%, p-0.002), grade of nerve injury- 22/78 (28%, p<0.01), confidence in diagnosis of neuropathy- 36/78 (46%, p<0.001), confidence in anatomical approach to surgery- 16/50 (32%, p-0.012) and estimated length of incision 18/78 (23%, p<0.01).
Conclusion: High resolution, high field MR Neurography significantly impacts the pre-surgical decision making in patients with suspected but not known peripheral nerve injuries and entrapments.
Clinical Relevance/Application: 3T MR Neurography is recommended in pre-surgical decision making for suspected peripheral nerve injuries and entrapments.
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