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Eur Radiol. 2016 May;26(5):1235-44. doi: 10.1007/s00330-015-3958-y. Epub 2015 Sep 22.

Impact of high resolution 3 tesla MR neurography (MRN) on diagnostic thinking and therapeutic patient management.

Author information

1
Department of Radiology, Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA. avneesh.chhabra@utsoutwestern.edu.
2
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA. avneesh.chhabra@utsoutwestern.edu.
3
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
4
Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
5
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA.
6
Dellon Institute, Towson, MD, USA.
7
Department of Radiology, University of Miami Health System, Miami, FL, USA.
8
Department of Radiology and Imaging, Weill Cornell Medical College, Hospital for Special Surgery, New York, NY, USA.

Abstract

OBJECTIVE:

To evaluate the impact of magnetic resonance neurography (MRN) on diagnostic thinking and therapeutic choices in patients with suspected peripheral neuropathy.

METHODS:

IRB approval was obtained for this HIPAA-compliant study. Questionnaires were administered to six surgeons regarding the diagnosis and treatment in 85 patients suspected of having peripheral neuropathy, before (pretest) and after (posttest) MRN. Multiple outcome measures related to diagnostic confidence and surgical decision-making were assessed.

RESULTS:

The final cohort included 81 patients (30 men and 51 women, age 47 ± 17 years). The following changes were observed from pretest to posttest questionnaires: 23% in nerve involvement (P < 0.05), 48% in degree of confidence of nerve involvement (P < 0.01), 27% in grade of injury (P < 0.05), 33% in differential diagnosis (P < 0.05), 63% in degree of confidence in need for surgery (P < 0.001), 41% in timing of surgery (P < 0.01), 30% in approach to surgery (P < 0.05), 58% in degree of confidence in approach to surgery (P < 0.001), 30% in estimated length of surgery (P < 0.05) and 27% in length of incision (P < 0.05). The dichotomous decision regarding surgical or nonsurgical treatment changed from pro to con in 17%.

CONCLUSION:

MRN results significantly influenced the diagnostic thinking and therapeutic recommendations of peripheral nerve surgeons.

KEY POINTS:

• In patients with peripheral neuropathy, MRN significantly impacts diagnostic thinking. • In patients with peripheral neuropathy, MRN significantly impacts therapeutic choices. • 3-T MRN should be considered in presurgical planning of patients with peripheral neuropathy.

KEYWORDS:

Decision-making; Diagnostic approach; MR neurography; Peripheral nerve injury; Therapeutic management

PMID:
26396110
DOI:
10.1007/s00330-015-3958-y
[Indexed for MEDLINE]

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