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The Neuropathy Score Reporting and Data System (NS-RADS) is a newly developed MR imaging-based classification that standardizes reporting and multidisciplinary communication for MR imaging diagnosis and follow-up of peripheral neuropathies. NS-RADS classification has shown to be accurate and reliable across different centers, readers' experience levels, and degrees of peripheral neuropathies, which include nerve injury, entrapment, neoplasm, diffuse neuropathy, post-interventional status, and temporal changes in muscle denervation. This article brings a practical review of NS-RADS classification, representative MR cases, and a step-by-step tutorial on how to approach this staging system. Readers can gain knowledge and apply it in their practice, aiming to standardize the communications between specialties and improve patient management.
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Doenças do Sistema Nervoso Periférico , Humanos , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Imageamento por Ressonância MagnéticaRESUMO
We retrospectively analyzed clinical, NCS/EMG, and NMRI aspects of five COVID-19 intensive care unit inpatients that received mechanical ventilation. After awakening from sedation, they experienced peripheral neuromyopathic symptoms. Teaching Point: Acquired peripheral nerve injury has been described in COVID-19 infection and knowledge of the clinical, nerve conduction studies/electromyography (NCS/EMG) and neurographic magnetic resonance imaging (NMRI) findings are crucial.
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Peripheral neuropathy in patients with rheumatoid arthritis is associated with a maladaptive autoimmune response that may cause chronic pain and disability. Nerve conduction studies are the routine method performed when rheumatologists presume its presence. However, this approach is invasive, may not reveal subtle malfunctions in the early stages of the disease, and does not expose abnormalities in structures surrounding the nerves and muscles, limiting the possibility of a timely diagnosis. This work aims to present a narrative review of new technologies for the clinical assessment of peripheral neuropathy in Rheumatoid Arthritis. Through a bibliographic search carried out in five repositories, from 1990 to 2020, we identified three technologies that could detect peripheral nerve lesions and perform quantitative evaluations: (1) magnetic resonance neurography, (2) functional magnetic resonance imaging, and (3) high-resolution ultrasonography of peripheral nerves. We found these tools can overcome the main constraints imposed by the previous electrophysiologic methods, enabling early diagnosis.
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Artrite Reumatoide/complicações , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/patologia , Humanos , Imageamento por Ressonância Magnética/efeitos adversos , Imageamento por Ressonância Magnética/métodos , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Sistema Nervoso Periférico/patologia , Ultrassonografia/efeitos adversos , Ultrassonografia/métodosRESUMO
The pudendal nerve entrapment is an entity understudied by diagnosis imaging. Various causes are recognized in relation to difficult labors, rectal, perineal, urological and gynecological surgery, pelvic trauma fracture, bones tumors and compression by tumors or pelvic pseudotumors. Pudendal neuropathy should be clinically suspected, and confirmed by different methods such as electrofisiological testing: evoked potentials, terminal motor latency test and electromyogram, neuronal block and magnetic resonance imaging. The radiologist should be acquainted with the complex anatomy of the pelvic floor, particularly on the path of pudendal nerve studied by magnetic resonance imaging. High resolution magnetic resonance neurography should be used as a complementary diagnostic study along with clinical and electrophysiological examinations in patients with suspected pudendal nerve neuralgia.
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Imageamento por Ressonância Magnética , Nervo Pudendo/diagnóstico por imagem , Neuralgia do Pudendo/diagnóstico por imagem , Diagnóstico Diferencial , Eletromiografia , Humanos , Neuroimagem/métodos , Nervo Pudendo/anatomia & histologia , Neuralgia do Pudendo/etiologia , Neuralgia do Pudendo/terapiaRESUMO
La neuralgia del nervio pudendo (NP) es una entidad poco estudiada por imágenes. Se reconocen varias causas, tales como compresión a través de su paso por estructuras ligamentarias; estiramiento por partos laboriosos; lesiones secundarias a cirugías rectales, perineales, urológicas y ginecológicas, traumatismos con o sin fractura de huesos pelvianos; procesos inflamatorios/autoinmunes; tumores del NP, y, compresión/desplazamiento por tumores o seudotumores de pelvis. El diagnóstico de neuralgia del NP se sospecha por la clínica y se confirma por diferentes métodos, tales como las pruebas electrofisiolológicas: potenciales evocados, test de latencia motora terminal y electromiograma, y, a través de bloqueos neurales y resonancia magnética. La neurografía por resonancia magnética de alta resolución, debería ser empleada como estudio diagnóstico complementario junto a la clínica y exámenes electrofisiológicos, en los pacientes con sospecha de neuralgia del NP.
The pudendal nerve entrapment is an entity understudied by diagnosis imaging. Various causes are recognized in relation to difficult labors, rectal, perineal, urological and gynecological surgery, pelvic trauma fracture, bones tumors and compression by tumors or pelvic pseudotumors. Pudendal neuropathy should be clinically suspected, and confirmed by different methods such as electrofisiological testing: evoked potentials, terminal motor latency test and electromyogram, neuronal block and magnetic resonance imaging. The radiologist should be acquainted with the complex anatomy of the pelvic floor, particularly on the path of pudendal nerve studied by magnetic resonance imaging. High resolution magnetic resonance neurography should be used as a complementary diagnostic study along with clinical and electrophysiological examinations in patients with suspected pudendal nerve neuralgia.
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Humanos , Imageamento por Ressonância Magnética , Nervo Pudendo/diagnóstico por imagem , Neuralgia do Pudendo/diagnóstico por imagem , Diagnóstico Diferencial , Eletromiografia , Nervo Pudendo/anatomia & histologia , Neuralgia do Pudendo/etiologia , Neuralgia do Pudendo/terapia , Neuroimagem/métodosRESUMO
Magnetic resonance neurography (MRN), with high resolution sequences, allows for a detailed study of the plexus and peripheral nerves. For its interpretation, it is necessary to have a general knowledge of MR, as well as of the anatomy of the neuromuscular system and lesions that affect it. Nerve and plexus pathology can be divided into mononeuropathies (for trauma, entrapment or tumors) and hereditary polyneuropathies (such as Charcot-Marie-Tooth disease) or acquired (for chronic idiopathic demyelinating polyradiculoneuropathy, diabetes, vasculitis or inflammation). The objective of this review is to describe the study technique of Magnetic Resonance Neurography as well as the characteristics of the normal and pathological peripheral nerve.
La neurografía por resonancia magnética (NRM), con secuencias de alta resolución, permite un detallado estudio de los plexos y nervios periféricos. Para su interpretación, es necesario contar con conocimientos generales de RM, así como de la anatomía del sistema neuromuscular y de las lesiones que lo afectan. La patología de los nervios y plexos puede dividirse en mononeuropatías (por trauma, atrapamiento o tumores) y polineuropatías hereditarias (como la enfermedad de Charcot Marie Tooth) o adquiridas (por poliradiculoneuropatía desmielinizante idiopática crónica, diabetes, vasculitis o inflamación) El objetivo de esta revisión es describir la técnica de estudio de la neurografía por resonancia magnética, así como las características del nervio periférico normal y patológico.