Abstract
Objectives
MR neurography, diffusion tensor imaging (DTI) and tractography at 3 Tesla were evaluated for the assessment of patients with ulnar neuropathy at the elbow (UNE).
Methods
Axial T2-weighted and single-shot DTI sequences (16 gradient encoding directions) were acquired, covering the cubital tunnel of 46 patients with clinically and electrodiagnostically confirmed UNE and 20 healthy controls. Cross-sectional area (CSA) was measured at the retrocondylar sulcus and FA and ADC values on each section along the ulnar nerve. Three-dimensional nerve tractography and T2-weighted neurography results were independently assessed by two raters.
Results
Patients showed a significant reduction of ulnar nerve FA values at the retrocondylar sulcus (p = 0.002) and the deep flexor fascia (p = 0.005). At tractography, a complete or partial discontinuity of the ulnar nerve was found in 26/40 (65 %) of patients. Assessment of T2 neurography was most sensitive in detecting UNE (sensitivity, 91 %; specificity, 79 %), followed by tractography (88 %/69 %). CSA and FA measurements were less effective in detecting UNE.
Conclusion
T2-weighted neurography remains the most sensitive MR technique in the imaging evaluation of clinically manifest UNE. DTI-based neurography at 3 Tesla supports the MR imaging assessment of UNE patients by adding quantitative and 3D imaging data.
Key Points
• DTI and tractography support conventional MR neurography in the detection of UNE
• Regionally reduced FA values and discontinuous tractography patterns indicate UNE
• T2-weighted MR neurography remains the imaging gold standard in cases of UNE
• DTI-based ulnar nerve tractography offers additional topographic information in 3D
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Abbreviations
- ADC:
-
apparent diffusion coefficient
- CSA:
-
cross-sectional area
- DTI:
-
diffusion tensor imaging
- FA:
-
fractional anisotropy
- ICC:
-
intraclass correlation coefficient
- ROC:
-
receiver operating characteristic
- ROI:
-
region of interest
- UNE:
-
ulnar neuropathy at the elbow
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Acknowledgements
The scientific guarantor of this publication is Gregor Kasprian. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Michael Weber kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was obtained from all subjects in this study. Methodology: prospective diagnostic study performed at one institution
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Breitenseher, J.B., Kranz, G., Hold, A. et al. MR neurography of ulnar nerve entrapment at the cubital tunnel: a diffusion tensor imaging study. Eur Radiol 25, 1911–1918 (2015). https://doi.org/10.1007/s00330-015-3613-7
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DOI: https://doi.org/10.1007/s00330-015-3613-7