Download PDF
CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2021; 16(01): e24-e30
DOI: 10.1055/s-0041-1731280
Review Article

Techniques for Imaging Vascular Supply of Peripheral Nerves

Alec Giron
1   Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center School of Medicine Lubbock, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas, United Sates
,
Cameron Cox
2   Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
,
Brendan MacKay 
3   Department of Orthopaedic Surgery, Texas Tech Health Sciences Center, Lubbock, Texas, United Sates
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Few studies have been developed to map the vascular structures feeding peripheral nerves, with the majority using cadaveric models and inadequate sample sizes. Preliminary evidence, while limited, indicates that the mapping of these vessels may allow or preclude certain procedures in nerve reconstruction due to the location of essential arterial inflow to the vasa nervorum. This review evaluates the evidence regarding historical, current, and emerging techniques for visualizing these vascular structures in vivo and considers their potential application in peripheral nerve vasculature.

Keywords

imaging - peripheral nerve repair - CT imaging - ultrasound - peripheral vasculature - MRI - CEMRI - surgery

Summary Statement

Among imaging techniques used to visualize nerve vasculature, contrast enhanced magnetic resonance angiography (CE-MRA) and laser angiography show potential for mapping common perforating vessels and visualizing these structures in individuals, respectively.


Essentials:


1. Adequate vascular perfusion is necessary for normal nerve function and regeneration of injured nerves. Yet, the literature is lacking in assessments of techniques for visualizing nerve vasculature.


2. Mapping of common perforating vessels and imaging of these structures in individual patients may enable surgeons to better preserve blood flow, allowing for improved patient outcomes.


3. Ultrasound/Doppler, optical coherence tomography (OCT), and laser angiography are most useful in a clinical setting to visualize superficial structures, with laser angiography showing the most potential benefit for intraoperative imaging. While various MR techniques have been used to visualize nerve vasculature, CE-MRA may provide the greatest utility for mapping common perforating vessels of the peripheral nerves.




Publication History

Received: 10 September 2020

Accepted: 31 March 2021

Article published online:
23 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Laviña B. Brain vascular imaging techniques. Int J Mol Sci 2016; 18 (01) E70
    CrossrefPubMedSearch in Google Scholar
  • 2 Rydevik B, Lundborg G, Nordborg C. Intraneural tissue reactions induced by internal neurolysis. An experimental study on the blood-nerve barrier, connective tissues and nerve fibres of rabbit tibial nerve. Scand J Plast Reconstr Surg 1976; 10 (01) 3-8
    CrossrefPubMedSearch in Google Scholar
  • 3 Rydevik B, Lundborg G. Permeability of intraneural microvessels and perineurium following acute, graded experimental nerve compression. Scand J Plast Reconstr Surg 1977; 11 (03) 179-187
    CrossrefPubMedSearch in Google Scholar
  • 4 Lundborg G. Structure and function of the intraneural microvessels as related to trauma, edema formation, and nerve function. J Bone Joint Surg Am 1975; 57 (07) 938-948
    CrossrefPubMedSearch in Google Scholar
  • 5 Gao Y, Weng C, Wang X. Changes in nerve microcirculation following peripheral nerve compression. Neural Regen Res 2013; 8 (11) 1041-1047
    PubMedSearch in Google Scholar
  • 6 Ferretti A, Boschi E, Stefani A. et al. Angiogenesis and nerve regeneration in a model of human skin equivalent transplant. Life Sci 2003; 73 (15) 1985-1994
    CrossrefPubMedSearch in Google Scholar
  • 7 Merolli A, Rocchi L, Catalano F. et al. In vivo regeneration of rat sciatic nerve in a double-halved stitch-less guide: a pilot-study. Microsurgery 2009; 29 (04) 310-318
    CrossrefPubMedSearch in Google Scholar
  • 8 Goedee HS, Brekelmans GJ, van Asseldonk JT, Beekman R, Mess WH, Visser LH. High resolution sonography in the evaluation of the peripheral nervous system in polyneuropathy--a review of the literature. Eur J Neurol 2013; 20 (10) 1342-1351
    CrossrefPubMedSearch in Google Scholar
  • 9 Caillaud M, Richard L, Vallat JM, Desmoulière A, Billet F. Peripheral nerve regeneration and intraneural revascularization. Neural Regen Res 2019; 14 (01) 24-33
    CrossrefPubMedSearch in Google Scholar
  • 10 Suami H, Taylor GI, Pan WR. Angiosome territories of the nerves of the lower limbs. Plast Reconstr Surg 2003; 112 (07) 1790-1798
    CrossrefPubMedSearch in Google Scholar
  • 11 Hong MK, Hong MK, Taylor GI. Angiosome territories of the nerves of the upper limbs. Plast Reconstr Surg 2006; 118 (01) 148-160
    CrossrefPubMedSearch in Google Scholar
  • 12 Koehler SM, Matson AP, Ruch DS, Mithani SK. Neural perforasomes of the upper extremity. Plast Reconstr Surg 2018; 142 (06) 1539-1546
    CrossrefPubMedSearch in Google Scholar
  • 13 Giesen T, Acland RD, Thirkannad S, Elliot D. The vascularization of the median nerve in the distal forearm and its potential clinical importance. J Hand Surg Am 2012; 37 (06) 1200-1207
    CrossrefPubMedSearch in Google Scholar
  • 14 Mostardi PM, Young PM, McKusick MA, Riederer SJ. High temporal and spatial resolution imaging of peripheral vascular malformations. J Magn Reson Imaging 2012; 36 (04) 933-942
    CrossrefPubMedSearch in Google Scholar
  • 15 Li X-X, Wu W, Zhou H. et al. A quantitative comparison of five optical coherence tomography angiography systems in clinical performance. Int J Ophthalmol 2018; 11 (11) 1784-1795
    PubMedSearch in Google Scholar
  • 16 Aung T, Heidekrueger PI, Geis S. et al. A novel indication for indocyanine green (ICG): Intraoperative monitoring of limb and sciatic nerve perfusion during rotationplasty for sarcoma patients. Clin Hemorheol Microcirc 2018; 70 (04) 441-447
    CrossrefPubMedSearch in Google Scholar
  • 17 Ohana M, Moser T, Moussaouï A. et al. Current and future imaging of the peripheral nervous system. Diagn Interv Imaging 2014; 95 (01) 17-26
    CrossrefPubMedSearch in Google Scholar
  • 18 Wang Y, Tang P, Zhang L, Guo Y, Wan W. Quantitative evaluation of the peripheral nerve blood perfusion with high frequency contrast-enhanced ultrasound. Acad Radiol 2010; 17 (12) 1492-1497
    CrossrefPubMedSearch in Google Scholar
  • 19 Baş A, Dikici AS, Gülşen F. et al. Corkscrew collateral vessels in Buerger disease: vasa vasorum or vasa nervorum. J Vasc Interv Radiol 2016; 27 (05) 735-739
    CrossrefPubMedSearch in Google Scholar
  • 20 Thawait SK, Wang K, Subhawong TK. et al. Peripheral nerve surgery: the role of high-resolution MR neurography. AJNR Am J Neuroradiol 2012; 33 (02) 203-210
    CrossrefPubMedSearch in Google Scholar
  • 21 Behr B, Schnabel R, Mirastschijski U, Ibrahim B, Angenstein F, Schneider W. Magnetic resonance imaging monitoring of peripheral nerve regeneration following neurotmesis at 4.7 Tesla. Plast Reconstr Surg 2009; 123 (06) 1778-1788
    CrossrefPubMedSearch in Google Scholar
  • 22 Cudlip SA, Howe FA, Griffiths JR, Bell BA. Magnetic resonance neurography of peripheral nerve following experimental crush injury, and correlation with functional deficit. J Neurosurg 2002; 96 (04) 755-759
    CrossrefPubMedSearch in Google Scholar
  • 23 Stroman PW, Bosma RL, Kornelsen J. et al. Advanced MR imaging techniques and characterization of residual anatomy. Clin Neurol Neurosurg 2012; 114 (05) 460-470
    CrossrefPubMedSearch in Google Scholar
  • 24 Larkman N, Lefebvre G, Jacques T, Demondion X, Cotten H, Cotten A. Anatomical and MR correlative study of the proximal sciatic nerve vasculature. Br J Radiol 2017; 90 (1077): 20170031
    CrossrefPubMedSearch in Google Scholar
  • 25 Yoon D, Biswal S, Rutt B, Lutz A, Hargreaves B. Feasibility of 7T MRI for imaging fascicular structures of peripheral nerves. Muscle Nerve 2018; 57 (03) 494-498
    CrossrefPubMedSearch in Google Scholar
  • 26 Chen Y, Haacke EM, Li J. Peripheral nerve magnetic resonance imaging. F1000 Res 2019; 8: F1000 Faculty Rev-1803
    CrossrefPubMedSearch in Google Scholar
  • 27 Sugimoto H, Miyaji N, Ohsawa T. Carpal tunnel syndrome: evaluation of median nerve circulation with dynamic contrast-enhanced MR imaging. Radiology 1994; 190 (02) 459-466
    CrossrefPubMedSearch in Google Scholar
  • 28 Prünte C, Flammer J, Markstein R, Rudin M. Quantification of optic nerve blood flow changes using magnetic resonance imaging. Invest Ophthalmol Vis Sci 1995; 36 (01) 247-251
    PubMedSearch in Google Scholar
  • 29 Bäumer P, Reimann M, Decker C. et al. Peripheral nerve perfusion by dynamic contrast-enhanced magnetic resonance imaging: demonstration of feasibility. Invest Radiol 2014; 49 (08) 518-523
    CrossrefPubMedSearch in Google Scholar
  • 30 Chen F, Ni YC. Magnetic resonance diffusion-perfusion mismatch in acute ischemic stroke: An update. World J Radiol 2012; 4 (03) 63-74
    CrossrefPubMedSearch in Google Scholar
  • 31 Korosec FR, Mistretta CA. MR angiography: basic principles and theory. Magn Reson Imaging Clin N Am 1998; 6 (02) 223-256
    CrossrefPubMedSearch in Google Scholar
  • 32 Shibukawa S, Nishio H, Niwa T. et al. Optimized 4D time-of-flight MR angiography using saturation pulse. J Magn Reson Imaging 2016; 43 (06) 1320-1326
    CrossrefPubMedSearch in Google Scholar
  • 33 Lu Y, Luan S, Liu L. et al. Evaluation of the applicability of territorial arterial spin labeling in meningiomas for presurgical assessments compared with 3-dimensional time-of-flight magnetic resonance angiography. Eur Radiol 2017; 27 (10) 4072-4081
    CrossrefPubMedSearch in Google Scholar
  • 34 HaiFeng L, YongSheng X, YangQin X. et al. Diagnostic value of 3D time-of-flight magnetic resonance angiography for detecting intracranial aneurysm: a meta-analysis. Neuroradiology 2017; 59 (11) 1083-1092
    CrossrefPubMedSearch in Google Scholar
  • 35 Wei N, Zhang Z, An J, Weng D, Zhuo Y. Improved visualization of superficial temporal artery using segmented time-of-flight MR angiography with venous suppression at 7T. Neuroradiology 2018; 60 (11) 1243-1246
    CrossrefPubMedSearch in Google Scholar
  • 36 Stepansky F, Hecht EM, Rivera R. et al. Dynamic MR angiography of upper extremity vascular disease: pictorial review. Radiographics 2008; 28 (01) e28
    CrossrefPubMedSearch in Google Scholar
  • 37 Turski P, Scarano A, Hartman E. et al. Neurovascular 4DFlow MRI (phase contrast MRA): emerging clinical applications. Neurovasc Imaging 2016; 2 (01) 8
    CrossrefPubMedSearch in Google Scholar
  • 38 Wu Y, Chang W, Johnson KM. et al. Fast whole-brain 4D contrast-enhanced MR angiography with velocity encoding using undersampled radial acquisition and highly constrained projection reconstruction: image-quality assessment in volunteer subjects. AJNR Am J Neuroradiol 2011; 32 (03) E47-E50
    CrossrefPubMedSearch in Google Scholar
  • 39 Gu T, Korosec FR, Block WF. et al. PC VIPR: a high-speed 3D phase-contrast method for flow quantification and high-resolution angiography. AJNR Am J Neuroradiol 2005; 26 (04) 743-749
    PubMedSearch in Google Scholar
  • 40 Johnson KM, Markl M. Improved SNR in phase contrast velocimetry with five-point balanced flow encoding. Magn Reson Med 2010; 63 (02) 349-355
    CrossrefPubMedSearch in Google Scholar
  • 41 Bilecen D, Aschwanden M, Heidecker HG, Bongartz G. Optimized assessment of hand vascularization on contrast-enhanced MR angiography with a subsystolic continuous com-pression technique. AJR Am J Roentgenol 2004; 182: 180-182
    CrossrefPubMedSearch in Google Scholar
  • 42 Winterer JT, Blanke P, Schaefer A, Pache G, Langer M, Markl M. Bilateral contrast-enhanced MR angiography of the hand: diagnostic image quality of accelerated MRI using echo sharing with interleaved stochastic trajectories (TWIST). Eur Radiol 2011; 21 (05) 1026-1033
    CrossrefPubMedSearch in Google Scholar
  • 43 Loecher M, Magrath P, Aliotta E, Ennis DB. Time-optimized 4D phase contrast MRI with real-time convex optimization of gradient waveforms and fast excitation methods. Magn Reson Med 2019; 82 (01) 213-224
    CrossrefPubMedSearch in Google Scholar
  • 44 Riederer SJ, Haider CR, Borisch EA, Weavers PT, Young PM. Recent advances in 3D time-resolved contrast-enhanced MR angiography. J Magn Reson Imaging 2015; 42 (01) 3-22
    CrossrefPubMedSearch in Google Scholar
  • 45 Mull M, Nijenhuis RJ, Backes WH, Krings T, Wilmink JT, Thron A. Value and limitations of contrast-enhanced MR angiography in spinal arteriovenous malformations and dural arteriovenous fistulas. AJNR Am J Neuroradiol 2007; 28 (07) 1249-1258
    CrossrefPubMedSearch in Google Scholar
  • 46 Liu J, Li Y, Yu Y. et al. Cerebral edema detection in vivo after middle cerebral artery occlusion using swept-source optical coherence tomography. Neurophotonics 2019; 6 (04) 045007
    PubMedSearch in Google Scholar
  • 47 Alfonso F, Prati F. Optical coherence tomography or intravascular ultrasound to optimize coronary stent implantation. Eur Heart J 2017; 38 (42) 3148-3151
    CrossrefPubMedSearch in Google Scholar
  • 48 Chang YC, Alperin N, Bagci AM. et al. Relationship between optic nerve protrusion measured by OCT and MRI and papilledema severity. Invest Ophthalmol Vis Sci 2015; 56 (04) 2297-2302
    CrossrefPubMedSearch in Google Scholar
  • 49 Wang RK. Optical microangiography: a label free 3D imaging technology to visualize and quantify blood circulations within tissue beds in vivo. IEEE J Sel Top Quantum Electron 2010; 16 (03) 545-554
    CrossrefPubMedSearch in Google Scholar
  • 50 Meiburger KM, Chen Z, Sinz C. et al. Automatic skin lesion area determination of basal cell carcinoma using optical coherence tomography angiography and a skeletonization approach: preliminary results. J Biophotonics 2019; 12 (09) e201900131
    CrossrefPubMedSearch in Google Scholar
  • 51 Wang RK, An L. Doppler optical micro-angiography for volumetric imaging of vascular perfusion in vivo. Opt Express 2009; 17 (11) 8926-8940
    CrossrefPubMedSearch in Google Scholar
  • 52 Gurtner GC, Jones GE, Neligan PC. et al. Intraoperative laser angiography using the SPY system: review of the literature and recommendations for use. Ann Surg Innov Res 2013; 7 (01) 1-1
    CrossrefPubMedSearch in Google Scholar
  • 53 Lu KB, Sanniec K, Amirlak B. Application of SPY angiography in the management of a chronic sternal wound. Plast Reconstr Surg Glob Open 2019; 7 (06) e2245-e2245
    CrossrefPubMedSearch in Google Scholar
  • 54 Hajiran A, Zekan D, Trump T, Dangerfield D, Luchey A. Use of SPY elite fluorescence imaging in creation of a continent urinary diversion. Case Rep Urol 2019; 2019: 9069841
    PubMedSearch in Google Scholar
  • 55 Kastellanos S, Aznaouridis K, Vlachopoulos C, Tsiamis E, Oikonomou E, Tousoulis D. Overview of coronary artery variants, aberrations and anomalies. World J Cardiol 2018; 10 (10) 127-140
    CrossrefPubMedSearch in Google Scholar
  • 56 Carroll AS, Simon NG. Current and future applications of ultrasound imaging in peripheral nerve disorders. World J Radiol 2020; 12 (06) 101-129
    CrossrefPubMedSearch in Google Scholar
  • 57 Sato K, Yamada M, Kuroda H. et al. Time-of-flight MR angiography for detection of cerebral hyperperfusion syndrome after superficial temporal artery-middle cerebral artery anastomosis in moyamoya disease. AJNR Am J Neuroradiol 2016; 37 (07) 1244-1248
    CrossrefPubMedSearch in Google Scholar
  • 58 Bignotti B, Assini A, Signori A, Martinoli C, Tagliafico A. Ultrasound versus MRI in common fibular neuropathy. Muscle Nerve 2017; 55 (06) 849-857
    CrossrefPubMedSearch in Google Scholar
  • 59 Oudeman J, Eftimov F, Strijkers GJ. et al. Diagnostic accuracy of MRI and ultrasound in chronic immune-mediated neuropathies. Neurology 2020; 94 (01) e62-e74
    CrossrefPubMedSearch in Google Scholar