Hand and Wrist Neuropathies: High-resolution Ultrasonography and MR Neurography

Abstract

High-resolution ultrasonography (US) and magnetic resonance neurography (MRN) have followed parallel paths for peripheral nerve imaging with little comparison of the two modalities. They seem equally effective to study a variety of neuropathies affecting large and small nerves in the wrist and hand. This article outlines the technical considerations of US and MRN and discusses normal and abnormal imaging appearances of hand and wrist nerves from etiologies such as entrapment, injury, tumor, and proximal and diffuse neuropathy, with specific case illustrations.

Keywords

nerves - wrist and hand - ultrasonography - magnetic resonance imaging - magnetic resonance neurography

• References

• 1 Bignotti B, Tagliafico A, Martinoli C. Ultrasonography of peripheral nerves: anatomy and pathology. Ultrasound Clin 2014; 9: 525-536
• 2 Tagliafico AS. Peripheral nerve imaging: not only cross-sectional area. World J Radiol 2016; 8 (08) 726-728
• 3 Choi SJ, Ahn JH, Ryu DS. et al. Ultrasonography for nerve compression syndromes of the upper extremity. Ultrasonography 2015; 34 (04) 275-291
• 4 Ghasemi-Esfe AR, Khalilzadeh O, Vaziri-Bozorg SM. et al. Color and power Doppler US for diagnosing carpal tunnel syndrome and determining its severity: a quantitative image processing method. Radiology 2011; 261 (02) 499-506
• 5 Del Grande F, Santini F, Herzka DA. et al. Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system. Radiographics 2014; 34 (01) 217-233
• 6 Chhabra A, Madhuranthakam AJ, Andreisek G. Magnetic resonance neurography: current perspectives and literature review. Eur Radiol 2018; 28 (02) 698-707
• 7 Amrami KK, Felmlee JP, Spinner RJ. MRI of peripheral nerves. Neurosurg Clin N Am 2008; 19 (04) 559-572 ; vi
• 8 Guggenberger R, Markovic D, Eppenberger P. et al. Assessment of median nerve with MR neurography by using diffusion-tensor imaging: normative and pathologic diffusion values. Radiology 2012; 265 (01) 194-203
• 9 Martín Noguerol T, Barousse R, Gómez Cabrera M, Socolovsky M, Bencardino JT, Luna A. Functional MR neurography in evaluation of peripheral nerve trauma and postsurgical assessment. Radiographics 2019; 39 (02) 427-446
• 10 Chhabra A, Soldatos T, Subhawong TK. et al. The application of three-dimensional diffusion-weighted PSIF technique in peripheral nerve imaging of the distal extremities. J Magn Reson Imaging 2011; 34 (04) 962-967
• 11 Chhabra A, Subhawong TK, Bizzell C, Flammang A, Soldatos T. 3T MR neurography using three-dimensional diffusion-weighted PSIF: technical issues and advantages. Skeletal Radiol 2011; 40 (10) 1355-1360
• 12 Subhawong TK, Wang KC, Thawait SK. et al. High resolution imaging of tunnels by magnetic resonance neurography. Skeletal Radiol 2012; 41 (01) 15-31
• 13 Linda DD, Harish S, Stewart BG, Finlay K, Parasu N, Rebello RP. Multimodality imaging of peripheral neuropathies of the upper limb and brachial plexus. Radiographics 2010; 30 (05) 1373-1400
• 14 Brit GW, Haynor DR, Kuntz C, Goodkin R, Gitter A, Kliot M. Carpal tunnel syndrome: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurgery 1995; 37 (06) 1097-1103
• 15 Buchberger W, Judmaier W, Birbamer G, Lener M, Schmidauer C. Carpal tunnel syndrome: diagnosis with high-resolution sonography. AJR Am J Roentgenol 1992; 159 (04) 793-798
• 16 Klauser AS, Halpern EJ, Faschingbauer R. et al. Bifid median nerve in carpal tunnel syndrome: assessment with US cross-sectional area measurement. Radiology 2011; 259 (03) 808-815
• 17 Bianchi S, Della Santa D, Glauser T, Beaulieu JY, van Aaken J. Sonography of masses of the wrist and hand. AJR Am J Roentgenol 2008; 191 (06) 1767-1775
• 18 Lee RKL, Griffith JF, Ng AWH. et al. Cross-sectional area of the median nerve at the wrist: comparison of sonographic, MRI, and cadaveric measurements. J Clin Ultrasound 2019; 47 (03) 122-127
• 19 Mhoon JT, Juel VC, Hobson-Webb LD. Median nerve ultrasound as a screening tool in carpal tunnel syndrome: correlation of cross-sectional area measures with electrodiagnostic abnormality. Muscle Nerve 2012; 46 (06) 871-878
• 20 Klauser AS, Halpern EJ, De Zordo T. et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology 2009; 250 (01) 171-177
• 21 Mesgarzadeh M, Triolo J, Schneck CD. Carpal tunnel syndrome. MR imaging diagnosis. Magn Reson Imaging Clin N Am 1995; 3 (02) 249-264
• 22 Martín Noguerol T, Barousse R, Socolovsky M, Luna A. Quantitative magnetic resonance (MR) neurography for evaluation of peripheral nerves and plexus injuries. Quant Imaging Med Surg 2017; 7 (04) 398-421
• 23 Chhabra A, Ahlawat S, Belzberg A, Andreseik G. Peripheral nerve injury grading simplified on MR neurography: as referenced to Seddon and Sunderland classifications. Indian J Radiol Imaging 2014; 24 (03) 217-224
• 24 Aggarwal A, Jana M, Kumar V, Srivastava DN, Garg K. MR neurography in intraosseous median nerve entrapment. World J Radiol 2017; 9 (10) 400-404
• 25 Gamber D, Motte J, Kerasnoudis A. et al. High-resolution nerve ultrasound to assess nerve echogenicity, fascicular count, and cross-sectional area using semiautomated analysis. J Neuroimaging 2020; 30 (04) 493-502
• 26 Thawait SK, Chaudhry V, Thawait GK. et al. High-resolution MR neurography of diffuse peripheral nerve lesions. AJNR Am J Neuroradiol 2011; 32 (08) 1365-1372
• 27 Zhai H, Lv Y, Kong X, Liu X, Liu D. Magnetic resonance neurography appearance and diagnostic evaluation of peripheral nerve sheath tumors. Sci Rep 2019; 9 (01) 6939
• 28 Ahlawat S, Chhabra A, Blakely J. Magnetic resonance neurography of peripheral nerve tumors and tumorlike conditions. Neuroimaging Clin N Am 2014; 24 (01) 171-192
• 29 Bhargava R, Parham DM, Lasater OE, Chari RS, Chen G, Fletcher BD. MR imaging differentiation of benign and malignant peripheral nerve sheath tumors: use of the target sign. Pediatr Radiol 1997; 27 (02) 124-129
• 30 Li CS, Huang GS, Wu HD. et al. Differentiation of soft tissue benign and malignant peripheral nerve sheath tumors with magnetic resonance imaging. Clin Imaging 2008; 32 (02) 121-127
• 31 Tagliafico AS, Isaac A, Bignotti B, Rossi F, Zaottini F, Martinoli C. Nerve tumors: what the MSK radiologist should know. Semin Musculoskelet Radiol 2019; 23 (01) 76-84
• 32 Yang F, Chen XX, Wu HL. et al. Sonographic features and diagnosis of peripheral schwannomas. J Clin Ultrasound 2017; 45 (03) 127-133
• 33 Ryu JA, Lee SH, Cha EY, Kim TY, Kim SM, Shin MJ. Sonographic differentiation between schwannomas and neurofibromas in the musculoskeletal system. J Ultrasound Med 2015; 34 (12) 2253-2260
• 34 Molinari III WJ, Elfar JC. The double crush syndrome. J Hand Surg Am 2013; 38 (04) 799-801 ; quiz 801
• 35 Hobson-Webb LD. Neuromuscular ultrasound in polyneuropathies and motor neuron disease. Muscle Nerve 2013; 47 (06) 790-804
• 36 Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS. Nerve ultrasound score in distinguishing chronic from acute inflammatory demyelinating polyneuropathy. Clin Neurophysiol 2014; 125 (03) 635-641
• 37 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
• 38 Grimm A, Décard BF, Axer H. Ultrasonography of the peripheral nervous system in the early stage of Guillain-Barré syndrome. J Peripher Nerv Syst 2014; 19 (03) 234-241
• 39 Grimm A, Décard BF, Schramm A. et al. Ultrasound and electrophysiologic findings in patients with Guillain-Barré syndrome at disease onset and over a period of six months. Clin Neurophysiol 2016; 127 (02) 1657-1663
• 40 Martinoli C, Schenone A, Bianchi S. et al. Sonography of the median nerve in Charcot-Marie-Tooth disease. AJR Am J Roentgenol 2002; 178 (06) 1553-1556
• 41 Bayrak AO, Bayrak IK, Battaloglu E, Ozes B, Yildiz O, Onar MK. Ultrasonographic findings in hereditary neuropathy with liability to pressure palsies. Neurol Res 2015; 37 (02) 106-111
• 42 Kollmer J, Bäumer P, Milford D. et al. T2-signal of ulnar nerve branches at the wrist in Guyon's canal syndrome. PLoS One 2012; 7 (10) e47295
• 43 Shea JD, McClain EJ. Ulnar-nerve compression syndromes at and below the wrist. J Bone Joint Surg Am 1969; 51 (06) 1095-1103
• 44 Kenneth ER, Li J, Martha AK. et al. Ultrasound evaluation of the normal ulnar nerve in Guyon's tunnel: cross-sectional area and anthropometric measurements. J Med Ultrasound 2015; 23 (04) 171-176
• 45 Capitani D, Beer S. Handlebar palsy—a compression syndrome of the deep terminal (motor) branch of the ulnar nerve in biking. J Neurol 2002; 249 (10) 1441-1445
• 46 Karvelas KR, Walker FO. Clinical and ultrasonographic features of distal ulnar neuropathy: a review. Front Neurol 2019; 10: 632
• 47 Dang AC, Rodner CM. Unusual compression neuropathies of the forearm, part I: radial nerve. J Hand Surg Am 2009; 34 (10) 1906-1914
• 48 Lanzetta M, Foucher G. Association of Wartenberg's syndrome and De Quervain's disease: a series of 26 cases. Plast Reconstr Surg 1995; 96 (02) 408-412
• 49 Zaidman CM, Seelig MJ, Baker JC, Mackinnon SE, Pestronk A. Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology 2013; 80 (18) 1634-1640
• 50 Picasso R, Zaottini F, Pistoia F. et al. High-resolution ultrasound of small clinically relevant nerves running across the posterior triangle of the neck. Semin Musculoskelet Radiol 2020; 24 (02) 101-112
• 51 Lauretti L, D'Alessandris QG, Granata G. et al. Ultrasound evaluation in traumatic peripheral nerve lesions: from diagnosis to surgical planning and follow-up. Acta Neurochir (Wien) 2015; 157 (11) 1947-1951 ; discussion 1951