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10 MRI perfusion of proximal nerve roots can help identify inflammatory neuropathies
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  1. Edrich Rodrigues,
  2. Meng Law and
  3. Elspeth Hutton
  1. Alfred Health, Melbourne 3004, VIC, Australia

Abstract

Background Dynamic contrast-enhanced-MRI (DCE-MRI) has shown promise in assessment of peripheral neuropathies.1 2 The aim of this study was to use DCE-MRI to obtain perfusion parameters, including the plasma to extravascular volume transfer (Ktrans) and the extravascular fluid volume (Ve) in patients with inflammatory neuropathies and controls.

Methods We recruited patients who presented with Gullain-Barre syndrome (GBS) or active Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) (new diagnosis or relapse) for this study between 2019 and 2022. Patients with genetic neuropathies and patients who were undergoing routine MRI scans post lumbar discectomy formed the control group.

3T-MRI examinations of the lumbo-sacral spine were carried out on participants including T1 weighted DCE volume interpolated breath-hold (VIBE) sequences with gadolinium-based contrast agents. Ktrans and Ve maps for motor nerve roots (MR), sensory root (SR), dorsal root ganglion (DRG) and mixed spinal nerves (MSN) were generated using the Tofts Model.3–5

We calculated the ratio of the Ktrans of the MSN to that of the MR and similarly that of the SR to the DRG at the L4, L5 and S1 root bilaterally. A linear mixed model analysis was used to compare differences between the two groups.

Results We analyzed 32 nerve segments from controls (n=7) and 43 nerve segments from patients with GBS/CIDP (n=11). The Ktrans ratio was for both motor and sensory roots were higher in the patients with inflammatory neuropathies than controls (p<0.05).

Conclusions DCE-MRI of proximal nerve roots may help complement other modalities in the diagnosis of inflammatory neuropathies.

References

  1. Bäumer P, Reimann M, Decker C, Radbruch A, Bendszus M, Heiland S, et al. Peripheral nerve perfusion by dynamic contrast-enhanced magnetic resonance imaging: Demonstration of feasibility. Investigative Radiology. 2014;49(8):518–23.

  2. Zochodne DW. Local blood flow in peripheral nerves and their ganglia: Resurrecting key ideas around its measurement and significance. Muscle and Nerve. 2018;57(6):884–95.

  3. Larsson HB, Courivaud F, Rostrup E, Hansen AE. Measurement of brain perfusion, blood volume, and blood-brain barrier permeability, using dynamic contrast-enhanced T(1)-weighted MRI at 3 tesla. Magn Reson Med. 2009;62(5):1270–81.

  4. Law M, Yang S, Babb JS, Knopp EA, Golfinos JG, Zagzag D, et al. Comparison of cerebral blood volume and vascular permeability from dynamic susceptibility contrast-enhanced perfusion MR imaging with glioma grade. AJNR Am J Neuroradiol. 2004;25(5):746–55.

  5. Montagne A, Barnes SR, Sweeney MD, Halliday MR, Sagare AP, Zhao Z, et al. Blood-brain barrier breakdown in the aging human hippocampus. Neuron. 2015;85(2):296–302.

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