Abstract
Magnetic resonance neurography is a high-resolution imaging technique that allows evaluating different neurological pathologies in correlation to clinical and the electrophysiological data. The aim of this article is to present a review on the anatomy of the lumbosacral plexus nerves, along with imaging protocols, interpretation pitfalls, and most common pathologies that should be recognized by the radiologist: traumatic, iatrogenic, entrapment, tumoral, infectious, and inflammatory conditions. An extensive series of clinical and imaging cases is presented to illustrate key-points throughout the article.
Highlights
The lumbosacral plexus represents an intricate network of nerve unifications and divisions that results in terminal nerves responsible for sensory and motor innervation of the pelvis and the lower extremities [1]
A complete evaluation of the lumbosacral plexus should include T1-weighted and fluid sensitive fat-suppressed sequence images [3, 19]: they serve as basis for magnetic resonance neurography (MRN) interpretation regarding peripheral nerve signal intensity (SI), course, caliber, fascicular pattern, size, and perineural fibrosis or mass lesions [24]
Is a list of the main MRNrelated pitfalls: (1) The magic angle effect (MA) is a potential artifact mimicking hyperintense SI in a normal peripheral nerve, which may lead to false-positive abnormalities by increasing intraneural T2 signal intensity [28]
Summary
The lumbosacral plexus represents an intricate network of nerve unifications and divisions that results in terminal nerves responsible for sensory and motor innervation of the pelvis and the lower extremities [1]. Electromyography (EMG) studies have limitations, mostly related to patient pain, nonspecific results in almost 1/3 of cases, and limited information on location, extent, and etiology of the nerve injury. They have high sensitivity, they lack specificity and displaying the anatomic detail needed to localize the nerve lesion and treatment planning. To confirm the involvement of the lumbosacral plexus and its extension in patients with tumor diseases To assess the extent of injuries To evaluate the lumbosacral plexus in patients with indeterminate MR of the lumbar spine To exclude presence of masses in patients with unilateral changes in EMG To exclude lesions in patients with persistent symptoms and normal or indeterminate findings on EMG To confirm changes of lumbar plexus in patients with confusing clinical findings To evaluate abnormalities of peripheral nerve branches and associated lesions (e.g., piriformis syndrome, pudendal neuralgia, and meralgia paresthetica) To plan administration of medications guided by imaging Note. Anatomy, protocols, applications, pitfalls, and pathologies involved, along with an extensive case presentation and literature review
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