Abstract
Abstract *Objective:* Methods were invented that made it possible to image peripheral nerves in the body and to image neural tracts in the brain. Over a 15 year period, these techniques – MR Neurography and Diffusion Tensor Imaging – were then deployed in the clinical and research community and applied to about 50,000 patients. Within this group, about 5,000 patients having MR Neurography were carefully tracked on a prospective basis.*Method:* In the study group a uniform imaging methodology was applied and all images were reviewed and registered by referral source, clinical indication, efficacy of imaging and quality. Various classes of image findings were identified and subjected to a variety of small targeted prospective outcome studies. Those findings demonstrated to be clinically significant were then tracked in the larger clinical volume data set. *Results:* MR Neurography demonstrates mechanical distortion of nerves, hyperintensity consistent with nerve irritation, nerve swelling, discontinuity, relations of nerves to masses, and image features revealing distortion of nerve at entrapment points. These findings are often clinically relevant and warrant full consideration in the diagnostic process. They result in specific pathologic diagnoses that are comparable to electrodiagnostic testing in clinical efficacy. *Conclusions:* MR Neurography and DTI neural tract imaging have been validated as indispensable clinical diagnostic methods that provide reliable anatomical pathological information. There is no alternative diagnostic method in many situations. With the elapse of 15 years, tens of thousands of imaging studies, and hundreds of publications, these methods should no longer be considered experimental.
Highlights
IntroductionThe discovery of a series of MR pulse sequence strategies for tissue specific imaging of nerve and nerve tracts in 1991 and 1992 has opened a new diagnostic world in which a wide variety of pathologies involving nerves and neural tracts can be visualized directly [4, 5, 13, 18, 20, 24, 25, 36] these techniques are grouped under the terms “MR Neurography” for peripheral nerve and “Diffusion Tensor Imaging” or “Tractography” for the CNS
About 5,000 patients having MR Neurography were carefully tracked on a prospective basis
The first DTI image showing curved neural tracts traversing the brain (Fig. 1) and the first neurography images were submitted in a series of UK patent descriptions by Filler et al between March and July of 1992 [18] and were published by the US patent office in 1993(19)
Summary
The discovery of a series of MR pulse sequence strategies for tissue specific imaging of nerve and nerve tracts in 1991 and 1992 has opened a new diagnostic world in which a wide variety of pathologies involving nerves and neural tracts can be visualized directly [4, 5, 13, 18, 20, 24, 25, 36] these techniques are grouped under the terms “MR Neurography” for peripheral nerve and “Diffusion Tensor Imaging” or “Tractography” for the CNS.
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