PC46. MRI Neurography as an Adjunct for the Diagnosis of Meralgia Paresthetica

Abstract

PURPOSE: Meralgia paresthetica (MP) is a sequela of Lateral Femoral Cutaneous Nerve (LFCN) compression characterized by numbness, tingling, and burning sensation in the outer thigh. Traditional methods of diagnosis are usually extremely limited to provide a certain diagnosis. MRI neurography (MRN) is a tissue-specific imaging that provides excellent characterization of nerve anatomy. We propose MRN as an adjunct for the diagnosis and management of meralgia paresthetica. METHODS: We reviewed 13 consecutive patients who were surgically treated for MP in the last 2 years. Treatment protocol offered patients with VAS scores 3-4 with nerve release, 5-7 either LFCN decompression or resection with regenerative peripheral nerve interface (RPNI), and 8-10 RPNI. Since MRN was only recently introduced into our practice, 7 out of 13 patients had MRN pre-operatively. RESULTS: Patients presented with hypersensitivity and burning pain to the LFCN distribution with an average VAS score of 7.8. Of the 7 patients with MRN, 6 patients had complete resolution of symptoms, 1 patient with history of complex regional pain syndrome still reported improvement of symptoms. The 6 patients that didn’t get MRN were treated according to VAS score, EMG, and clinical assessment. 5 of them had complete resolution of symptoms after surgery with 1 reporting significant improvement. CONCLUSION: MRN is a useful resource for the evaluation of peripheral nerves. The ability to provide a comprehensive evaluation of the regional neuromuscular structures helps the diagnosis and management of MP. Nevertheless, larger prospective studies are still warranted to further investigate its utilization and accuracy.