For some time now, magnetic resonance imaging has also made it possible to visualize nerves in high resolution and high contrast. This particularly benefits patients with peripheral nerve disorders. The procedure known as MR neurography has been researched and practiced at the University Hospital Zurich for years. Responsible is PD Dr. Roman Guggenberger, Head of Musculoskeletal Radiology at the USZ.
Damage to the nervous system is not always easy to localize – especially when peripheral nerves and nerve fibres are affected. These are located outside the brain and spinal cord and run through the entire body.
Thanks to the use of the latest technology, however, it has been possible for radiologists to visualize nerves in high resolution and high contrast for some years now. The procedure is called MR neurography and is based on magnetic resonance imaging (MRI). “MR neurography also makes previously blind spots in imaging, such as arm and lumbar nerve plexuses, more visible,” says PD Dr. Roman Guggenberger, Head of Musculoskeletal Radiology at the University Hospital Zurich. In addition, the procedure allows a very large area of the body to be imaged, which is helpful, for example, if the exact location of the nerve damage cannot be determined with certainty.
MR neurography is an interesting additional diagnostic tool for neurologists if their electrophysiological methods do not allow a clear diagnosis. MR neurography can provide valuable additional information, particularly in the differential diagnosis of polyneuropathic diseases – i.e. when several peripheral nerves are affected.
However, there are also cases in which a referral directly by the family doctor makes sense. For example, peripheral nerve damage can cause similar symptoms to a slipped disc. “Instead of compression of the L5 root on the spine, nerve damage to the knee can also be the cause of the pain experienced and paralysis of the lower leg,” explains USZ radiologist Guggenberger. However, this would remain undetected during the typical clarification procedure – an MRI of the lumbar spine. MR neurography, on the other hand, can follow changes in the nerve along its entire course up to the lower leg. According to expert Guggenberger, direct referral can also make sense in cases of suspected “entrapment syndromes” such as carpal tunnel (wrist), cubital tunnel(elbow) or tarsal tunnel (ankle) syndrome.
However, even the best radiological images only make sense with the necessary technical expertise. The University Hospital Zurich, where specialists from neurology, radiology and other disciplines such as plastic surgery work closely together, offers the best conditions for this. Specifically in the field of MR neurography, the musculoskeletal radiology team led by PD Dr. Roman Guggenberger has excellent references thanks to its research and many years of practical experience.