High resolution ultrasound and MR neurography in the evaluation of pediatric mononeuropathies: a prospective study evaluating the efficacy and feasibility of the two modalities.

Congress:

ECR 2020

Poster Number:

C-05992

Type:

Scientific Exhibit

Keywords:

Performed at one institution, Diagnostic or prognostic study, Prospective, Outcomes, Diagnostic procedure, Ultrasound, MR, Neuroradiology peripheral nerve, Paediatric

Authors:

A. Agarwal Chandra, U. JAIPAL, M. Bagarhatta, A. Prakash, V. JHANWAR; Jaipur/IN

DOI:

10.26044/ecr2020/C-05992

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-05992

Fig. 2: Cross sectional appearance of nerve fibres on HRUS and MRI

Fig. 4: Etiology of mononeuropathies in our study.

Fig. 3: Classification of nerve injury according to Seddon and Sunderland...

Fig. 5: Diagnostic confidence levels of HRUS and various MR sequences

Purpose

Paediatric mononeuropathies pose a diagnostic and management challenge. The purpose of this study was to evaluate the utility of imaging in the diagnosis of mononeuropathies in children. Mononeuropahties account for less than 10% of all referrals for nerve conduction velocity testing, but majority fall under potentially treatable causes. Unlike in adults, in whom compressive neuropathies account for majority of cases, trauma is the main etiology in pediatric age.

Methods and materials

STUDY POPULATION & STUDY AREA: This was a hospital based prospective study carried out between January to March 2019. Out of all patients referred for nerve conduction velocity (NCV) test after clinical suspicion of mononeuropathy, those who tested postive were included in the study after taking informed consent. A total of 72 patients tested positive on NCV out of which 17 were paediatric patients and formed our study group. Each of them underwent HRUS and 3TMR imaging on the same day. Paediatric patients who tested...

Results

Demographics Out of the 17 paediatric patients with mononeuropathy diagnosed on NCV, 13 were males and 4 females. Trauma accounted for maximum cases (9/17) followed by two cases each of infective etiology, impingement on nerve by orthopedic implant and perineural vascular malformations. There was one case of infiltration of nerve by soft tissue epitheliod sarcoma of forearm and another case of entrapment of radial nerve in a local hematoma in a case of hemophilia. Thus, entrapment neuropathy, which is more common in adults, was seen...

Conclusion

Compared with NCV, imaging is as effective; as opposed to NCV it is painless. HRUS is better endured by children, allows real time evaluation, needs no sedation and permits scanning of the nerve along its entire path in a short period of time. PDFS is more sensitive than HRUS but the advantages of HRUS outweighs the challenges with MR- time, acceptance and cost. MRI serves as a problem solving tool. HRUS can serve as a screening tool while focussed MR may act as an imaging...

Personal information and conflict of interest

A. Agarwal; Jaipur/IN - nothing to disclose U. Jaipal; Jaipur/IN - nothing to disclose M. Bagarhatta; Jaipur/IN - nothing to disclose A. Prakash; Jaipur/IN - nothing to disclose V. Jhanwar; Jaipur/IN - nothing to disclose

References

Seddon HJ (1943) Three types of nerve injuries. Brain 66:237–288 Sunderland S (1951) A classification of peripheral nerve injuries producing loss of function. Brain 74:491–516 Agarwal A, Chandra A, Jaipal U, Saini N (2018) A panorama of radial nerve pathologies—an imaging diagnosis: a step ahead. Insights Imaging. 9(6):1021–1034 Garg K, Aggarwal A, Srivastava DN et al (2017) Comparison of different sequences of MRI and ultrasonogram with nerve conduction studies in peripheral neuropathies. World Neurosurg (17):31355–31354. Chhabra A, Ahlawat S, Belzberg A, Andreseik G (2014) Peripheral...