Evaluation of Chronic Inflammatory Demyelinating Polyneuropathy: New Simultaneous T2 mapping and neurography method with 3D Nerve-Sheath Signal Increased with Inked Rest-Tissue Rapid Acquisition of Relaxation Enhancement Imaging (SHINKEI Quant)
Akio Hiwatashi1, Osamu Togao1, Koji Yamashita1, Kazufumi Kikuchi1, Masami Yoneyama2, and Hiroshi Honda1

1Clinical Radiology, Kyushu University, Fukuoka, Japan, 2Philips Electronics Japan, Tokyo, Japan

Synopsis

MR neurography (MRN) is a useful technique with which to evaluate abnormal conditions of the peripheral nerves such as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We have developed a new simultaneous T2 mapping and MRN method called SHINKEI Quant. Patients with CIDP could be distinguished from normal subjects in size and T2 value of the peripheral nerves with SHINKEI Quant.

Purpose

MR neurography (MRN) is a useful technique with which to evaluate abnormal conditions of the peripheral nerves such as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Various MRN techniques were advocated, however, it is difficult to analyze T2 mapping of the peripheral nerves with high spatial resolution. We have developed the new T2 mapping method called SHINKEI Quant using three-dimensional nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation imaging (1). The purpose of this study is to discriminate the patients with CIDP from normal subjects using SHINKEI Quant.

Methods

Three patients with CIDP (2 males and 1 female; age range 51 - 65 year old; median 52 year) and 5 normal subjects (5 males; age range 25 - 43 year old; median 30 year) were studied. MRI was conducted on a 3T clinical scanner (Ingenia CX, Philips Healthcare, NL). Typical imaging parameters were as follows; TR/TE = 2400/61 ms, FOV = 220 x 310 mm for cervical and 280 x 394 mm for lumbar spine, ETL = 100, matrix = 224 x 320 for cervical and 256 x 360 for lumbar spine, voxel size = 0.98 x 0.98 x 2.0 mm3 for cervical and 1.09 x 1.09 x 1.8 mm3 for lumbar spine, b = 10 s/mm2, iMSDE duration = 36 and 72 ms, acquisition time = 6 min 18 s for cervical and 6 min 14 s for lumbar spine. T2 values and size of the nerves at C5-T1 and T12-L5 were evaluated. Statistical analysis was performed with Mann-Whitney U test. A p-value less than 0.05 was considered significant.

Results

The size of the patients with CIDP (4.61 ± 0.94 mm for cervical and 4.66 ± 1.37 mm for lumbar spine) was significantly larger than in the normal subjects (3.50 ± 0.62 mm for cervical and 3.66 ± 0.75 mm for lumbar spine; P<0.01). T2 of the patients with CIDP (106.84 ± 17.28 for cervical and 116.47 ± 18.71 for lumbar spine) was significantly larger than in the normal subjects (85.29 ± 13.22 for cervical and 74.96 ± 10.98 for lumbar spine; P<0.001).

Discussion

Previous qualitative studies have shown increased signal intensity on T2-weighted images in the brachial plexus or nerve trunks in patients with CIDP (3). With our new MRN with T2 mapping technique, we could discriminate the patients with CIDP from normal subjects qualitatively.

Conclusion

Patients with CIDP could be distinguished from normal patients in size and T2 value of the peripheral nerves with SHINKEI Quant.

Acknowledgements

None

References

1. Yoneyama M, Takahara T, Kwee TC, et al. Rapid high resolution MR neurography with a diffusion-weighted pre-pulse. Magn Reson Med Sci. 2013;12(2):111-119.

2. Kasper JM, Wadhwa V, Scott KM, et al. SHINKEI-a novel 3D isotropic MR neurography technique: technical advantages over 3DIRTSE-based imaging. Eur Radiol. 2015;25(6):1672-1677.

3. Tazawa K, Matsuda M, Yoshida T, et al. Spinal nerve root hypertrophy on MRI: clinical significance in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy. Intern Med. 2008;47(23):2019-2024.

Figures

A 52-year-old male with CIDP. The swollen cervical nerves are well visualized.


A 43-year-old male without neurological symptoms. The normal lower cervical nerves are well visualized.



Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)
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