Purpose: Recent studies have demonstrated the usefulness of diffusion-weighted MR neurography (DW MRN) for assessing nerve roots. This study aimed to evaluate the utility of DW MRN with a unidirectional motion-probing gradient (MPG) for the lumbar nerve roots at 1.5T MR. Materials and Methods: Sixty-four lumbar spine MRI scans with DW MRN using anteroposterior unidirectional MPG were retrospectively analyzed. Any changes in the 512 lumbar spinal nerve roots from L3 to S1 were evaluated using T2-weighted imaging (T2WI), contrast-enhanced T1-weighted imaging (CE T1WI), and DW MRN, with agreement and correlation analysis. Results: T2WI revealed compression of 78 nerve roots, and CE T1WI revealed 52 instances of nerve root enhancement. Sixty-seven nerve roots showed swelling and hyperintensity on DW MRN. A total of 42 nerve roots showed changes in the CE T1WI and DW MRN sequences.Moderate to substantial agreement and moderate positive correlation were observed between DW MRN and CE T1WI, as well as DW MRN and T2WI (κ = 0.59–0.65, ρ = 0.600–0.653). Conclusion DW MRN with unidirectional anteroposterior MPG can help evaluate neuritisrelated changes in spinal nerve roots and could serve as a sequence capable of complementing or substituting gadolinium CE imaging.

Purpose: Recent studies have demonstrated the usefulness of diffusion-weighted MR neurography (DW MRN) for assessing nerve roots. This study aimed to evaluate the utility of DW MRN with a unidirectional motion-probing gradient (MPG) for the lumbar nerve roots at 1.5T MR. Materials and Methods: Sixty-four lumbar spine MRI scans with DW MRN using anteroposterior unidirectional MPG were retrospectively analyzed. Any changes in the 512 lumbar spinal nerve roots from L3 to S1 were evaluated using T2-weighted imaging (T2WI), contrast-enhanced T1-weighted imaging (CE T1WI), and DW MRN, with agreement and correlation analysis. Results: T2WI revealed compression of 78 nerve roots, and CE T1WI revealed 52 instances of nerve root enhancement. Sixty-seven nerve roots showed swelling and hyperintensity on DW MRN. A total of 42 nerve roots showed changes in the CE T1WI and DW MRN sequences.Moderate to substantial agreement and moderate positive correlation were observed between DW MRN and CE T1WI, as well as DW MRN and T2WI (κ = 0.59–0.65, ρ = 0.600–0.653). Conclusion DW MRN with unidirectional anteroposterior MPG can help evaluate neuritisrelated changes in spinal nerve roots and could serve as a sequence capable of complementing or substituting gadolinium CE imaging.

Purpose: Recent studies have demonstrated the usefulness of diffusion-weighted MR neurography (DW MRN) for assessing nerve roots. This study aimed to evaluate the utility of DW MRN with a unidirectional motion-probing gradient (MPG) for the lumbar nerve roots at 1.5T MR. Materials and Methods: Sixty-four lumbar spine MRI scans with DW MRN using anteroposterior unidirectional MPG were retrospectively analyzed. Any changes in the 512 lumbar spinal nerve roots from L3 to S1 were evaluated using T2-weighted imaging (T2WI), contrast-enhanced T1-weighted imaging (CE T1WI), and DW MRN, with agreement and correlation analysis. Results: T2WI revealed compression of 78 nerve roots, and CE T1WI revealed 52 instances of nerve root enhancement. Sixty-seven nerve roots showed swelling and hyperintensity on DW MRN. A total of 42 nerve roots showed changes in the CE T1WI and DW MRN sequences.Moderate to substantial agreement and moderate positive correlation were observed between DW MRN and CE T1WI, as well as DW MRN and T2WI (κ = 0.59–0.65, ρ = 0.600–0.653). Conclusion DW MRN with unidirectional anteroposterior MPG can help evaluate neuritisrelated changes in spinal nerve roots and could serve as a sequence capable of complementing or substituting gadolinium CE imaging.

OBJECTIVE: To suggest rotation angles of fluoroscopy that can bypass the carotid sheath according to vertebral levels for cervical transforaminal epidural steroid injection (TFESI). METHODS: Patients who underwent cervical spine magnetic resonance imaging (MRI) from January 2009 to October 2017 were analyzed. In axial sections of cervical spine MRI, three angles to the vertical line (α, angle not to insult carotid sheath; β, angle for the conventional TFESI; γ, angle not to penetrate carotid artery) were measured. RESULTS: Alpha (α) angles tended to increase for upper cervical levels (53.3° in C6-7, 65.2° in C5-6, 75.3° in C4-5, 82.3° in C3-4). Beta (β) angles for conventional TFESI showed a constant value of 45° to 47° (47.5° in C6-7, 47.4° in C5-6, 45.7° in C4-5, 45.0° in C3-4). Gamma (γ) angles increased at higher cervical levels as did α angles (25.2° in C6-7, 33.6° in C5-6, 43.0° in C4-5, 56.2° in C3-4). CONCLUSION: The risk of causing injury by penetrating major vessels in the carotid sheath tends to increase at upper cervical levels. Therefore, prior to cervical TFESI, measuring the angle is necessary to avoid carotid vessels in the axial section of CT or MRI, thus contributing to a safer procedure.
Carotid Arteries ; Fluoroscopy ; Humans ; Jugular Veins ; Magnetic Resonance Imaging ; Needles* ; Spine ; Vascular System Injuries

PURPOSE: The purpose of this study was to evaluate the ultrasonographic findings associated with posterior interosseous nerve (PIN) syndrome. METHODS: Approval from the Institutional Review Board was obtained. A retrospective review of 908 patients' sonographic images of the upper extremity from January 2001 to October 2010 revealed 10 patients suspicious for a PIN abnormality (7 male and 3 female patients; mean age of 51.8±13.1 years; age range, 32 to 79 years). The ultrasonographic findings of PIN syndrome, including changes in the PIN and adjacent secondary changes, were evaluated. The anteroposterior diameter of the pathologic PIN was measured in eight patients and the anteroposterior diameter of the contralateral asymptomatic PIN was measured in six patients, all at the level immediately proximal to the proximal supinator border. The size of the pathologic nerves and contralateral asymptomatic nerves was compared using the Mann-Whitney U test. RESULTS: Swelling of the PIN proximal to the supinator canal by compression at the arcade of Fröhse was observed in four cases. Swelling of the PIN distal to the supinator canal was observed in one case. Loss of the perineural fat plane in the supinator canal was observed in one case. Four soft tissue masses were noted. Secondary denervation atrophy of the supinator and extensor muscles was observed in two cases. The mean anteroposterior diameter of the pathologic nerves (n=8, 1.79±0.43 mm) was significantly larger than that of the contralateral asymptomatic nerves (n=6, 1.02±0.22 mm) (P=0.003). CONCLUSION: Ultrasonography provides high-resolution images of the PIN and helps to diagnose PIN syndrome through visualization of its various causes and adjacent secondary changes.
Atrophy ; Denervation ; Ethics Committees, Research ; Female ; Humans ; Male ; Muscles ; Nerve Compression Syndromes ; Radial Nerve ; Retrospective Studies ; Ultrasonography ; Upper Extremity

Desmoid type fibromatosis is a benign fibroblastic tumor arising from the fascia or musculoaponeurosis. It may occur in various locations, but most commonly in the shoulder girdle and neck; to our knowledge, there has been no reported case originating from a facet joint of the spine. We report CT and MR imaging findings of a desmoid type fibromatosis, involving the facet joint of the L3-4 spine with bone involvement.
Adult ; Biopsy ; Fibromatosis, Aggressive/*diagnosis ; Humans ; *Lumbar Vertebrae ; Magnetic Resonance Imaging ; Male ; Spinal Neoplasms/*diagnosis ; *Zygapophyseal Joint

OBJECTIVE: To investigate the reference value for cross sectional area (CSA) of the fibular nerve in Koreans. METHOD: One musculoskeletal radiologist and one physiatrist performed fibular nerve ultrasonography (US) on 60 lower extremities of 30 asymptomatic Korean volunteers (16 males, 14 females). The mean age was 46.6 years (range: 21-75 years). We measured CSA of the fibular nerve at three sites: proximal portion (PP) at the bifurcation, mid-portion (MP), and an area just above the fibular head (FH). In addition, the fibular nerves of 7 lower extremities from 4 cadavers were cut from the fibular head to the proximal portion and divided into three sections (PP, MP, FH). They were subsequently fixed with 10% neutral buffered formalin and perpendicularly excised to 2 mm thickness. They were photographed by an operating microscope and CSA was measured. Using the Kruskal-Wallis test, measurements obtained from US images were compared between asymptomatic volunteers with a significance level of 0.05. RESULTS: In asymptomatic volunteers, the CSA of the three portions were PP: 13.8+/-1.2 mm2, MP: 11.1+/-1.0 mm2, FH: 10.9+/-0.6 mm2. The fibular nerves were well visualized with clear borders by US. In cadavers, the CSA of three portions were PP: 20.3+/-10.3 mm2, MP: 16.7+/-8.6 mm2, FH: 14.4+/-8.9 mm2. There was no significant difference between the three portions in asymptomatic volunteers and cadavers (p>0.05). CONCLUSION: In normal Korean adults, the area of fibular nerve at the fibular head is 10.9+/-0.6 mm2. Ultrasonographic evaluation of the fibular nerve can be helpful in diagnosing fibular nerve lesions.
Adult ; Cadaver ; Formaldehyde ; Head ; Humans ; Lower Extremity ; Male ; Peroneal Nerve ; Reference Values

This report discusses a pregnancy case following a series of two consecutive magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) procedures for the treatment of two different myomas in an individual patient. Both procedures were completed without adverse events, and the patient conceived naturally four months after treatment. At 39 weeks, she gave birth to a healthy baby girl, via a vaginal delivery. There were no complications in the pregnancy or during labor.
Adult ; Female ; Humans ; Magnetic Resonance Imaging, Interventional/*methods ; Myoma/*surgery ; Pregnancy ; Pregnancy Outcome ; Surgery, Computer-Assisted/*methods ; Uterine Neoplasms/*surgery

Pacinian neuroma is a rare tumor characterized by hypertrophy and hyperplasia of preexisting pacinian corpuscles. This tumor most frequently presents as a small superficial mass affecting the hands and feet, which produces localized sharp pain. The etiology is unknown, but local trauma has been postulated as an important factor. Here we report a case of posttraumatic pacinian neuroma in a 24-year-old woman who presented with severe local pain in the palm. The clinical features, and the sonographic and pathologic findings of posttraumatic pacinian neuroma are discussed.
Female ; Foot ; Hand ; Humans ; Hyperplasia ; Hypertrophy ; Neuroma ; Pacinian Corpuscles ; Young Adult

Pigmented villonodular synovitis (PVNS) is a rare proliferative disease involving synovial membranes. Natural history and etiology of PVNS are not well known. PVNS presents as localized or diffuse tumor like nodular lesion of the synovial lining of the joint and the synovial spaces adjacent to the joints. Though histologically benign, it is a very aggressive lesion, capable of bone destruction and widespread infiltration of surrounding tissues. Standard therapy is surgical resection, but due to the infiltrative growth, the recurrence rate is significantly high. After several relapses surgical treatment of diffuse PVNS becomes difficult and may require amputation of the involved limb. Radiotherapy can provide an effective treatment option for patients with large lesions or lesions which are not suitable for surgery, after incomplete resection to prevent relapses or to avoid amputation. We report 2 cases of diffuse PVNS in the knee joint treated with arthroscopic gross total synovectomy and radiotherapy.
Amputation ; Extremities ; Humans ; Joints ; Knee Joint ; Knee* ; Natural History ; Radiotherapy* ; Recurrence ; Synovial Membrane ; Synovitis, Pigmented Villonodular*