WHAT THE NEUROLOGIST EXPECTS

FROM THE ULTRASOUND OF THE PERIPHERAL NERVOUS SYSTEM

MARIA TRAVASAROU

NEUROLOGIST POLUMED “ΗΧΟΔΙΑΓΝΩΣΤΙΚΗ”

PRESENTATION OUTLINE

INDICATIONS FOR THE USE OF U/S IN THE PNS

ADVANTAGES

LIMITATIONS

COMPARISON WITH MRI

FUTURE PROSPECTS

INDICATIONS

ENTRAPMENT SYNDROMES

TRAUMATIC NERVE INJURIES

MISCELLANEOUS DISORDERS CHARCOT MARIE TOOTH LEPROSY

CARPAL TUNNEL SYNDROME

SPIRAL GROOVE SYNDROME

CUBITAL TUNNEL SYNDROME

PERONEAL NEUROPATHY

TRACTION PENETRATING TRAUMA IATROGENIC TUMORS-TUMOR LIKE

SYNDROMES NEUROFIBROMA, SCHWANNOMA HEMANGIOMA,LYMPHOMA,GANGLION CYST, SARCOMA INVASION,METASTASIS

CONGENITAL DISORDERS HNPP

AXIAL SECTION Background of hyperechoic connective tissue . Oval to round hypoechoic areas nerve’s fascicles

NORMAL US OF A PERIPHERAL NERVE

(sonograms obtained over the median nerve-white

arrow- at the carpal tunnel)

LONGITUDINAL SECTION Tubular structure with hypoanechoic discontinuous segments fascicular pattern

CARPAL TUNNEL SYNDROME

(Axial a and longitudinal b sonograms over the

median nerves-whitte arrows- at the carpal tunnel)

Enlarged nerve compressed by a hypertrophied synovian tendon sheath (asterisks)

Nerve swollen proximally to the tunnel but thinned and hypoechoic in the canal

CUBITAL TUNNNEL SYNDROME

AXIAL Swollen hypoechoic nerve (whitte arrows)

LONGITUDINAL normal internal pattern of the nerve portion located proximal to the tunnel and irregular pattern of the nerve inside the tunnel, at the level of the medial epycondile (asterisk).

ULNAR NERVE TRAUMA

TIBIAL NERVE SCHWANNOMA

AXIAL COLOR DOPLER SONOGRAM Hypoechoic mass close to the tibialis posterior artery and veins

LONSITUDINAL Tumor clearly located Inside the nerve

ADVANTAGES

Excellent spatial resolution

No contraindications

Dynamic investigations possible

Investigation of a large part of the nerve path

Interventional ultrasound with diagnostic and therapeutic procedures

Easily available

Low cost

LIMITATIONS

Operator dependent

Relatively long learning curve

Poor contrast resolution

Limitations in some deep or difficult to assess, anatomical areas

ADVANTAGES AND DISADVANTAGES OF MRI

TO EXAMINE THE PERIPHERAL NERVOUS

SYSTEM

excellent contrast resolution

very good spatial resolution

Three dimensional planes

no limitation in examining deep

structures

good investigation of muscle mass

Research and development potential

Investigation is less operator dependent

Advantages Disadvantages

Contraindications to mri

Availability

High cost

static investigation occasionally

performed in non physiological positions

Long acquisition time

Developments and future

prospects

CONTRSAST ENHANCED ULTRASOUND

An animal study has shown that contrast enhanced ultrasound is feasible in the peripheral nervous imaging, enabling quantative measurements of PNS perfusion.

LITERATURE

ULTRASOUND IS THE FIRST CHOICE FOR PERIPHERAL NERVE IMAGING? Luka PADUA ET AL NEUROLOGY 2013;80;1627-7

ULTRASOUND OF THE PERIPHERAL NERVE BIANCHI ET AL JOINTBONE SPINE75 (2008) 643-649

MUSKULOSKELETAL ULTRASOUND FOR PERIPHERAL NERNE LESIONS KARE et al EUR J PHYS REHABIL MED 2012 48 665-74

CURRENT AND FUTURE IMAGING OF THE PERIPHERAL NERVOUS SYSTEM OHARA ET AL DIAGNOSTIC AND INTERVENTIONAL IMAGING 2014 95,17-26

HIGH RESOLUTION ULTRASONOGRAPHY IN EVALUATING PERIPHERAL NERVE ENTRAPMENT AND TRAUMA KOENIG et al NEUROSURG FOCUS 26 (2) 2009

INTRAOPERATIVE HIGH SOLUTION ULTRASOUND;A NEW TECHNIQUE IN THE MANAGEMENT OF PNS DISORDERS J NEUROSURG 2011 114 514-521