Chhabra A, Andreisek G. Magnetic Resonance Neurography. JAYPEE 2012, 218 pages, $125.
Magnetic resonance imaging is being increasingly utilized by neurologists and neurosurgeons in the evaluation of their patients with suspected peripheral nerve pathology. Neuroradiologists more oriented to MRI of CNS diseases may find themselves inexperienced and uncomfortable with peripheral nerve imaging. A recently published book seeks to remedy the situation.
The single volume Magnetic Resonance Neurography, by Avneesh Chhabra and Gustav Andreisek, is imminently readable and concise at 193 pages of text. Published by Jaypee Brothers Medical Publishers (P) Ltd, one of India’s premier medical publishers, the book is printed on good quality stock and is hardcover bound. Organized into nine chapters, this book provides an organized overview of MRI of peripheral neuropathy. Each chapter is well referenced. The authors and contributors are well qualified and recognized as leaders in their field. The book is particularly notable for being well illustrated with a number of high quality images of clinical cases that serve to illuminate and reinforce the text. There are a number of tables and multiple quality color renderings of regional anatomy.
The initial three chapters lay the foundation for the remainder of the book. The first chapter provides a brief concise review of nerve anatomy and the basics of nerve injury, with a short general clinical and imaging description of neuropraxia, axonotmesis, and neurotmesis. The second chapter discusses the essentials of MR neurographic technique, including developing techniques such as diffusion tensor imaging. Here the authors provide specific protocols and in-depth information they deem necessary to optimally image peripheral nerves. The authors advocate 3 Tesla field strength for peripheral nerve imaging. All the protocol tables and most of the comments related to MR technique are 3T-based, although brief protocol recommendations are also made for 1.5T MR units. The third chapter provides the ground rules for and potential pitfalls of magnetic resonance interpretation of peripheral nerves.
The next five chapters are the heart of the book. Chapters four and five address magnetic resonance neurography of tunnels in the upper and lower extremities respectively. Tunnels are confined anatomic spaces through which peripheral nerves pass and where these nerves are particularly susceptible to injury. Each chapter is particularly well illustrated with multiple case examples. Chapter six addresses peripheral nerve tumors and tumor-like conditions. The text discusses a wide range of disease from peripheral nerve sheath tumors and Morton’s neuroma to amyloidosis and lepromatous neuropathy. Chapters seven and eight review imaging of the brachial plexus and the lumbosacral plexus, which are regions perhaps more familiar to practicing neuroradiologists. Both chapters are heavily illustrated with cases amplifying and supporting the chapter text.
The final twelve-page chapter discusses MR guided injections. While ultrasound and CT are the most common modalities currently utilized for diagnostic and therapeutic selective perineural and muscular injections, in this chapter the authors address the advantages, challenges, and limitations of MR-guided procedures. The short chapter provides the author’s technique as well as several examples of cases from peripheral nerve blocks to Botox muscular injections. A limited number of key articles are referenced.
Magnetic Resonance Neurography by Avneesh Chhabra and Gustav Andreisek is an excellent one stop resource for any neuroradiologist, musculoskeletal radiologist, or general radiologist interested in the subject. Peripheral nerve imaging, be it by MR or ultrasound, is a growing concern, and its importance is not going unnoticed by our clinical colleagues, who may find reason to order such studies or, perhaps, to more directly compete with radiologists in imaging and interventional procedures of peripheral nerves. The book will be of particular value for those radiologists initiating MR Neurography in their practice.
