Mukherji SK, consulting ed. Chhabra A, guest ed. MR Neurography. Elsevier; February 2013. Neuroimaging Clinics of North America; vol. 23; no. 1; pgs. 1–268.
MR neurography, a discipline that straddles the line between neuroradiology and musculoskeletal radiology, is becoming a more frequently utilized technique. To have an issue (February 2014) of the Neuroimaging Clinics of North America devoted to this topic is a welcome thing for neuroradiology because it allows a review of some fundamental concepts and anatomy of the cranial nerves and brain stem, reviews the important topics of the MR imaging of the brachial plexus and lumbosacral plexus, and describes the issues involved in peripheral neurography.
Edited by Dr. Avneesh Chhabra from UT Southwestern, 43 authors have contributed to this 267-page book. To make this issue interesting, the editor has combined authorship consisting of radiologists, plastic surgeons, neurosurgeons, and neurologists. There are 16 chapters, each of which is richly illustrated (with normal and abnormal images), with well written legends. Much of the material in the cranial nerves and brainstem chapters can serve as substantial review material for the experienced neuroradiologist, so it is to the other areas of the book one’s attention is drawn. With the chapter entitled “Technical Considerations in MR Neurography,” the sequences utilized for both proximal and distal nerve visualization are described, and guidelines for implementation are described and illustrated.
The imaging of the brachial plexus and MR neurography of the pelvis will hold, in this reviewer’s opinion, the greatest interest for the neuroradiologist, because many the studies are ordered infrequently (compared to more routine MR studies), and the anatomy of these areas often requires review. Of greatest benefit in both chapters are the anatomical descriptions, along with images showing the pertinent structures. Because the pathologic entities affecting these areas are limited when compared to the differential diagnoses in other neuroradiology imaging exams, having solid footing of the anatomic relationships is key in reading these chapters.
Equally well described are the techniques employed (tabulated and easily read). From an imaging display standpoint, there could have been closer attention paid to the contrast and brightness scale, particularly in the brachial plexus chapter, where some of the details are not depicted quite as well because of the darkness of the images. Pathologic conditions shown include NSTS, apical lung mass, neck tumor-lymphoma, metastatic disease to the brachial plexus, radiation plexopathy, inflammatory demyelinating disease, and injury to the brachial plexus. Pelvic and lumbosacral MR neurography are described in a longer chapter (23 pages) vs. the 17-page brachial plexus chapter, and deservedly so, because the anatomic considerations are more complex and the technical challenges greater. The authors of the chapter were correct in saying, in essence, that this part of MR imaging requires demystifying. As one reads the chapter, it could be of benefit to have an anatomy text on hand, as the material shown does not include line drawings of this complex neuromuscular, bony, and pelvic anatomy. In this chapter there are abundant tables outlining imaging protocols, findings in neuropathies, and normal MR patterns. Each critical nerve is summarized in a separate paragraph, and the reader is directed toward the corresponding neurography. Interestingly, with each nerve description, the authors describe the neural dysfunction/associated symptomatology.
Other chapters describe lower extremity and upper extremity neurography, nerve sheath tumors (a dedicated chapter on that subject), peripheral nerve surgery (a primer for imagers), MR-guided nerve blocks in the pelvis, peripheral nerve injuries, and possible directions of MR neurography research.
Because this topic of MR neurography is covered inadequately in prominent neuroradiology textbooks, this particular issue of the NICNA is highly recommended.
