High-resolution ultrasonography in the diagnosis and intraoperative management of peripheral nerve lesions.
OBJECTIVE
The diagnosis of peripheral nerve lesions relies on clinical history, physical examination, electrodiagnostic studies, and radiography. Magnetic resonance neurography offers high-resolution visualization of structural peripheral nerve lesions. The availability of MR neurography may be limited, and the costs can be significant. By comparison, ultrasonography is a portable, dynamic, and economic technology. The authors explored the clinical applicability of high-resolution ultrasonography in the preoperative and intraoperative management of peripheral nerve lesions.


METHODS
The authors completed a retrospective analysis of 13 patients undergoing ultrasonographic evaluation and surgical treatment of nerve lesions at their institution (nerve entrapment [5], trauma [6], and tumor [2]). Ultrasonography was used for diagnostic (12 of 13 cases) and intraoperative management (6 of 13 cases). The authors examine the initial impact of ultrasonography on clinical management.


RESULTS
Ultrasonography was an effective imaging modality that augmented electrophysiological and other neuroimaging studies. The modality provided immediate visualization of a sutured peroneal nerve after a basal cell excision, prompting urgent surgical exploration. Ultrasonography was used intraoperatively in 2 cases to identify postoperative neuromas after mastectomy, facilitating focused excision. Ultrasonography correctly diagnosed an inflamed lymph node in a patient in whom MR imaging studies had detected a schwannoma, and the modality correctly diagnosed a tendinopathy in another patient referred for ulnar neuropathy. Ultrasonography was used in 6 patients to guide the surgical approach and to aid in intraoperative localization; it was invaluable in localizing the proximal segment of a radial nerve sectioned by a humerus fracture. In all cases, ultrasonography demonstrated the correct lesion diagnosis and location (100%); in 7 (58%) of 12 cases, ultrasonography provided the correct diagnosis when other imaging and electrophysiological studies were inconclusive or inadequate.


CONCLUSIONS
High-resolution ultrasonography may provide an economical and accurate imaging modality with utility in diagnosis and management of peripheral nerve lesions. Further research is required to assess the role of ultrasonography in evaluation of peripheral nerve pathology.
Lee
Franklin C
FC
Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Singh
Harminder
H
Nazarian
Levon N
LN
Ratliff
John K
JK
D000328:Adult; D000368:Aged; D055724:Electrophysiological Phenomena / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009408:Nerve Compression Syndromes / Q000000981:diagnostic imaging / Q000503:physiopathology; D009442:Neurilemmoma / Q000000981:diagnostic imaging / Q000503:physiopathology; D010523:Peripheral Nervous System Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010524:Peripheral Nervous System Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012189:Retrospective Studies; D020196:Trauma, Nervous System / Q000000981:diagnostic imaging / Q000503:physiopathology; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*