title: The application of three-dimensional diffusion-weighted PSIF technique in peripheral nerve imaging of the distal extremities.
abstract: OBJECTIVE
  To evaluate whether the addition of the three-dimensional diffusion-weighted reversed fast imaging with steady state free precession (3D DW-PSIF) sequence improves the identification of peripheral nerves in the distal extremities.
  
  
  METHODS
  Twelve MR neurography (MRN) studies of the distal upper extremity and 12 MRN studies of distal lower extremity were evaluated. From the 24 subjects who were enrolled, 10 had clinically suspected peripheral neuropathy, whereas 14 suffered from various orthopedic diseases and had no clinical signs of neuropathy. In each examination, the ability to identify each peripheral nerve on T2-weighted and 3D DW-PSIF sequences was evaluated using a semi-quantitative (0-2) scale. Thereafter, a total certainty score was registered for each sequence.
  
  
  RESULTS
  Combining the results of all studies, the mean certainty score was 1.92 ± 0.28 on the 3D DW-PSIF images and 1.50 ± 0.72 on the T2-weighted images (P < 0.001). In the upper extremity studies, the corresponding certainty scores were 2.0 and 1.70 ± 0.55, respectively (P = 0.008), and in the lower extremity studies, 1.86 ± 0.35 and 1.36 ± 0.79, respectively (P < 0.001).
  
  
  CONCLUSIONS
  The 3D DW-PSIF images provide improved identification of the nerves compared with the T2-weighted images, and should be incorporated in the MRN protocol, whenever accurate nerve localization and/or presurgical evaluation are required.
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. achhabr6@jhmi.edu
authors.forename: Avneesh
authors.initials: A
authors.lastname: Chhabra
authors.forename: Theodoros
authors.initials: T
authors.lastname: Soldatos
authors.forename: Ty K
authors.initials: TK
authors.lastname: Subhawong
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Machado
authors.forename: Shrey K
authors.initials: SK
authors.lastname: Thawait
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Wang
authors.forename: Abraham
authors.initials: A
authors.lastname: Padua
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Flammang
authors.forename: Eric H
authors.initials: EH
authors.lastname: Williams
authors.forename: John A
authors.initials: JA
authors.lastname: Carrino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D035002:Lower Extremity / Q000294:innervation / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000473:pathology; D012016:Reference Values; D012680:Sensitivity and Specificity; D034941:Upper Extremity / Q000294:innervation / Q000473:pathology; D055815:Young Adult