Sequential MR imaging of denervated and reinnervated skeletal muscle as correlated to functional outcome.
OBJECTIVE
To prospectively assess the short inversion time inversion-recovery (STIR) magnetic resonance (MR) signal intensity changes of denervated and reinnervated skeletal muscle over time in clinical patients.


METHODS
This study was approved by the institutional review board, and informed consent was obtained from all patients. Twenty-three patients with complete traumatic transection of the median or ulnar nerve in the forearm were prospectively followed for 12 months after surgical nerve repair. STIR MR images of selected intrinsic hand muscles were obtained 1, 3, 6, 9, and 12 months after nerve repair, and signal intensities of denervated and reinnervated muscles were measured semiquantitatively. After 12 months, hand function was assessed. Signal intensity ratios were correlated to functional outcome with analysis of variance.


RESULTS
Of the 23 patients, 10 had good function recovery, while 13 had poor recovery. For the group with good function recovery, mean signal intensity ratios of 1.267 ± 0.060 (standard deviation), 1.357 ± 0.116, 1.297 ± 0.111, 1.205 ± 0.096, and 1.086 ± 0.104 were found at 1-, 3-, 6-, 9-, and 12-month follow-up, respectively. In the group with poor recovery, mean signal intensity ratios of 1.299 ± 0.056, 1.377 ± 0.094, 1.419 ± 0.117, 1.398 ± 0.111, and 1.342 ± 0.095 were found at 1-, 3-, 6-, 9-, and 12-month follow-up, respectively. Comparison of the group with poor function recovery and the group with good function recovery showed significant differences at 6-, 9-, and 12-month follow-up (P = .035, P = .001, and P < .001, respectively), with normalizing signal intensities in the group with good function recovery and sustained high signal intensity in the group with poor function recovery.


CONCLUSIONS
STIR MR imaging can be used to differentiate between denervated and reinnervated muscles for at least 12 months after nerve transection.
Department of Radiology, University of Groningen, Groningen, the Netherlands. a.r.viddeleer@umcg.nl
Alain R
AR
Viddeleer
Paul E
PE
Sijens
Peter M A
PM
van Ooyen
Paul D L
PD
Kuypers
Steven E R
SE
Hovius
Matthijs
M
Oudkerk
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008475:Median Nerve / Q000293:injuries* / Q000601:surgery; D008875:Middle Aged; D009121:Muscle Denervation; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000294:innervation* / Q000601:surgery; D011446:Prospective Studies; D020127:Recovery of Function; D014459:Ulnar Nerve / Q000293:injuries* / Q000601:surgery