title: Diffusion Tensor Imaging Adds Diagnostic Accuracy in Magnetic Resonance Neurography.
abstract: OBJECTIVE
  The aim of this study was to determine whether quantitative diffusion tensor imaging (DTI) adds diagnostic accuracy in magnetic resonance neurography.
  
  
  METHODS
  This prospective study was approved by the institutional review board. We enrolled 16 patients with peripheral polyneuropathy of various etiologies involving the upper arm and 30 healthy controls. Magnetic resonance neurography was performed at 3 T using transverse T2-weighted (T2-w) turbo spin echo and spin echo planar imaging diffusion-weighted sequences. T2-weighted normalized signal (nT2), fractional anisotropy (FA), apparent diffusion coefficient (ADC), radial diffusivity (RD), and axial diffusivity (AD) of the median, ulnar, and radial nerves were quantified after manual segmentation. Diagnostic performance of each separate parameter and combinations of parameters was assessed using the area under the receiver operating characteristic curve (AUC). Bootstrap validation was used to adjust for potential overfitting.
  
  
  RESULTS
  Average nT2, ADC, RD, and AD values of the median, ulnar, and radial nerve were significantly increased in neuropathy patients compared with that in healthy controls (nT2, 1.49 ± 0.05 vs 1.05 ± 0.05; ADC, 1.4 × 10(-3) ± 2.8 × 10(-5) mm(2)/s vs 1.1 × 10(-3) ± 1.3 × 10(-5) mm(2)/s; RD, 9.5 × 10(-4) ± 2.9 × 10(-5) mm(2)/s vs 7.2 × 10(-4) ± 1.3 × 10(-5) mm(2)/s; AD, 2.3 × 10(-3) ± 3.7 × 10(-5) mm(2)/s vs 2.0 × 10(-3) ± 2.2 × 10(-5) mm(2)/s; P < 0.001 for all comparisons). Fractional anisotropy values were significantly decreased in patients (0.51 ± 0.01 vs 0.59 ± 0.01; P < 0.001). T2-weighted normalized signal and DTI parameters had comparable diagnostic accuracy (adjusted AUC: T2-w, 0.92; FA, 0.88; ADC, 0.89; AD, 0.84; RD, 0.86). Combining DTI parameters significantly improved the diagnostic accuracy over single-parameter analysis. In addition, the combination of nT2 with DTI parameters yielded excellent adjusted AUCs up to 0.97 (nT2 + FA).
  
  
  CONCLUSIONS
  Diffusion tensor imaging has high diagnostic accuracy in peripheral neuropathy. Combining DTI with T2 can outperform T2-w imaging alone and provides added value in magnetic resonance neurography.
authors: From the *Department of Neuroradiology, Heidelberg University Hospital, †Institute of Medical Biometry and Informatics, and ‡Section of Experimental Radiology, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany.
authors: Michael O
authors: MO
authors: Breckwoldt
authors: Christian
authors: C
authors: Stock
authors: Annie
authors: A
authors: Xia
authors: Andreas
authors: A
authors: Heckel
authors: Martin
authors: M
authors: Bendszus
authors: Mirko
authors: M
authors: Pham
authors: Sabine
authors: S
authors: Heiland
authors: Philipp
authors: P
authors: Bäumer
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001132:Arm / Q000294:innervation; D003430:Cross-Sectional Studies; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011115:Polyneuropathies / Q000473:pathology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult