title: The role of magnetic resonance imaging in the evaluation of peripheral nerves following traumatic lesion: where do we stand?
abstract: Peripheral nerve injury is a common and important cause of morbidity and disability in patients who have suffered a traumatic injury, particularly younger people. Various different injuries can result in damage to specific nerves. In patients with multiple trauma, the prevalence of peripheral nerve injury is estimated at 2.8%, but can reach 5% with the inclusion of brachial plexus involvement. Physical examination, as well as the origin and location of the trauma, can indicate the nerve involved and the type of nerve damage. However, the depth and severity of damage, and the structures involved often cannot be determined initially, but depend on longer periods of observation to reach a definitive and accurate diagnosis for which treatment can be proposed. Current approaches to locate and assess the severity of traumatic nerve injury involve clinical and electrodiagnostic studies. From a clinical and neurophysiological point of view, nerve injuries are classified in an attempt to correlate the degree of injury with symptoms, type of pathology, and prognosis, as well as to determine the therapy to be adopted.
  
  
  
  MRI in the diagnosis of traumatic peripheral nerve injury has increasingly been used by surgeons in clinical practice. In this article, we analyze the use of magnetic resonance (MR) for the evaluation of traumatic peripheral nerve diseases that are surgically treatable. We also consider basic concepts in the evaluation of technical and MR signs of peripheral nerve injuries.
  
  
  
  Studies were identified following a computerized search of MEDLINE (1950 to present), EMBASE (1980 to present), and the Cochrane database. The MEDLINE search was conducted on PUBMED, the EMBASE search was conducted on OVID, and the Cochrane database was conducted using their online library. A set was created using the terms: 'traumatic', 'nerve', and 'resonance'.
  
  
  
  The included articles were identified using a computerized search and the resulting databases were then sorted according to the inclusion and exclusion criteria. This yielded 10,340 articles (MEDLINE, n = 758; EMBASE, n = 9564; and Cochrane, n = 18). A search strategy was then built by excluding articles that only concern plexus injury and adding the terms 'neuropathies', 'DTI' and 'neurotmesis'. In total, seven studies were included in the review effectively addressing the role of MRI in the evaluation of traumatic peripheral nerve injury. We extracted all relevant information on the imaging findings and the use of magnetic resonance in trauma. We did not include technical or specific radiological aspects of the imaging techniques.
  
  
  
  These seven articles were subsequently evaluated by analyzing their results, methodological approach, and conclusions presented.
authors.affiliation: Department of Neurosurgery, University Hospital of Brasilia, UnB, Secretaria de Clínica Cirurgica SGAN 605, Av. L2 Norte, Brasilia, DF, CEP: 70.830200, Brazil. oswaldo.marquez@gmail.com.
authors.forename: Oswaldo Ribeiro
authors.initials: OR
authors.lastname: Marquez Neto
authors.affiliation: Department of Neurosurgery, Hospital de Base do Distrito Federal, SMHS - Área Especial- Q. 101, Brasília, DF, CEP :70330-150, Brazil.
authors.forename: Matheus Silva
authors.initials: MS
authors.lastname: Leite
authors.affiliation: Department of Neurosurgery, Hospital de Base do Distrito Federal, SMHS - Área Especial- Q. 101, Brasília, DF, CEP :70330-150, Brazil.
authors.forename: Tiago
authors.initials: T
authors.lastname: Freitas
authors.affiliation: Department of Radiology, University Hospital of Brasilia, UnB, Radiologia SGAN 605, Av. L2 Norte, Brasilia, DF, CEP: 70.830200, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Mendelovitz
authors.affiliation: Department of Hand Surgery, Hospital de Base do Distrito Federal, SMHS - Área Especial- Q. 101, Brasília, DF, CEP :70330-150, Brazil.
authors.forename: Eric Arruda
authors.initials: EA
authors.lastname: Villela
authors.affiliation: Department of Neurosurgery, University Hospital of Brasilia, UnB, Secretaria de Clínica Cirurgica SGAN 605, Av. L2 Norte, Brasilia, DF, CEP: 70.830200, Brazil.
authors.forename: Iruena Moraes
authors.initials: IM
authors.lastname: Kessler
mesh_terms: D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D059348:Peripheral Nerve Injuries / Q000000981:diagnostic imaging*
keywords: Axonotmesis; Magnetic resonance neurography; Nerve injury; Nerve trauma; Neurography; Peripheral nerve; Peripheral nerve injury; Resonance