Diagnostic and interventional imaging
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Peripheral nervous system (PNS) imaging is usually carried out by ultrasound and MRI. Thanks to its wide availability and excellent spatial resolution, ultrasound is a mature investigation with clearly established indications, particularly in entrapment syndromes and tumors. ⋯ This review describes the current methods for imaging the PNS, concentrating on acquisition techniques, normal results and basic pathological semiology. Ongoing and future developments are described in order to underline the forthcoming changes in this very dynamic field of musculoskeletal radiology.
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Injuries are separated into spinal nerve root avulsions (pre-ganglionic lesions) and more distal rupture (post-ganglionic lesions). The lesions may be associated with different nerve root levels. Spinal MRI is used to diagnose pre-ganglionic lesions, which may be present in the absence of pseudomeningoceles. ⋯ Contrast enhancement in the scalene triangle does not predict the quality of the nerve root (continuous injury with response to peroperative stimulation or division of the root needing grafting). Understanding post-traumatic neuronal injuries to the brachial plexus. Knowing how to look for spinal MRI abnormalities and post-ganglionic abnormalities.
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Two different clinical entities, essential or secondary neuralgia, are associated with different pathologies. The pathways of CN V comprise the cervical spine, the brainstem, the root of the nerve and the three peripheral branches: V1, V2 and V3. The lesions responsible for neuralgia are neoplastic, vascular, inflammatory, malformative or post-traumatic. ⋯ It is investigated by T2-weighted inframillimetric volume. Two conditions are necessary to diagnose a neurovascular compression: localised on the root entry zone [(REZ), 2-6mm from the emergence of the pons] and perpendicularly. In the absence of neurovascular compression, thin slices and a gadolinium injection are necessary.
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Diagn Interv Imaging · May 2013
Review Comparative StudyUltrasound elastography: principles and techniques.
Ultrasonography has been widely used for diagnosis since it was first introduced in clinical practice in the 1970's. Since then, new ultrasound modalities have been developed, such as Doppler imaging, which provides new information for diagnosis. ⋯ Several dynamic methods are discussed: vibro-acoustography, Acoustic Radiation Force Impulsion (ARFI), transient elastography, shear wave imaging, etc. This paper aims to help the reader at understanding the differences between the different methods of this promising imaging modality that may become a significant tool in medical imaging.
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Diagn Interv Imaging · Apr 2013
ReviewUltrasound-guided lymph node sampling in the initial management of breast cancer.
Ultrasound-guided fine needle sampling is proving very useful for avoiding surgical biopsy of the sentinel lymph node for N+breast cancer. Because of its high specificity, cytology is sufficient in most cases. ⋯ It should be possible to optimise identification of the sentinel lymph node by the intradermal injection of ultrasound contrast agent. The cost/effectiveness ratio is positive but unknown and should be assessed in the initial management of breast cancer.