Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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MR Neurography: Current Several Issues for Novice Radiologists

자기공명영상 신경조영술: 경험이 적은 영상의학과 의사가 이해해야 할 몇 가지 쟁점들

  • Dong-ho Ha (Department of Radiology, Dong-A University)
  • Received : 2019.09.19
  • Accepted : 2020.01.08
  • Published : 2020.01.01
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Abstract

Magnetic resonance neurography (MRN) has been increasingly used in recent years for the assessment of peripheral neuropathies. Fat suppression T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) have typically been used to provide high contrast MRN. Isotropic 3-dimensional (3D) sequences with fast spin echo, post-processing imaging techniques, and fast imaging methods, among others, allow good visualization of peripheral nerves that have a small diameter, complex anatomy, and oblique course within a reasonable scan time. However, there are still several issues when performing high contrast and high resolution MRN including standard sequence; fat saturation techniques; balance between resolution, field of view, and slice thickness; post-processing techniques; 2D vs. 3D image acquisition; different T2 contrasts between proximal and distal nerves; high T2 signal intensity of adjacent veins or joint fluid; geometric distortion; and appropriate p-values on DWI. The proper understanding of these issues will help novice radiologists evaluate peripheral neuropathies using MRN.

말초신경병증의 진단을 위해 MR neurography의 사용이 점차 증가하고 있다. 고대조도와 고해상도로 말초신경을 직접 영상화한 MR 영상을 MR neurography라고 하고, 지방억제 T2 강조영상과 확산강조영상이 흔히 사용되는 시퀀스이다. 작은 직경, 복잡한 해부학적 구조를 가진 말초신경을 합리적 시간 안에 영상화하기 위해서 최신의 isotropic 3차원 기법, 다양한 고속영상기법, post-processing 영상 기법 등이 사용된다. 이런 발전들로 인해 MR neurography가 유용하게 사용되지만 항상 적절한 MR neurography 영상을 얻을 수 있는 것은 아니다. 적절한 MR neurography 영상을 얻기 위해 영상의학과 의사가 고려해야 할 다음의 몇 가지 쟁점들이 있다. 이에는 적절한 표준 프로토콜의 선책, 지방억제 기법의 선택, 해상도와 field of view와 slice thickness 간의 상호 관계의 이해, 적절한 post-processing 영상 기법의 적용, 2차원 영상획득 기법과 3차원 영상획득 기법의 장단점, 근위부 말초신경과 말단부 말초신경의 T2 대조도의 차이, 말초신경에 인접한 정맥이 MR neurography에 미치는 영향, 확산강조영상에서 기하학적 왜곡의 발생과 적절한 b value의 선택 등이다. 이런 쟁점들을 잘 이해하는 것이 경험이 적은 영상의학과 의사가 적절한 MR neurography 영상을 얻고, 말초신경병증을 정확히 평가하는 데 많은 도움이 될 것이다.

Keywords

Acknowledgement

This work was supported by the research funds from Dong-A University.

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