3T MRN new mathematical approaches
Posted: Sun Aug 21, 2011 11:13 pm
I just wanted to post information on some newer ideas with 3T MRN that I tried to say were not Filler and included 3Tessla MRI as in my report that was signed by John Carrino MD in my reply to Jen- see excerpts from Dellon's book for the details. Thanks
Janet
Jen,
Johns Hopkins in Baltimore has an Magnetic Resonance Neurography (MRN) which listed the following at the start of my report:
RESULT:
INDICATION: Left pudendal neuralgia
TECHNIQUE: High resolution MRI was performed of the pelvis employing MR neurography techniques on a 3-Tesla system using multiplanar 3-D anatomical and fluid sensitive sequences per the descrpition on my MRN report.
To note Dr. Marvel said the MRN was being done to eliminate other problems, not to diagnose PN/PNE.
Also, this is not a Dr. Filler MRN as described in chapter 12 of Dr. Dellon's pain solution book.
It took me about a month to get in for the MRN March 2011
Janet
From chapter 12 of Dellon's Pain solutions book:
A commonly used approach today is to have radiographic imaging of the pelvis. The
best “x-ray” approach is actually with magnetic resonance imaging (MRI) which puts
energy into the tissues and records the energy given off in response to that stimulus.
Mathematical models applied to this generated energy can be used to create a
photographic image, which looks like a traditional x-ray, but can be manipulated in many
ways to highlight different tissues, such as bone versus muscle, primarily related to the
water and fat content of that tissue. Sadly, nerve as a tissue, has been traditionally hard to
image because it is similar to blood vessels in its water content. So radiologists usually
assume they know where the nerve is because the nerve is related to the blood vessel or
certain bone landmarks. In other words, traditional MRI tests do not directly image the
peripheral nerves. A neurosurgeon, Aaron Filler, MD, developed a mathematical
A. Lee Dellon, MD, PhD
Chronic Pelvic Pain 335
approach designed to identify nerves more easily and he has termed this “MR
Neurography”. There are many radiology locations in the country at which this testing
using his proprietary, patented, formula can be done. Other medical institutions are
developing their own mathematical approach to visualize these small nerves better. At
Johns Hopkins Hospital, we have a dedicated Musculoskeletal Unit, organized by John
Carino MD and Avneesh Chhabra, MD, in the department of radiology that is currently
correlating their images with intra-operative photographs that my partners in the Dellon
Institute for Peripheral Nerve Surgery® are sending to them. These clinical/radiologic
correlations already have enabled better understanding of the location of nerve
entrapment with regard to all peripheral nerve problems in the arms and legs,*, **, *** and
it is now being applied to the pudendal nerve. We, doctors and patients, must bear in
mind that this imaging is still in its infancy with regard to the pudendal nerve, and it is
still difficult to distinguish scarring from nerve entrapment from the adjacent pudendal
artery. The appearance of a nerve that is entrapped or one that is freed from entrapment
may still appear abnormal due to the scar remaining from the neurolysis surgery itself.
The good news is that, at present, I do not routinely require this test to be done in the
evaluation of my pelvic pain patients. If a patient has had previous surgery, or if a pelvic
tumor is suspected, or if there has been a pelvic fracture, a high intensity MRI with special
imaging should be recommended. An example of an MRI of the pudendal nerve using the
approach developed at Johns Hopkins is given in Figure 12-18.
* Chhabra, A, Williams, EH, Wang, KC, Dellon, AL, Carrino, JA, Magnetic
resonance neurography of neuromas related to nerve injury and entrapment with
surgical correlation, American Journal of Neuroradiology, 31:1363-1368, 2010.
** Chhabra A, Faridian-Aragh N, Chalian M, Soldatos T, Thawait SK, Williams EH,
Andreisek G. High-resolution 3-T MR neurography of peroneal neuropathy.
Skeletal Radiology, in press 2011.
*** Subhawong TK, Wang KC, Thawait SK, Williams EH, Hashemi SS, Machado AJ,
Carrino JA, Chhabra A., High resolution imaging of tunnels with magnetic
reasonance neurography, Skeletal Radiology, in press 2011.
CHRONIC PELVIC PAIN
CHAPTER 12 336
A
B
Figure12-18. MRI of the pudendal nerve in a man using a high intensity 3 Tessla protocol as
developed by the Musculoskeletal Radiology Group at Johns Hopkins Hospital, Baltimore. A: Level of
ischial spine. Pudendal nerve is between the sacrospinous and sacrotuberous ligaments (white
arrow). B: Level of Alcock’s canal, the pudendal nerve is alongside the obturator internus muscle
(white arrow). Images courtesy of John Carrino MD and Avneesh Chhabra, MD.
Janet
Jen,
Johns Hopkins in Baltimore has an Magnetic Resonance Neurography (MRN) which listed the following at the start of my report:
RESULT:
INDICATION: Left pudendal neuralgia
TECHNIQUE: High resolution MRI was performed of the pelvis employing MR neurography techniques on a 3-Tesla system using multiplanar 3-D anatomical and fluid sensitive sequences per the descrpition on my MRN report.
To note Dr. Marvel said the MRN was being done to eliminate other problems, not to diagnose PN/PNE.
Also, this is not a Dr. Filler MRN as described in chapter 12 of Dr. Dellon's pain solution book.
It took me about a month to get in for the MRN March 2011
Janet
From chapter 12 of Dellon's Pain solutions book:
A commonly used approach today is to have radiographic imaging of the pelvis. The
best “x-ray” approach is actually with magnetic resonance imaging (MRI) which puts
energy into the tissues and records the energy given off in response to that stimulus.
Mathematical models applied to this generated energy can be used to create a
photographic image, which looks like a traditional x-ray, but can be manipulated in many
ways to highlight different tissues, such as bone versus muscle, primarily related to the
water and fat content of that tissue. Sadly, nerve as a tissue, has been traditionally hard to
image because it is similar to blood vessels in its water content. So radiologists usually
assume they know where the nerve is because the nerve is related to the blood vessel or
certain bone landmarks. In other words, traditional MRI tests do not directly image the
peripheral nerves. A neurosurgeon, Aaron Filler, MD, developed a mathematical
A. Lee Dellon, MD, PhD
Chronic Pelvic Pain 335
approach designed to identify nerves more easily and he has termed this “MR
Neurography”. There are many radiology locations in the country at which this testing
using his proprietary, patented, formula can be done. Other medical institutions are
developing their own mathematical approach to visualize these small nerves better. At
Johns Hopkins Hospital, we have a dedicated Musculoskeletal Unit, organized by John
Carino MD and Avneesh Chhabra, MD, in the department of radiology that is currently
correlating their images with intra-operative photographs that my partners in the Dellon
Institute for Peripheral Nerve Surgery® are sending to them. These clinical/radiologic
correlations already have enabled better understanding of the location of nerve
entrapment with regard to all peripheral nerve problems in the arms and legs,*, **, *** and
it is now being applied to the pudendal nerve. We, doctors and patients, must bear in
mind that this imaging is still in its infancy with regard to the pudendal nerve, and it is
still difficult to distinguish scarring from nerve entrapment from the adjacent pudendal
artery. The appearance of a nerve that is entrapped or one that is freed from entrapment
may still appear abnormal due to the scar remaining from the neurolysis surgery itself.
The good news is that, at present, I do not routinely require this test to be done in the
evaluation of my pelvic pain patients. If a patient has had previous surgery, or if a pelvic
tumor is suspected, or if there has been a pelvic fracture, a high intensity MRI with special
imaging should be recommended. An example of an MRI of the pudendal nerve using the
approach developed at Johns Hopkins is given in Figure 12-18.
* Chhabra, A, Williams, EH, Wang, KC, Dellon, AL, Carrino, JA, Magnetic
resonance neurography of neuromas related to nerve injury and entrapment with
surgical correlation, American Journal of Neuroradiology, 31:1363-1368, 2010.
** Chhabra A, Faridian-Aragh N, Chalian M, Soldatos T, Thawait SK, Williams EH,
Andreisek G. High-resolution 3-T MR neurography of peroneal neuropathy.
Skeletal Radiology, in press 2011.
*** Subhawong TK, Wang KC, Thawait SK, Williams EH, Hashemi SS, Machado AJ,
Carrino JA, Chhabra A., High resolution imaging of tunnels with magnetic
reasonance neurography, Skeletal Radiology, in press 2011.
CHRONIC PELVIC PAIN
CHAPTER 12 336
A
B
Figure12-18. MRI of the pudendal nerve in a man using a high intensity 3 Tessla protocol as
developed by the Musculoskeletal Radiology Group at Johns Hopkins Hospital, Baltimore. A: Level of
ischial spine. Pudendal nerve is between the sacrospinous and sacrotuberous ligaments (white
arrow). B: Level of Alcock’s canal, the pudendal nerve is alongside the obturator internus muscle
(white arrow). Images courtesy of John Carrino MD and Avneesh Chhabra, MD.
