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European Radiology
Published in: European Radiology 5/2017

Open Access 01-05-2017 | Neuro

MRI shows thickening and altered diffusion in the median and ulnar nerves in multifocal motor neuropathy

Authors: Wieke Haakma, Bas A. Jongbloed, Martijn Froeling, H. Stephan Goedee, Clemens Bos, Alexander Leemans, Leonard H. van den Berg, Jeroen Hendrikse, W. Ludo van der Pol

Published in: European Radiology | Issue 5/2017

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Abstract

Objectives

To study disease mechanisms in multifocal motor neuropathy (MMN) with magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) of the median and ulnar nerves.

Methods

We enrolled ten MMN patients, ten patients with amyotrophic lateral sclerosis (ALS) and ten healthy controls (HCs). Patients underwent MRI (in a prone position) and nerve conduction studies. DTI and fat-suppressed T2-weighted scans of the forearms were performed on a 3.0T MRI scanner. Fibre tractography of the median and ulnar nerves was performed to extract diffusion parameters: fractional anisotropy (FA), mean (MD), axial (AD) and radial (RD) diffusivity. Cross-sectional areas (CSA) were measured on T2-weighted scans.

Results

Forty-five out of 60 arms were included in the analysis. AD was significantly lower in MMN patients (2.20 ± 0.12 × 10-3 mm2/s) compared to ALS patients (2.31 ± 0.17 × 10-3 mm2/s; p < 0.05) and HCs (2.31± 0.17 × 10-3 mm2/s; p < 0.05). Segmental analysis showed significant restriction of AD, RD and MD (p < 0.005) in the proximal third of the nerves. CSA was significantly larger in MMN patients compared to ALS patients and HCs (p < 0.01).

Conclusions

Thickening of nerves is compatible with changes in the myelin sheath structure, whereas lowered AD values suggest axonal dysfunction. These findings suggest that myelin and axons are diffusely involved in MMN pathogenesis.

Key Points

• Diffusion magnetic resonance imaging provides quantitative information about multifocal motor neuropathy (MMN).
• Diffusion tensor imaging allows non-invasive evaluation of the forearm nerves in MMN.
• Nerve thickening and lowered diffusion parameters suggests myelin and axonal changes.
• This study can help to provide insight into pathological mechanisms of MMN.
Appendix
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Metadata
Title
MRI shows thickening and altered diffusion in the median and ulnar nerves in multifocal motor neuropathy
Authors
Wieke Haakma
Bas A. Jongbloed
Martijn Froeling
H. Stephan Goedee
Clemens Bos
Alexander Leemans
Leonard H. van den Berg
Jeroen Hendrikse
W. Ludo van der Pol
Publication date
01-05-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4575-0

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