High Resolution Sonography Of The Peripheral Nervous System

Diagnostic sonography of the peripheral nervous system is an evolving specialty of musculoskeletal ultrasound. This book provides an in-depth description of sonographic examination technique - how to access an individual nerve with sonography and how to interpret local findings. A particular focus is on sonographic-anatomic correlations. All currently possible clinical applications are addressed, including the evaluation of nerve compression syndromes, traumatic lesions, tumors, and postoperative complications. The book contains a huge number of high-quality patient sonograms, all derived from cases with clinical and in many instances surgical correlation.

Since the first edition of this book, sonography of the peripheral nervous system has evolved further. This second, revised edition includes many state-of-the-art high-resolution images, the text has been adapted to reflect the current state of the literature, and information is presented using a more modern layout. This book provides a practical, clinically oriented overview of all aspects of sonographic diagnosis and interventional therapy of the peripheral nervous system.

Diagnostic sonography of the peripheral nervous system is an evolving specialty of musculoskeletal ultrasound. This book provides an in-depth description of sonographic examination technique -- how to access an individual nerve with sonography and how to interpret local findings. A particular focus is on sonographic-anatomic correlations, based on the use of anatomic cadaver cryosections and comparative sonograms. All currently possible clinical applications are addressed, including the evaluation of nerve compression syndromes, traumatic lesions, tumors, and postoperative complications. A special section is dedicated to interventional procedures and sonographic guidance in anesthesia. In addition, two experts give a basic introduction to electrophysiologic testing and peripheral nerve surgery. The book contains a huge number of high-quality patient sonograms, all derived from cases with clinical and in many instances surgical correlation.

In recent years, sonography of the peripheral nervous system has gained widespread acceptance. New diagnostic applications have emerged, and the field of ultrasound-guided interventions has expanded significantly: regional anesthesia, peripheral nerve blocks, and similar techniques are now frequently performed under ultrasound guidance by anesthesiologists and pain physicians alike. This atlas of peripheral nerve ultrasound is designed to meet the daily needs of both radiologists and clinicians by allowing rapid review of typical features, knowledge of which is important for successful diagnosis and intervention. The side by side presentation of ultrasound images with anatomical cryosections and photographs of transducer positions allows for reliable sonographic identification of even tiny nerves in regions of complex topography. The practical value of the atlas is further enhanced by correlations with high-resolution MRI scans.

This chapter summarizes progress in the evaluation of peripheral nerve (PN) lesions and disorders by imaging techniques encompassing magnetic resonance imaging (MRI) and nerve ultrasound (US). Due to the radiation exposure and limited sensitivity in soft tissue contrast, computed-tomography (CT) plays no significant role in the diagnostic work-up of PN disorders. MRI and US are complementary techniques for the evaluation of peripheral nerves, each having particular advantages and disadvantages. Nerve injury induces intrinsic MRI signal alterations on T2-weighted sequences in degenerating or demyelinating nerve segments as well as in corresponding muscle groups exhibiting denervation which can be exploited diagnostically. Nerve US is based on changes in the nerve echotexture due to tumor formation or focal enlargement caused by entrapment or inflammation. Both MRI and US provide morphological information on the precise site and extent of nerve injury. While US has the advantage of easy accessibility, providing images with superior spatial resolution at low cost, MRI shows better soft tissue contrast and better image quality for deep-lying nerve structures since imaging is not hindered by bone. Recent advances have remarkably increased spatial resolution of both MRI and US making imaging indispensible for the elucidation of causes of nerve compression, peripheral nerve tumors, and focal inflammatory conditions. Both MRI and US further guide neurosurgical exploration and can simplify treatment. Importantly, imaging can reveal treatable conditions even in the absence of gross electrophysiological alterations, illustrating its increasing role in clinical practice. In experimental settings, novel molecular and cellular MRI contrast agents allow in-vivo assessment of nerve regeneration as well as monitoring of neuroinflammation. Depending on further clinical development, contrast-enhanced MRI has the potential to follow cellular responses over time in vivo and to overcome the current limitations of histological assessment of nerve afflictions. Further advances in contrast-enhanced US has the potential for developing into a tool for the assessment of nerve blood perfusion, paving the way for better assessments of ischemic neuropathies.

This first of its kind richly illustrated book provides a tabular and schematic representation of all the peripheral nerves in the human body using a standardized landmark-based algorithm for the definition of the nerve’s “Point of optimal visibility (POV)”. In this atlas the nerves of the human body are depicted with high-frequent ultrasound probes with frequencies up to 24 MHz: it presents not only the “known” large nerves (N. ischiadicus, N. femoralis, N. medianus etc.), but also the tiny nerves you have learned in your anatomy sessions but forgotten in the course of time! Based on clear illustrations using palpaple/visible external and easily accessible internal landmarks, it offers “nerve sonographers” a clear sonoanatomic guidance on how to easily find the nerve. Additionally, it describes the exact positioning of the probe so that each nerve can be found at its point of optimal visibility. These mental maps for nerve sonographeurs are intended not only for beginners but also for “advanced” specialists requiring instructions on how to easily find even tiny peripheral nerves: especially for neurologists, anaesthesiologists, radiologists, pain practionioners, rheumatologists and surgeons who seek a clear standardized step by step manual on “Where do I find a nerve the easiest?”

This open access book focuses on imaging of the musculoskeletal diseases. Over the last few years, there have been considerable advances in this area, driven by clinical as well as technological developments. The authors are all internationally renowned experts in their field. They are also excellent teachers, and provide didactically outstanding chapters. The book is disease-oriented and covers all relevant imaging modalities, with particular emphasis on magnetic resonance imaging. Important aspects of pediatric imaging are also included. IDKD books are completely re-written every four years. As a result, they offer a comprehensive review of the state of the art in imaging. The book is clearly structured with learning objectives, abstracts, subheadings, tables and take-home points, supported by design elements to help readers easily navigate through the text. As an IDKD book, it is particularly valuable for general radiologists, radiology residents, and interventional radiologists who want to update their diagnostic knowledge, and for clinicians interested in imaging as it relates to their specialty.