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Magnetic Resonance Imaging Monitoring of Peripheral Nerve Regeneration following Neurotmesis at 4.7 Tesla

Behr, Björn M.D.; Schnabel, Reinhild Ph.D.; Mirastschijski, Ursula M.D., Ph.D.; Ibrahim, Bchar M.D.; Angenstein, Frank Ph.D.; Schneider, Wolfgang M.D., Ph.D.

Plastic & Reconstructive Surgery: June 2009 - Volume 123 - Issue 6 - pp 1778-1788
doi: 10.1097/PRS.0b013e3181a3f343
Hand/Peripheral Nerve: Original Articles

Background: The preoperative diagnostic imaging of peripheral nerve lesions and the postoperative monitoring of microsurgically coapted nerves remain unsolved problems. The aim of this study was to investigate peripheral nerve regeneration after complete neurotmesis with magnetic resonance imaging techniques.

Methods: Study groups included 70 rats. Their right sciatic nerve was either cut and left untreated or epineurially coapted. After postoperative days 3, 6, 10, and 14 and then weekly until postoperative day 84, these rats underwent scanning at 4.7 T. T2 signal intensities of the nerves were analyzed. In parallel, on postoperative days 3, 6, 10, 14, 21, 28, 42, 63, or 84, rats were killed for histologic processing. These findings were related to the corresponding images.

Results: After an initial T2 signal increase of the nerves in both groups, the coapted group demonstrated a major T2 signal decrease in the distal part of the nerve after postoperative day 21, whereas in the unrepaired group a signal decrease was not observed until postoperative day 42. Differences between the two groups were significant at postoperative days 3, 6, and 28 and thereafter. The signal decrease in the coapted nerves could be correlated to the ingrowth of regenerating axons observed by histology. Moreover, the continuity of coapted nerves or an explicit gap in the unrepaired group was detectable at every time point.

Conclusions: This study presents novel magnetic resonance imaging data regarding regeneration after neurotmesis. High-field-strength magnetic resonance imaging has the potential to diagnose a discontinuity within a nerve of interest and monitor its regeneration after coaptation.

Magdeburg, Germany

From the Department of Plastic, Reconstructive, and Hand Surgery, University of Magdeburg, and the Leibniz Institute for Neurobiology.

Received for publication July 13, 2008; accepted December 19, 2008.

Presented at the 53rd Annual Meeting of the Plastic Surgery Research Council, in Springfield, Illinois, May 28 through 31, 2008; and at the 14th Congress of the International Confederation of Plastic, Reconstructive, and Aesthetic Surgery, in Berlin, Germany, June 26 through 30, 2007.

Disclosure: None of the authors has any financial interests to disclose.

Björn Behr, M.D.; Department of Plastic, Reconstructive and Hand Surgery; University of Magdeburg; Leipziger Str. 44; 39120 Magdeburg, Germany; bjorn.behr@gmx.de

©2009American Society of Plastic Surgeons