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European Radiology

, Volume 27, Issue 5, pp 2216–2224

First Online: 21 September 2016Received: 18 April 2016Revised: 09 August 2016Accepted: 22 August 2016DOI: 10.1007-s00330-016-4575-0

Cite this article as: Haakma, W., Jongbloed, B.A., Froeling, M. et al. Eur Radiol 2017 27: 2216. doi:10.1007-s00330-016-4575-0


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

MethodsWe 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.

ResultsForty-five out of 60 arms were included in the analysis. AD was significantly lower in MMN patients 2.20 ± 0.12 × 10 mm-s compared to ALS patients 2.31 ± 0.17 × 10 mm-s; p < 0.05 and HCs 2.31± 0.17 × 10 mm-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.

ConclusionsThickening 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.

KeywordsMagnetic resonance imaging Diffusion tensor imaging Multifocal motor neuropathy Amyotrophic lateral sclerosis Median and ulnar nerve Electronic supplementary materialThe online version of this article doi:10.1007-s00330-016-4575-0 contains supplementary material, which is available to authorized users.

Autor: Wieke Haakma - Bas A. Jongbloed - Martijn Froeling - H. Stephan Goedee - Clemens Bos - Alexander Leemans - Leonard H. va


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