Ces radiol. 2025, 79(3):182-187 | DOI: 10.55095/CesRadiol2025/025

The use of MR tractography of peripheral nerves in clinical practiceReview article

Simona Kurková1, Ibrahim Ibrahim2, 3, Jaroslav Tintěra2
1 Klinika rehabilitace a tělovýchovného lékařství 2. LF UK a FN Motol, Praha
2 Pracoviště zobrazovacích metod, oddělení magnetické rezonance IKEM, Praha
3 Pracoviště zobrazovacích metod 2. LF UK Motol, Praha Korespondenční adresa:

The review article summarizes the current possibilities for using MR tractography (MRT) and diffusion tensor imaging (DTI) in the visualization of peripheral nerves. It describes the principles of DTI, explains the main diffusion parameters, and traces the development of the method from the 1960s to the present. MRT and DTI allow for non-invasive assessment of the structure and regeneration of peripheral nerves, have clinical value in neuropathies, and complement electrophysiological examinations. Although technically demanding, the method has the potential to become a standard part of clinical practice as development continues.

Keywords: MR tractography (MRT), diffusion tensor imaging (DTI), peripheral neuropathy, MR neurography (MRN), electromyogrphy (EMG).

Accepted: August 31, 2025; Published: December 1, 2025  Show citation

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Kurková S, Ibrahim I, Tintěra J. The use of MR tractography of peripheral nerves in clinical practice. Ces radiol. 2025;79(3):182-187. doi: 10.55095/CesRadiol2025/025.
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References

  1. . Ibrahim I, Tintěra J. Teoretické základy pokročilých metod magnetické rezonance na poli neurověd. Ces Radiol. 2013; 67(1): 9-18.
  2. . Ibrahim I, Tintěra J, Škoch A, Jirů F. MR traktografie mozku a MR neurografie periferních nervů. Ces Radiol. 2017; 71(4): 345-352. Go to original source...
  3. . Tournier JD, Mori S, Leemans A. Diffusion tensor imaging and beyond. Magn Reson Med. 2011; 65(6): 1532-1556. Go to original source...
  4. . Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M. MR imaging of intravoxel incoherent motions: Application to diffusion and perfusion in neurologic disorders. Radiology 1986; 161(2): 401-407. Go to original source...
  5. . Stejskal EO, Tanner JE. Spin Diffusion Measurements: Spin Echoes in the Presence of a Time-Dependent Field Gradient. J Chem Phys. 1965; 42(1): 288-292. Go to original source...
  6. . Basser PJ, Mattiello J, LeBihan D. MR diffusion tensor spectroscopy and imaging. Biophys J. 1994; 66(1): 259-267. Go to original source...
  7. . Tuch DS, Reese TG, Wiegell MR, Makris N, Belliveau JW, van Wedeen J. High angular resolution diffusion imaging reveals intravoxel white matter fiber heterogeneity. Magn Reson Med. 2002; 48(4): 577-582. Go to original source...
  8. . Wedeen VJ, Wang RP, Schmahmann JD, Benner T, Tseng WYI, Dai G, et al. Diffusion spectrum magnetic resonance imaging (DSI) tractography of crossing fibers. Neuroimage 2008; 41(4): 1267-1277. Go to original source...
  9. . Yeh FC, Wedeen VJ, Tseng WYI. Generalized q-sampling imaging. IEEE Trans Med Imaging 2010; 29(9): 1626-1635. Go to original source...
  10. . Zhang H, Schneider T, Wheeler-Kingshott CA, Alexander DC. NODDI: Practical in vivo neurite orientation dispersion and density imaging of the human brain. Neuroimage 2012; 61(4): 1000-1016. Go to original source...
  11. . Ibrahim I, Skoch A, Herynek V, Humhej I, Beran J, Flusserova V, et al. Magnetic resonance tractography of the brachial plexus: step-by-step. Quant Imaging Med Surg. 2022; 12(9): 4488-4501. Go to original source...
  12. . Ibrahim I, Škoch A, Herynek V, Jírů F, Tintěra J. Magnetic resonance tractography of the lumbosacral plexus: Step-by-step. Medicine 2021; 100(6): e24646. Go to original source...
  13. . Simon NG, Kliot M. Diffusion weighted MRI and tractography for evaluating peripheral nerve degeneration and regeneration. Neural Regen Res. 2014; 9(24): 2122-2124. Go to original source...
  14. . Vo NQ, Hoang NT, Nguyen DD, Nguyen THD, Le TB, Le NTN, et al. Quantitative parameters of diffusion tensor imaging in the evaluation of carpal tunnel syndrome. Quant Imaging Med Surg. 2022; 12(6): 3379-3390. Go to original source...
  15. . Zhai Y, Yu W, Shen W, Zhang Y. Diffusion Tensor Imaging Evaluates Effects of Acupoint Injection at Zusanli (ST36) for Type 2 Diabetic Peripheral Neuropathy. Medical Science Monitor 2022; 28: 1-7. Go to original source...
  16. . Azmi S, Ferdousi M, Kalteniece A, Al-Muhannadi H, Al-Mohamedi A, Hadid NH, et al. Diagnosing and managing diabetic somatic and autonomic neuropathy. Ther Adv Endocrinol Metab. 2019; 10: 1-10. Go to original source...
  17. . Jaques G, Becce F, Ledoux JB, Durand S. Diagnosis of ulnar nerve entrapment anterior to the medial epicondyle by ultrasound elastography and diffusion tensor imaging with fiber tractography: a case report. Surgical and Radiologic Anatomy 2022; 44(2): 201-205. Go to original source...
  18. . Bellanti R, Rinaldi S. Guillain-Barré syndrome: a comprehensive review. Eur J Neurol. 2024; 31(8): e16365. doi: 10.1111/ene.16365 [Epub 2024 May 30]. PMID: 38813755; PMCID: PMC11235944. Go to original source... Go to PubMed...
  19. . Cheah PL, Krisnan T, Wong JHD, Rozalli FI, Fadzli F, Rahmat K, et al. Microstructural Integrity of Peripheral Nerves in Charcot-Marie-Tooth Disease: An MRI Evaluation Study. Journal of Magnetic Resonance Imaging 2021; 53(2): 437-444. Go to original source...
  20. . Chalasani P, Taljanovic M, Segar J, Farr K, Win H, Wertheim BC, et al. Diffuse tensor imaging of lower extremities: a novel MR imaging technique for chemotherapy-induced peripheral neuropathy. Breast Cancer Res Treat. 2020; 184(3): 771-778. Go to original source...
  21. . Kronlage M, Pitarokoili K, Schwarz D, Godel T, Heiland S, Yoon MS, et al. Diffusion Tensor Imaging in Chronic Inflammatory Demyelinating Polyneuropathy. Invest Radiol. 2017; 52(11): 701-707. Go to original source...
  22. . Mazal AT, Ashikyan O, Cheng J, Le LQ, Chhabra A. Diffusion-weighted imaging and diffusion tensor imaging as adjuncts to conventional MRI for the diagnosis and management of peripheral nerve sheath tumors: current perspectives and future directions. Eur Radiol. 2019; 29(8): 4123-4132. Go to original source...
  23. . Gasparotti R, Lodoli G, Meoded A, Carletti F, Garozzo D, Ferraresi S. Feasibility of diffusion tensor tractography of brachial plexus injuries at 1.5 T. Invest Radiol. 2013; 48(2): 104-112. Go to original source...
  24. . Wade RG, Tanner SF, Teh I, Ridgway JP, Shelley D, Chaka B, et al. Diffusion Tensor Imaging for Diagnosing Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Proof-of-Concept Study. Front Surg. 2020; 7: 1-8. Go to original source...
  25. . Duraffourg M, Rougereau G, Fawaz R, Ltaief A, Jacquesson T, Freydier M, et al. Lumbosacral plexus and pudendal nerve magnetic resonance tractography: A systematic review of the clinical applications for pudendal neuralgia. Magn Reson Imaging 2024; 112: 18-26. Go to original source...
  26. . Wada K, Hashimoto T, Miyagi R, Sakai T, Sairyo K. Diffusion tensor imaging and tractography of the sciatic nerve: assessment of fractional anisotropy and apparent diffusion coefficient values relative to the piriformis muscle, a preliminary study. Skeletal Radiol. 2017; 46(3): 309-314. Go to original source...
  27. . Eguchi Y, Kanamoto H, Oikawa Y, Suzuki M, Yamanaka H, Tamai H, et al. Recent advances in magnetic resonance neuroimaging of lumbar nerve to clinical applications: A review of clinical studies utilizing Dffusion Tensor Imaging and Diffusion-weighted magnetic resonance neurography. Spine Surg Relat Res. 2017; 1(2): 61-71. Go to original source...
  28. . Zhang J, Zhang F, Xiao F, Xiong Z, Liu D, Hua T, et al. Quantitative Evaluation of the Compressed L5 and S1 Nerve Roots in Unilateral Lumbar Disc Herniation by Using Diffusion Tensor Imaging. Clin Neuroradiol. 2018; 28(4): 529-537. Go to original source...
  29. . Lemos N, Melo HJF, Sermer C, Fernandes G, Ribeiro A, Nascimento G, Luo ZC, Girão MJBC, Goldman SM. Lumbosacral plexus MR tractography: A novel diagnostic tool for extraspinal sciatica and pudendal neuralgia? Magn Reson Imaging 2021; 83: 107-113. Go to original source...
  30. . Kamble N, Shukla D, Bhat D. Peripheral Nerve Injuries: Electrophysiology for the Neurosurgeon. Neurol India. 2019; 67(6): 1419-1422. Go to original source...
  31. . Wiertel-Krawczuk A, Huber J, Szymankiewicz-Szukała A, Wincek A. Neurophysiological Evaluation of Neural Transmission in Brachial Plexus Motor Fibers with the Use of Magnetic versus Electrical Stimuli. Sensors. 2023; 23(8): 1-15. Go to original source...
  32. . Newhart H, Patterson J, Gunasekaran A, Pandey T, Kumar M, Kazemi N. The Incremental Value of Magnetic Resonance Neurography for the Neurosurgeon: Review of the Literature. World Neurosurg. 2019; 122: 331-341. Go to original source...

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