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Cystic lesions of peripheral nerves: Are we missing the diagnosis of the intraneural ganglion cyst?

AIM: To highlight the salient magnetic resonance imaging (MRI) features of the intraneural ganglion cyst (INGC) of various peripheral nerves for their precise diagnosis and to differentiate them from other intra and extra-neural cystic lesions. METHODS: A retrospective analysis of the magnetic reson...

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Autores principales: Panwar, Jyoti, Mathew, Anil, Thomas, Binu P
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441458/
https://www.ncbi.nlm.nih.gov/pubmed/28634514
http://dx.doi.org/10.4329/wjr.v9.i5.230
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author Panwar, Jyoti
Mathew, Anil
Thomas, Binu P
author_facet Panwar, Jyoti
Mathew, Anil
Thomas, Binu P
author_sort Panwar, Jyoti
collection PubMed
description AIM: To highlight the salient magnetic resonance imaging (MRI) features of the intraneural ganglion cyst (INGC) of various peripheral nerves for their precise diagnosis and to differentiate them from other intra and extra-neural cystic lesions. METHODS: A retrospective analysis of the magnetic resonance (MR) images of a cohort of 245 patients presenting with nerve palsy involving different peripheral nerves was done. MR images were analyzed for the presence of a nerve lesion, and if found, it was further characterized as solid or cystic. The serial axial, coronal and sagittal MR images of the lesions diagnosed as INGC were studied for their pattern and the anatomical extent along the course of the affected nerve and its branches. Its relation to identifiable anatomical landmarks, intra-articular communication and presence of denervation changes in the muscles supplied by involved nerve was also studied. RESULTS: A total of 45 cystic lesions in the intra or extraneural locations of the nerves were identified from the 245 MR scans done for patients presenting with nerve palsy. Out of these 45 cystic lesions, 13 were diagnosed to have INGC of a peripheral nerve on MRI. The other cystic lesions included extraneural ganglion cyst, paralabral cyst impinging upon the suprascapular nerve, cystic schwannoma and nerve abscesses related to Hansen’s disease involving various peripheral nerves. Thirteen lesions of INGC were identified in 12 patients. Seven of these affected the common peroneal nerve with one patient having a bilateral involvement. Two lesions each were noted in the tibial and suprascapular nerves, and one each in the obturator and proximal sciatic nerve. An intra-articular connection along the articular branch was demonstrated in 12 out of 13 lesions. Varying stages of denervation atrophy of the supplied muscles of the affected nerves were seen in 7 cases. Out of these 13 lesions in 12 patients, 6 underwent surgery. CONCLUSION: INGC is an important cause of reversible mono-neuropathy if diagnosed early and surgically treated. Its classic MRI pattern differentiates it from other lesions of the peripheral nerve and aid in its therapeutic planning. In each case, the joint connection has to be identified preoperatively, and the same should be excised during surgery to prevent further cyst recurrence.
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spelling pubmed-54414582017-06-21 Cystic lesions of peripheral nerves: Are we missing the diagnosis of the intraneural ganglion cyst? Panwar, Jyoti Mathew, Anil Thomas, Binu P World J Radiol Basic Study AIM: To highlight the salient magnetic resonance imaging (MRI) features of the intraneural ganglion cyst (INGC) of various peripheral nerves for their precise diagnosis and to differentiate them from other intra and extra-neural cystic lesions. METHODS: A retrospective analysis of the magnetic resonance (MR) images of a cohort of 245 patients presenting with nerve palsy involving different peripheral nerves was done. MR images were analyzed for the presence of a nerve lesion, and if found, it was further characterized as solid or cystic. The serial axial, coronal and sagittal MR images of the lesions diagnosed as INGC were studied for their pattern and the anatomical extent along the course of the affected nerve and its branches. Its relation to identifiable anatomical landmarks, intra-articular communication and presence of denervation changes in the muscles supplied by involved nerve was also studied. RESULTS: A total of 45 cystic lesions in the intra or extraneural locations of the nerves were identified from the 245 MR scans done for patients presenting with nerve palsy. Out of these 45 cystic lesions, 13 were diagnosed to have INGC of a peripheral nerve on MRI. The other cystic lesions included extraneural ganglion cyst, paralabral cyst impinging upon the suprascapular nerve, cystic schwannoma and nerve abscesses related to Hansen’s disease involving various peripheral nerves. Thirteen lesions of INGC were identified in 12 patients. Seven of these affected the common peroneal nerve with one patient having a bilateral involvement. Two lesions each were noted in the tibial and suprascapular nerves, and one each in the obturator and proximal sciatic nerve. An intra-articular connection along the articular branch was demonstrated in 12 out of 13 lesions. Varying stages of denervation atrophy of the supplied muscles of the affected nerves were seen in 7 cases. Out of these 13 lesions in 12 patients, 6 underwent surgery. CONCLUSION: INGC is an important cause of reversible mono-neuropathy if diagnosed early and surgically treated. Its classic MRI pattern differentiates it from other lesions of the peripheral nerve and aid in its therapeutic planning. In each case, the joint connection has to be identified preoperatively, and the same should be excised during surgery to prevent further cyst recurrence. Baishideng Publishing Group Inc 2017-05-28 2017-05-28 /pmc/articles/PMC5441458/ /pubmed/28634514 http://dx.doi.org/10.4329/wjr.v9.i5.230 Text en ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Basic Study
Panwar, Jyoti
Mathew, Anil
Thomas, Binu P
Cystic lesions of peripheral nerves: Are we missing the diagnosis of the intraneural ganglion cyst?
title Cystic lesions of peripheral nerves: Are we missing the diagnosis of the intraneural ganglion cyst?
title_full Cystic lesions of peripheral nerves: Are we missing the diagnosis of the intraneural ganglion cyst?
title_fullStr Cystic lesions of peripheral nerves: Are we missing the diagnosis of the intraneural ganglion cyst?
title_full_unstemmed Cystic lesions of peripheral nerves: Are we missing the diagnosis of the intraneural ganglion cyst?
title_short Cystic lesions of peripheral nerves: Are we missing the diagnosis of the intraneural ganglion cyst?
title_sort cystic lesions of peripheral nerves: are we missing the diagnosis of the intraneural ganglion cyst?
topic Basic Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441458/
https://www.ncbi.nlm.nih.gov/pubmed/28634514
http://dx.doi.org/10.4329/wjr.v9.i5.230
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