Impact of high resolution 3 tesla MR neurography (MRN) on diagnostic thinking and therapeutic patient management

Objective To evaluate the impact of magnetic resonance neurography (MRN) on diagnostic thinking and therapeutic choices in patients with suspected peripheral neuropathy. Methods IRB approval was obtained for this HIPAA-compliant study. Questionnaires were administered to six surgeons regarding the diagnosis and treatment in 85 patients suspected of having peripheral neuropathy, before (pretest) and after (posttest) MRN. Multiple outcome measures related to diagnostic confidence and surgical decision-making were assessed. Results The final cohort included 81 patients (30 men and 51 women, age 47 +/- 17 years). The following changes were observed from pretest to posttest questionnaires: 23 % in nerve involvement (P < 0.05), 48 % in degree of confidence of nerve involvement (P < 0.01), 27 % in grade of injury (P < 0.05), 33 % in differential diagnosis (P < 0.05), 63 % in degree of confidence in need for surgery (P < 0.001), 41 % in timing of surgery (P < 0.01), 30 % in approach to surgery (P < 0.05), 58 % in degree of confidence in approach to surgery (P < 0.001), 30 % in estimated length of surgery (P < 0.05) and 27 % in length of incision (P < 0.05). The dichotomous decision regarding surgical or nonsurgical treatment changed from pro to con in 17 %. Conclusion MRN results significantly influenced the diagnostic thinking and therapeutic recommendations of peripheral nerve surgeons.