MUSCULOSKELETAL Impact of high resolution 3 tesla MR neurography (MRN) on diagnostic thinking and therapeutic patient management Avneesh Chhabra 1,2 & Allan J Belzberg 3 & Gedge D Rosson 4 & Gaurav K Thawait 2 & M Chalian 2 & Sahar J Farahani 2 & Jaimie T Shores 4 & Gene Deune 4 & Shar Hashemi 5 & Shrey K Thawait 2 & Ty K Subhawong 6 & John A Carrino 7 Received: 16 February 2015 /Revised: 26 July 2015 /Accepted: 30 July 2015 # European Society of Radiology 2015 Abstract 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 regard- ing the diagnosis and treatment in 85 patients suspected of hav- ing peripheral neuropathy, before (pretest) and after (posttest) MRN. Multiple outcome measures related to diagnostic confi- dence 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 ob- served 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 confi- dence 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 surgi- cal or nonsurgical treatment changed from pro to con in 17 %. Conclusion MRN results significantly influenced the diag- nostic thinking and therapeutic recommendations of peripher- al nerve surgeons. Key Points • In patients with peripheral neuropathy, MRN significantly impacts diagnostic thinking. • In patients with peripheral neuropathy, MRN significantly impacts therapeutic choices. • 3-T MRN should be considered in presurgical planning of patients with peripheral neuropathy. Keywords Peripheral nerve injury . MR neurography . Decision-making . Diagnostic approach . Therapeutic management Introduction Before surgery is performed for peripheral neuropathy, imaging may be employed for a variety of reasons. Because many peo- ple with peripheral neuropathy present with non-specific sen- sory-motor complaints, the prospective clinical diagnosis of a particular neuropathy can be challenging [1, 2]. Peripheral nerve disorders can be broadly classified as injury, entrapment, tumour, hereditary and other multifactorial polyneuropathy conditions [3]. Current methods for evaluating a suspected neu- ropathy include clinical findings (signs/symptoms/clinical history/physical exam), electrophysiology and imaging. By some estimates, about 100,000 peripheral nerve surgeries are performed every year and the numbers are growing [4]. * Avneesh Chhabra avneesh.chhabra@utsoutwestern.edu 1 Department of Radiology, Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA 2 Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA 3 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA 4 Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA 5 Dellon Institute, Towson, MD, USA 6 Department of Radiology, University of Miami Health System, Miami, FL, USA 7 Department of Radiology and Imaging, Weill Cornell Medical College, Hospital for Special Surgery, New York, NY, USA Eur Radiol DOI 10.1007/s00330-015-3958-y