Diffusion tensor imaging of peripheral nerves in Churg-Strauss syndrome

Author(s): Ryuji Sakakibara, Masahiko Kishi, Tsutomu Inaoka, Hitoshi Terada, Hagino Rikitake

We here describe a case of a 41-year-old woman with asthma, eosinophilia, and multiple mononeuropathies due to Churg-Strauss syndrome (CSS). In this case, multiple mononeuropathies caused allodynia and nerve-stretch pain in the lower extremities. A nerve conduction study and diffusion tensor imaging (DTI) indicated that the major site of lesions was at the right popliteus. Peripheral nerve DTI was found to be a feasible method to help evaluate peripheral nerve function.

diffusion tensor tractography, peripheral nerve, entrapment, Churg-Strauss syndrome

1. Churg J, Strauss L. Allergic granulomatosis, allergic angiitis, and periarteritis nodosa. Am J Pathol 1951; 27: 277- 301
2. Masi AT, Hunder GG, Lie JT, Michel BA, Bloch DA, Arend WP, Calabrese LH, Edworthy SM, Fauci AS, Leavitt RY, et al.The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). Arthritis Rheum.1990; 33: 1094-1100
3. Vaglio A, Moosig F, Zwerina J. Churg-Strauss syndrome: update on pathophysiology and treatment. Curr Opin Rheumatol. 2012; 24: 24-30
4. Basser PJ, Pierpaoli C. Microstructural and physiological features of tissue elucidated by quantiative-diffusion-tensor MRI. J Magn Reson B 1996; 111: 209-219
5. Takagi T, Nakamura M, Yamada M, Hikishima K, Momoshima S, Fujiyoshi K, Shibata S, Okano HJ, Toyama Y, Okano H. Visualization of peripheral nerve degeneration and regeneration: monitoring with diffusion tensor tractography. Neuroimage. 2009; 44: 884-892
6. Hiltunen J, Suortti T, Arvela S, Seppä M, Joensuu R, Hari R. Diffusion tensor imaging and tractography of distal peripheral nerves at 3 T. Clin Neurophysiol. 2005; 116:2315-2323.
7. Chhabra A, Deune GE, Murano E, Prince JL, Soldatos T, Flammang A. Advanced MR neurography imaging of radial nerve entrapment at the spiral groove: a case report. J Reconstr Microsurg. 2012; 28: 263-266
8. Kakuda T, Fukuda H, Tanitame K, Takasu M, Date S, Ochi K, Ohshita T, Kohriyama T, Ito K, Matsumoto M, Awai K. Diffusion tensor imaging of peripheral nerve in patients with chronic inflammatory demyelinating polyradiculoneuropathy: a feasibility study. Neuroradiology. 2011; 53: 955-960