Abstract
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Objectives Surgical resection is one of the options in patients with a (malignant) tumour. Interventions for tumours in the head and neck area are challenging because of the many nerves located within the operating field. Iatrogenic nerve lesions and the resulting morbidity is often thought to be inevitable during radical tumor resections. In light of the upcoming hybrid PET/MRI modality, we evaluated the feasibility of visualization of nerves in the head and neck area using preoperative nerve specific MRI. The concept here is that in the future preoperative nerve localization is added to tumor delineation techniques using radiotracers.
Methods Five healthy volunteers and two patients with a tumor in the neck were scanned on a Philips 3T Ingenia MRI scanner. Nerves in the head and neck (specifically the cervical plexus and tongue base) were visualized using a D-prep neurography sequence. Anatomical detail was provided via acquisition of a standard T2-weighted MRI sequence. Overlays of D-prep MRN and T2-weighted images were made using Osirix software.
Results In all cases, nerves of the cervical plexus (diameter 4-5 mm) could be accurately visualized, and traced downward from their ganglion. Furthermore, the vagus nerve (approx. 1.9 mm) and smaller nerves with a diameter between 0.7-1.3 mm could be visualized. In the patients, nerves adjacent or in proximity of to the tumor could also be visualized.
Conclusions 3D identification of small nerves is possible with the D-prep MRN technique. This preoperatively acquired information might be helpful to increase the accuracy of surgical planning.