Epineural Scarring Visualization and Noninvasive Quantification of a Severe Posttraumatic Complication: An Experimental Magnetic Resonance Neurography Study.

Abstract

Aim: Peripheral nerve scarring is a severe yet common complication following nerve injury or surgery that can lead to impaired nerve function, including chronic pain and sensory or motor deficits. In this study, we aimed to establish high-resolution magnetic resonance neurography (MRN) to accurately visualize and monitor de novo-formed epineural fibrotic adhesions (EFAs) of the sciatic nerve in a rat nerve injury model.

Methods: Employing an established model to induce overshooting EFA, the study included 3 experimental groups of animals (n = 6 each): a positive control group (PC), an intervention group (IG), and a sham group. All groups underwent surgical nerve exposure: both PC and IG received an application of 10 μL 2.5% glutaraldehyde to induce EFA, but only IG received an additional preventive wrapping of the nerve with a collagen-containing matrix. Magnetic resonance imaging was performed 6, 8, and 12 weeks postoperatively using a standardized protocol including T2w and T1w without and with contrast media. Motor function and nerve regeneration was assessed using the visual static sciatic index. Histological specimens were obtained 12 weeks postoperatively and correlated with imaging.

Results: On high-resolution MRN, prominently contrast-enhancing epineural sleeves were present in vivo, which corresponded to histologically confirmed EFA (ratio of EFA to nerve area MRN 1.512 ± 0.106 vs histological ratio 1.459 ± 0.208, nonsignificant). As expected, average EFA in IG (0.310 ± 0.118 mm2) was smaller than in PC (0.909 ± 0.212 mm2, P < 0.01). Also, the average EFA in sham (0.386 ± 0.030 mm2) was less pronounced than in PC (P < 0.01). There was no significant difference in the average EFA between IG und sham. The EFA correlated with the functional outcome, which was measured by visual static sciatic index (correlation coefficient -0.59, P < 0.05).

Conclusions: The results of the present study for the first time confirm the clinical observation that epineural thickening on contrast-enhanced T1w imaging following manipulation to a nerve indeed corresponds to overshooting epineural scarring, which may be linked to impaired nerve function. This can be followed noninvasively in vivo over time providing an important basis for clinical decision-making in cases where further invasive therapies may be necessary.