American Society for Peripheral Nerve (ASPN)
Summer 2020
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What's new in nerve this month?
This month we interview Wesley Thayer, MD, PhD, senior author of, Diffusion magnetic resonance imaging predicts peripheral nerve recovery in a rat sciatic nerve injury model, by Angel Farinas, Isaac Manzanera Esteve, Alonda Pollins, Nancy Cardwell, Christodoulos Kaoutzanis, Marlieke Bussenbaum, Mark Does, Richard Dortch, Galen Perdikis, and Wesley Thayer. The article is published in the June issue of Plast Reconstr Surg. Huge shout out to Kevin Zuo, resident at the University of Toronto, for completing this interview and contribution.

1. What is the take home message of your study?
This MRI based, non-invasive imaging technology is capable of predicting nerve recovery before the nerves have reached their target. This could allow for earlier interventions which is particularly important for patients with proximal nerve injuries.

2. What are some of the challenges with regards to more institutions having access to DTI and tractography technology for peripheral nerve imaging?
The MRI run time is long for humans and requires a special coil to get quality data.

3. Where do you think DTI and tractography fit into other investigations of peripheral nerve injury such as clinical exam, electrodiagnostics, and direct surgical exploration?
If you've ever had, or administered, an EMG, you will see why a non-invasive nerve functional assessment is advantageous. We even have promising data on DTI assessment of Carpal Tunnel Syndrome and neuroma detection. I think eventually clinical exam coupled with MRI based assessment will be the standard of care in peripheral nerve assessment.

4. The results of your study suggest 4 weeks is an optimal time in rats to perform DTI to distinguish between different types of nerve injury. What time point do you think would be suitable in humans?
Probably 6-8 weeks, once inflammation has settled and the axons have had time to grow over 2 cm.

5. What are the next steps in your research?
We are using DTI to assess nerve recovery after repair in human clinical trials, also in volunteers to evaluate CTS, neuroma, innervated free tissue transfer cases, and in patients after amputation. It's an exciting technology with many potential applications.

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