From the Guidelines
Neuritis is best evaluated through a combination of MRI and ultrasound imaging, with MRI being the preferred modality for diagnosing neuritis as it provides excellent soft tissue contrast and can detect nerve inflammation, swelling, and signal changes. The choice of imaging modality depends on the suspected location and etiology of the neuritis. For example, in cases of suspected vagus nerve dysfunction, such as vocal cord paralysis, MRI is preferred for imaging the upper course of the nerve, including the skull base, while CT is better suited for examining the lower course of the nerve, particularly in the thorax 1.
In general, MRI sequences such as T2-weighted and STIR are particularly useful for identifying increased signal intensity within affected nerves, while gadolinium-enhanced T1-weighted images can demonstrate abnormal enhancement in cases of active inflammation 1. Ultrasound, on the other hand, serves as a complementary tool, offering real-time assessment of nerve morphology, showing increased cross-sectional area and reduced echogenicity in affected nerves.
Some specific conditions, like Guillain-Barré Syndrome (GBS), may require additional imaging considerations. For instance, nerve root enhancement on gadolinium-enhanced MRI can support a GBS diagnosis, especially in challenging cases 1. Moreover, ultrasound imaging of the peripheral nerves has shown promise in detecting enlarged cervical nerve roots early in the disease course of GBS, potentially aiding in early diagnosis 1.
Overall, the radiological approach to neuritis should be tailored to the specific clinical presentation, taking into account the suspected location and etiology of the neuritis to guide appropriate imaging selection and interpretation. CT has limited utility for neuritis but may help exclude other pathologies, and in cases of suspected inflammatory neuropathies, spine imaging may be necessary to evaluate nerve root involvement 1.
From the Research
Neuritis Radiology
- Neuritis refers to inflammation of the nerves, and radiology plays a crucial role in its diagnosis and treatment [@\5@].
- Optic neuritis, a type of neuritis, is the most common cause of optic neuropathy in young adults [@\1@].
- The use of corticosteroids in treating optic neuritis has been extensively studied, with high-dose intravenous corticosteroids being the standard of treatment [@\1@, @\4@].
- Recent studies have examined the effectiveness of oral corticosteroids as an alternative to intravenous corticosteroids in treating acute optic neuritis, with some studies suggesting that bioequivalent doses of oral corticosteroids may be used as an alternative [@\3@].
- However, other studies have found that corticosteroids may not have a significant impact on the final visual outcome in patients with optic neuritis [@\1@, @\4@].
- In the case of vestibular neuritis, the use of corticosteroids has been found to have short-term benefits in canal paresis but no long-term benefits in canal paresis and symptomatic recovery [@\2@].
- Imaging techniques such as MRI and nerve ultrasound have become useful tools in the diagnosis of inflammatory neuropathies, including neuritis [@\5@].
- These imaging techniques can help identify potentially treatable neuropathies and improve diagnosis [@\5@].