Health Organization for Pudendal Education

This information was posted under Australia & new Zealand forum. I thought I'd post it here too.

Information on MRI technique. Queensland XRay Brisbane Australia

With regards to imaging the pudendal nerve with MRI - it is possible. MRI can definitely image nerves and their course through anatomy. We have been imaging with MRI to diagnose piriformis syndrome for a considerable time and have extrapolated this technique for imaging the pudendal nerve.

We have just recently imaged 3 cases of suspected PNE for Peter. We did not find evidence of PNE on these cases. What I would like is a positive case of entrapment to verify the technique that we are using. We are using a 3T system, MRN sequences, diffusion sequences and 3D datasets to track the course of the nerve. We have been able to track the course of the nerve from S2 down into the perineum in normal patients as well as these 3 patients, looking at the two common areas of entrapment - alcocks canal and between the SS ligament and ST ligament.

With the MRN technique you are looking for increased fluid and thickening within the nerve sheath, and by using this technique (sensitive to increased water content in nerves) you are making everything else dark (using heavy fat suppression), making the abnormal nerve 'stand out'.
What is essential for optimal imaging of PNE - site with experience in interpreting and imaging PNE, MRI imaging on a 3T platform is preferred, utilising 3D, MRN, and diffusion sequences.

I think with more cases in this area (and hopefully show some positive cases) we will be able to provide a viable option for imaging PNE patients.

| MRI Coordinator | Queensland X-Ray

Hi Catherine,
Don't forget the dorsal and perineal branches of the Pudendal Nerve.It's great that the Aussie doctors are making headway in the MRI department like their counterparts in the USA.I believe the whole credit goes to you.

Best Regards,
Ali

Also don't forget to include the coccyx ,it is not included unless asked for.

Now which brings me to the question can we the doctors,therapists and PN /PNE suffers ,put together a format for a MRI ,everything that should be included when a doctor asks for a PNE /PN MRI as all the x-ray place will only do is what a doctor asks for ,when there are so many issues with the cause of PNE /PN . WE should have everything covered ,

EG; If a doctor asks for a lumbosacral MRI regarding PNE /PN the the x-ray place , can send a PNE /PN format back to the doctor of other things that should be included ,

Do you think we all can put together a full spectrum of a MRI for a PNE /PN ,so nothing is missed ??

This also can be done with a MRN as well ,and PNMLT ? and may be a physical therapist tests as well ??

What I'm trying to say with this wealth of knowledge on the site we should be able to standardise these tests so they cover every aspect to look for

May be make this a new thread so not to miss anyone ???????