Evaluation of MRI features of neuromas in oncological amputees, and the relation to pain

Eva van Vliet; Floris V Raasveld; Wen-Chih Liu; Ian L Valerio; Kyle R Eberlin; Erik T Newman; Mohamed Jarraya; F Joseph Simeone; Jad S Husseini

doi:10.1007/s00256-024-04779-0

Evaluation of MRI features of neuromas in oncological amputees, and the relation to pain

Skeletal Radiol. 2024 Sep 12. doi: 10.1007/s00256-024-04779-0. Online ahead of print.

Authors

Eva van Vliet^{1

2}, Floris V Raasveld^{1

3

2}, Wen-Chih Liu^{1

4}, Ian L Valerio², Kyle R Eberlin², Erik T Newman⁵, Mohamed Jarraya⁶, F Joseph Simeone⁶, Jad S Husseini⁷

Affiliations

¹ Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
² Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
³ Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands.
⁴ Department of Orthopedics, Kaohsiung Medical University Hospital, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. jad.husseini@mgh.harvard.edu.

PMID: 39264418
DOI: 10.1007/s00256-024-04779-0

Abstract

Objective: The impact of time on neuroma growth and morphology on pain intensity is unknown. This study aims to assess magnetic resonance imaging (MRI) differences between symptomatic and non-symptomatic neuromas in oncological amputees, and whether time influences MRI-detected neuroma dimensions and their association with pain.

Material and methods: Oncological patients who underwent traditional extremity amputation were included. Post-amputation MRIs were assessed before decision for neuroma surgery. Chart review was performed for residual limb pain (numeric rating scale, 0-10) and the presence of neuropathic symptoms. Neuromas were classified as symptomatic or non-symptomatic, with neuroma size expressed as radiological neuroma-to-nerve-ratio (NNR).

Results: Among 78 neuromas in 60 patients, the median NNR was 2.0, and 56 neuromas (71.8%) were symptomatic with a median pain score of 3.5. NNR showed no association with symptomatology or pain intensity but correlated with a longer time-to-neuroma-excision interval and a smaller nerve caliber. Symptomatic neuromas were associated with lower extremity amputation, T2 heterogeneity, and the presence of heterotopic ossification. Lower extremity amputation, T2 heterogeneity, perineural edema, and presence of heterotopic ossification were associated with more painful neuromas.

Conclusion: MRI features associated with symptomatic neuromas and pain intensity were identified. Awareness of the potential clinical significance of these imaging features may help in the interpretation of MRI exams and may aid clinicians in patient selection for neuroma surgery in oncological amputees.

Keywords: Amputation; MRI; Neuroma; Neuropathic pain.