Seeing the nerves that conventional MRI misses
Conventional pelvic MRI is designed to show organs, not nerves. This is why many patients with pudendal neuralgia or deep gluteal syndrome are told their scan is 'normal' even though the nerve is affected. MR neurography can help close that gap, but it supports a diagnosis rather than making one.
What MR neurography adds
Using 3-Tesla scanners and dedicated neurographic sequences, radiologists can now identify nerve calibre asymmetry, T2 hyperintensity, perineural fibrosis, vascular impingement and entrapment at the ischial spine, sacrospinous or sacrotuberous ligaments, and within Alcock's canal.
How much weight a scan carries
MR neurography is a supporting tool, not a standalone confirmation. How useful a scan is depends heavily on the radiologist reading it: a study read by a radiologist experienced in pelvic neurography is more informative than one read by a generalist. A normal scan does not rule out nerve entrapment, and an abnormal one does not by itself explain a patient's symptoms.
How MR neurography changes treatment planning
When a scan fits the clinical picture and a diagnostic nerve block is positive, it can help identify an anatomical target for treatment. This allows the surgical team to choose the correct approach, whether transgluteal, transperineal or laparoscopic, and to counsel the patient on realistic outcomes.