MRI in Chronic Pudendal Neuralgia: Diagnostic Criteria and Associated Pathologies

Background/Objectives: Chronic pudendal neuralgia is a relatively rare condition in the general population, with an incidence of 1%. Although diagnosis of pudendal neuralgia is mainly clinical, Magnetic Resonance Imaging (MRI) is commonly performed to obtain further information. However, clear criteria and guidelines to MRI diagnosis and clinical-radiological correlation are still not definite. Methods: We reviewed 81 patients with chronic pudendal neuralgia, studied by MRI designed protocol for pelvis and pelvic floor examination. A key element of the protocol was the application of a sequence Axial EPI b0,100,600 for a neurographic evaluation of the nerve. Results: MRI examination revealed DWI abnormalities in 42/81 patients. Pudendal nerve abnormalities were unilateral in 33/42 patients and bilateral in 9/42. Moreover, in 23/42 patients, pathologies related with high probability to the neuropathy have been identified. Conclusions: This study highlights the diagnostic potential of MRI in patients with chronic pudendal neuralgia. The authors suggest MRI criteria to increase reproducibility and confidence in pudendal neuropathy diagnosis.