Imaging Diagnosis of Pelvic Nerve Syndromes

Abstract

Pelvic pain syndromes are common and often neuropathic, with pudendal neuralgia being the most recognized. However, other nerves from the sacral and lumbar plexus-including the iliohypogastric, ilioinguinal, genitofemoral, and posterior femoral cutaneous branches-may also contribute to pelvic and genital neuropathic pain. Diagnosis is challenging due to complex pelvic neuroanatomy and overlapping etiologies. MR neurography plays a key role in evaluating affected nerves and musculoskeletal structures, with advanced sequences improving vascular suppression and nerve conspicuity. While ultrasound and CT mainly guide interventions, MR-ultrasound fusion imaging and MR neurography-guided perineural injections provide more accurate, image-guided treatment strategies.

Keywords: Imaging-guide injection; Lumbosacral plexus; MR neurography; Nerve block; Pain management; Pelvic nerve entrapment; Pelvic pain neuropathy.