Magnetic resonance neurography: part 2- interpretation decoded: a guide to Neuropathy Score Reporting and Data System and imaging signs for efficient diagnosis of peripheral nerve lesions.

AIM: To describe the Neuropathy Score Reporting and Data System (NS‑RADS), outline its practical application in interpreting peripheral neuropathies on magnetic resonance neurography (MRN), and integrate hallmark MRN imaging signs that aid diagnostic evaluation.

MATERIALS AND

METHODS

This narrative review synthesizes current literature on MRN‑based assessment of peripheral neuropathies, including classification frameworks, pattern‑based interpretation strategies, and characteristic imaging signs. NS‑RADS categories and criteria were examined alongside established MRN descriptors to provide a structured approach to evaluating nerve and muscle abnormalities.

RESULTS

Accurate interpretation of peripheral neuropathies on MRN requires high‑quality imaging and a reproducible framework for assessing nerve signal, caliber, fascicular distortion, and denervation. NS‑RADS offers a standardized MRI‑based system for classifying diffuse neuropathy, entrapment, traumatic injury, neoplastic processes, and post‑intervention changes, improving communication and diagnostic confidence. Integrating NS‑RADS with hallmark MRN signs-such as the target, spaghetti, honeycomb, garland, hourglass, Mount Fuji, meandering, zigzag, and triple‑B patterns-enhances recognition of common etiologies including traumatic, compressive, inflammatory, and neoplastic neuropathies. These imaging patterns provide valuable clues to lesion severity, chronicity, and underlying pathophysiology.

CONCLUSION

NS‑RADS, combined with pattern‑based MRN interpretation, provides a practical and efficient framework for evaluating peripheral nerve lesions and differentiating overlapping neuropathic entities. Incorporating standardized reporting with characteristic imaging signs strengthens diagnostic accuracy and supports consistent clinical decision‑making in routine practice.