Diagnostic imaging
MR neurography — seeing the pudendal nerve.
Standard pelvic MRI is designed for bones and organs, not peripheral nerves. MR neurography is the imaging test that actually shows the pudendal, sciatic and cluneal nerves — and it changes how complex pelvic pain is diagnosed and operated on.
Why standard MRI misses pudendal nerve entrapment
Routine pelvic MRI is optimised for the prostate, uterus, bladder and rectum. Its sequences average out the tiny signal produced by peripheral nerves, so the pudendal nerve is usually invisible on the images.
That is why patients with severe, textbook pudendal neuralgia are so often told their scans are 'normal'. The nerve was never actually imaged.
What MR neurography shows
On a dedicated pelvic MR neurography protocol, the pudendal and neighbouring nerves become directly visible, and typical findings include:
- Pudendal nerve swelling and hyperintensity in the Alcock canal
- Asymmetry between the affected and unaffected side
- Compression at the ischial spine by the sacrospinous ligament
- Concurrent sciatic nerve or piriformis pathology
- Scar tissue after prior pelvic surgery
- Vascular loops or venous varices crossing the nerve
When we order it
MR neurography is not needed for every pelvic pain patient. It is most valuable when the diagnosis is unclear, when a pudendal nerve block gave partial relief, when there is overlap with deep gluteal or piriformis syndrome, or when surgery is on the table and we need to know the precise level of entrapment.
The result is always interpreted alongside symptoms, examination and diagnostic block — not in isolation.
Common questions
What is MR neurography?
MR neurography (MRN) is a high-resolution MRI technique specifically tuned to visualise peripheral nerves. Unlike a standard pelvic MRI, MRN uses dedicated sequences to show the pudendal, sciatic and inferior cluneal nerves along their entire course, including through the Alcock canal and beneath the piriformis muscle.
How is MR neurography different from a normal MRI?
A standard MRI is designed for bones, joints and soft tissue. MR neurography uses fat-suppression, high-field magnets (usually 3 Tesla) and specialised sequences (DWI, T2 SPAIR) to isolate nerve signal. It reveals nerve swelling, asymmetry, scar tissue and entrapment that routine MRI cannot detect.
Can MR neurography confirm pudendal neuralgia?
MRN can support the diagnosis by showing pudendal nerve swelling, asymmetry or entrapment at the ischial spine or Alcock canal, but pudendal neuralgia remains a clinical diagnosis (Nantes criteria). A normal MRN does not exclude the condition, and abnormal findings must correlate with symptoms.
When should MR neurography be ordered?
It is most useful when the clinical picture is unclear, when a diagnostic pudendal nerve block has been positive but symptoms persist, when there is suspected sciatic nerve or piriformis involvement, or when surgery is being considered and the surgeon needs to identify the exact site of entrapment.
Where can I get MR neurography?
MRN requires specialised radiology expertise and is not available at every hospital. The Pelvic Institute works with dedicated pelvic MR neurography centres in Belgium and Dubai; we can guide you to the nearest qualified centre and interpret the images in the context of your symptoms.
Speak with a pudendal nerve specialist.
Dr Renaud Bollens leads a specialist practice dedicated to chronic pelvic pain, with centers in Dubai and Belgium.