Seeing the nerves that conventional MRI misses
Conventional pelvic MRI is designed to show organs, not nerves. This is why the majority of patients with pudendal neuralgia or deep gluteal syndrome are told their scan is 'normal' despite having a clear structural lesion. MR neurography closes that gap.
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.
Diagnostic accuracy
Published series from 2024 to 2026 report sensitivity of 76–91% and specificity above 85% for identifying pudendal nerve entrapment when the scan is read by a radiologist experienced in pelvic neurography. Accuracy drops significantly when the study is read by a generalist.
How MR neurography changes treatment planning
A positive scan combined with a positive diagnostic nerve block establishes an anatomical target for treatment. This allows the surgical team to choose the correct approach — transgluteal, transperineal or laparoscopic — and to counsel the patient on realistic outcomes.