If a standard MRI came back normal but you still have nerve symptoms - numbness, burning, weakness, a tingling that will not settle - your consultant may talk about ordering an MR neurography. It is a different scan doing a different job. Instead of imaging the anatomy around a nerve and inferring compression, it images the nerve itself.
MR neurography is not offered at every imaging centre in the UK. It needs a 3T scanner, a validated nerve-selective protocol, and a neuroradiologist trained to read peripheral nerve imaging. This guide is what patients and referrers actually need to know about it in 2026 - when it helps, what it shows, where to get it, and what it costs.
The one-line answer
MR neurography is a specialised MRI protocol that images peripheral nerves directly, using high-resolution 3T sequences designed to make nerve tissue stand out from everything around it. Use it when you need to know exactly where a nerve is compressed, injured or inflamed - and standard MRI has not answered the question.
What MR neurography actually is
A standard MRI of the lumbar spine, or the shoulder, or the wrist, images the region as a whole. Nerves appear on it, but they are not the star. Radiologists look at the discs, the bones, the muscles, the tendons, and then infer whether a nerve is being pinched - a bulging disc pressing on a root, a mass narrowing a tunnel, a scar tethering a plexus.
MR neurography is different. It is a dedicated protocol run on a 3T scanner, using nerve-selective sequences that suppress the signal from fat and blood vessels so peripheral nerves themselves stand out. The most modern variant, diffusion-weighted MR neurography (DW-MRN), uses diffusion sequences to isolate nerve tissue along its full course, producing images where a sciatic nerve or brachial plexus can be followed from origin to branch like a length of rope.
What the reporting neuroradiologist looks at is not the anatomy around the nerve. It is the nerve itself: its calibre, its signal, its fascicular pattern, whether it is continuous or interrupted, and whether it enhances after contrast. That is a genuinely different reading, and it answers questions a standard MRI cannot.
When it beats a standard MRI
A standard MRI is the right first test for most nerve problems - a disc prolapse causing sciatica, a cervical radiculopathy, a hip labral tear irritating a nerve. Neurography is a second-line tool, ordered when the standard scan does not explain the symptoms. In practice, that means five classic situations:
- Piriformis syndrome and deep gluteal pain. Sciatic pain without a clear lumbar cause. Standard lumbar MRI is normal, but the sciatic nerve is being irritated in the buttock. Neurography of the pelvis and proximal sciatic nerve is the test that shows it.
- Thoracic outlet syndrome. Arm pain, hand weakness, numbness worse with overhead activity. Standard MRI does not image the brachial plexus at the level required. A dedicated brachial plexus neurography does, showing compression by a cervical rib, fibrous band or hypertrophied muscle.
- Brachial plexus injury after trauma. Motorbike accidents, birth injuries, penetrating trauma. Neurography maps which nerve roots are avulsed, which are ruptured in continuity, and which are intact - the difference between reconstructable and not.
- Common peroneal nerve compression at the fibular head. A cause of foot drop that a lumbar MRI will never explain. Neurography of the knee shows the peroneal nerve compressed as it wraps the fibula, often by a ganglion or scar.
- Ulnar nerve entrapment beyond the elbow. Where standard MRI has shown a normal cubital tunnel but symptoms persist, neurography can trace the ulnar nerve into the forearm and Guyon's canal to find the real level of compression.
In all five, the pattern is the same. The clinical picture points at a nerve. The standard scan does not explain it. Neurography does.
The clinical questions it answers
Beyond the "where is it compressed" question, MR neurography answers a handful of specific clinical questions that no other test can answer as well:
- Is this nerve compressed, and by what? The most common indication. Neurography shows the site, the calibre change, and the responsible structure - disc, muscle, band, ganglion, tumour.
- Is there a tumour arising from the nerve itself? Schwannomas and neurofibromas grow from nerve sheath tissue and expand a segment of the nerve. Neurography identifies them and shows their relationship to the fascicles, which matters for surgical planning.
- Is there a post-traumatic neuroma? After trauma or surgery, a nerve stump can form a painful, bulbous neuroma. Neurography localises it precisely so it can be injected or resected.
- Is this an inflammatory neuritis? Conditions like Parsonage-Turner syndrome, chronic inflammatory demyelinating polyneuropathy and neuralgic amyotrophy cause nerve signal change and enhancement patterns that neurography can characterise.
The report from a good neuroradiologist reads more like a nerve-by-nerve inventory than a general MRI report. Which nerve, at what level, showing what abnormality, with what implication for treatment.
Which centres run it in the UK
This is the harder half of the answer. MR neurography is not a service every private imaging clinic in the UK offers. In 2026, dedicated peripheral nerve imaging with a validated protocol and specialist reporting is concentrated in a small number of centres, almost all of them in central London, with a few in Oxford, Cambridge and the larger teaching-hospital cities.
The bottleneck is three things: a 3T scanner (not every centre has one), a neurography protocol validated for the region of interest (brachial plexus and lumbosacral plexus are technically demanding), and a neuroradiologist or MSK radiologist with a fellowship in peripheral nerve imaging. Miss any of those three and you get an expensive standard MRI with the word "neurography" on the invoice.
If you are being referred for one, the right question to ask is not "do you do neurography" but "who is reporting it, and how many of these do they read a month". That question tells you whether the study will be worth the money.
The role of EMG and nerve conduction studies
MR neurography and electrodiagnostic tests - EMG and nerve conduction studies - answer different questions. Neurography is anatomical. It tells you where the problem is. EMG and nerve conduction studies are functional. They tell you how the nerve and the muscle it supplies are actually working, electrically.
In real clinical practice, the two are complementary. A neurologist or neurosurgeon planning surgery for a suspected nerve compression usually wants both: the neurography to see the lesion, the electrodiagnostics to confirm that the nerve is dysfunctional at that level and to establish a baseline against which recovery can be measured after treatment. Ordering one without the other often leaves the plan half-complete.
If your consultant orders only one, ask why. There are good reasons in some cases - an obvious tumour on neurography, a clear-cut carpal tunnel confirmed on nerve conduction studies alone - but for most of the interesting cases, both tests earn their keep.
Cost and access
MR neurography privately in the UK in 2026 typically costs £900 to £1,400. That is meaningfully more than a standard private MRI, which sits in the £450 to £900 range. Two reasons: the scan time is longer (45 to 75 minutes rather than 20 to 30), and the reporting radiologist is a subspecialist who commands a subspecialist fee.
Where you land in that range depends on the region imaged and whether contrast is used. Brachial plexus and lumbosacral plexus neurography studies tend to sit at the top of the range because the anatomy is large and the protocol complex. A focused neurography of the peroneal nerve at the knee, or the median nerve at the wrist, is at the lower end.
Access on the NHS exists but is limited to tertiary neurosciences centres and requires consultant-to-consultant referral. Waits are long. Most patients who need one in a useful timeframe end up self-funding or claiming on private insurance, where the study is usually covered when a consultant has requested it with a specific clinical question.
