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Ludi Z, Liau MYQ, Yong BSJ, Auyong ASY, Lynette QHT, Yeo SJ, Tan KSE, Mogali SR, Chandrasekaran R, Perumal V, Vallabhajosyula R. Morphometry of the sural nerve in diabetic neuropathy: a systematic review. J Ultrasound 2024; 27:225-239. [PMID: 38457087 PMCID: PMC11178711 DOI: 10.1007/s40477-024-00875-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/16/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE The aim of this systematic review is to evaluate the usefulness of sural nerve ultrasonography in diagnosing diabetes mellitus (DM) and diabetic polyneuropathy (DPN), the latter of which is a common long-term complication for diabetic patients that frequently involves the sural nerve. METHODOLOGY A meta-analysis of the cross-sectional areas (CSAs) of sural nerves in healthy individuals and patients with diabetes mellitus based on a total of 32 ultrasonographic-based studies from 2015 to 2023 was performed. Sub-analyses were performed for factors such as geographical location and measurement site. RESULTS The meta-analysis showed that the mean CSA of the sural nerve was significantly larger in DM patients with DPN only compared to healthy individuals across all regions and when pooled together. An age-dependent increase in the CSA of healthy sural nerves is apparent when comparing the paediatric population with adults. CONCLUSION Sural nerve ultrasonography can distinguish diabetic adults with DPN from healthy adults based on cross-sectional area measurement. Future studies are needed to clarify the relationships between other parameters, such as body metrics and age, with sural nerve CSAs. Cut-offs for DPN likely need to be specific for different geographical regions.
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Affiliation(s)
- Zhang Ludi
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Matthias Yi Quan Liau
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Bryan Song Jun Yong
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Amanda Sze Yen Auyong
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Quah Hui Ting Lynette
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Samuel Jianjie Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Khin Swee Elizabeth Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Sreenivasulu Reddy Mogali
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Ramya Chandrasekaran
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Vivek Perumal
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Ranganath Vallabhajosyula
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore.
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2
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Pelosi L, Mulroy E, Leadbetter R, Rodrigues M, Roxburgh R. Unique combinations of ultrasound and electrophysiological findings distinguish Friedreich's ataxia from other inherited ataxias. Clin Neurophysiol 2024; 161:157-158. [PMID: 38492270 DOI: 10.1016/j.clinph.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/16/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Luciana Pelosi
- Departments of Neurology and Neurophysiology, Bay Of Plenty District Health Board, Tauranga Hospital, Tauranga, New Zealand.
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, UK
| | - Ruth Leadbetter
- Department of Neurology, Wellington Hospital, Wellington, New Zealand
| | - Miriam Rodrigues
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand; Centre of Brain Research Neurogenetics Research Clinic, University of Auckland, New Zealand
| | - Richard Roxburgh
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand; Centre of Brain Research Neurogenetics Research Clinic, University of Auckland, New Zealand
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Di Pietro G, Cioffi E, Falco P, Galosi E, De Stefano G, Di Stefano G, Leone C, Martines V, Perotti S, Casali C, Truini A. Nerve ultrasound in Friedreich's Ataxia: enlarged nerves as a biomarker of disease severity. Clin Neurophysiol 2024; 159:75-80. [PMID: 38359552 DOI: 10.1016/j.clinph.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/28/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE In Friedreich's ataxia research, the focus is on discovering treatments and biomarkers to assess disease severity and treatment effects. Our study examines high-resolution nerve ultrasound in these patients, seeking correlations with established clinical markers of disease severity. METHOD Ten patients with Friedreich's Ataxia underwent a comprehensive clinical assessment with established scales (SARA, FARS, mFARS, INCAT, ADL 0-36, IADL). Additionally, they underwent nerve conduction studies and high-resolution nerve ultrasound. Quantitative evaluation of nerve cross-sectional area, conducted at 24 nerve sites using high-resolution nerve ultrasound, was compared with data obtained from 20 healthy volunteers. RESULTS All the patients had a severe sensory axonal neuropathy. High-resolution nerve ultrasound showed significant increase, in cross sectional area, of median and ulnar nerves at the axilla and arm. The cumulative count of affected nerve sites was directly associated with clinical disability, as determined by SARA, FARS, mFARS, ADL 0-36, and INCAT score, while displaying an inverse correlation with IADL. CONCLUSIONS Our study shows that high-resolution ultrasound reveals notable nerve abnormalities, primarily in the upper limbs of patients diagnosed with Friedreich's Ataxia. The observed correlation between these nerve abnormalities and clinical disability scales indicates the potential use of this technique as a biomarker for evaluating disease severity and treatment effects. SIGNIFICANCE Nerve Ultrasound is a potential biomarker of disease severity in Friedreich's Ataxia.
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Affiliation(s)
- G Di Pietro
- Department of Human Neuroscience, Sapienza University, Rome, Italy.
| | - E Cioffi
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - P Falco
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - E Galosi
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - G De Stefano
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - G Di Stefano
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - C Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - V Martines
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Italy; UOC Neuroradiologia, Policlinico Umberto I, Roma, Italy
| | - S Perotti
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Italy; UOC Neuroradiologia, Policlinico Umberto I, Roma, Italy
| | - C Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - A Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
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4
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Pelosi L, van Alfen N. Neuromuscular ultrasound as a marker for inherited sensory neuronopathy. Muscle Nerve 2023; 68:718-721. [PMID: 37436126 DOI: 10.1002/mus.27934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 07/13/2023]
Abstract
A review and detailed analysis of the literature over the past two decades has revealed a unique ultrasound feature of pathologically "small" nerves in inherited sensory neuronopathies. Although sample sizes were limited, due to the rarity of these diseases, this characteristic ultrasound finding has been consistently reported across a variety of inherited diseases that affect the dorsal root ganglia. Direct comparisons with both acquired and inherited diseases that primarily affect the axons in the peripheral nerves showed that the ultrasound finding of abnormally "small" cross-sectional areas (CSAs) in mixed nerves of the upper limbs has a high diagnostic accuracy for inherited sensory neuronopathy. Based on this review, ultrasound CSA of the mixed upper limb nerves can be proposed as a marker for inherited sensory neuronopathy.
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Affiliation(s)
- Luciana Pelosi
- Departments of Neurology and Neurophysiology, Bay of Plenty District Health Board, Tauranga Hospital, Tauranga, New Zealand
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
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5
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Roll SC, Takata SC, Yao B, Kysh L, Mack WJ. Sonographic reference values for median nerve cross-sectional area: A meta-analysis of data from healthy individuals. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2023; 39:492-506. [PMID: 37654772 PMCID: PMC10468154 DOI: 10.1177/87564793231176009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Objective Establish median nerve CSA reference values and identify patient-level factors impacting diagnostic thresholds. Methods Studies were identified through a robust search of multiple databases, and quality assessment was conducted using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A meta-analysis was performed to identify normative values stratified by anatomic location. A meta-regression was conducted to examine heterogeneity effects of age, sex, and laterality. Results The meta-analysis included 73 studies; 41 (56.2%) were high quality. The median nerve CSA [95% CI] was 6.46mm2 [6.09-6.84], 8.68mm2 [8.22-9.13], and 8.60mm2 [8.23-8.97] at the proximal forearm, the carpal tunnel inlet, and the proximal carpal tunnel, respectively. Age was positively associated with CSA at the level of proximal carpal tunnel (β=0.03mm2, p=0.047). Men (9.42mm2, [8.06-10.78]) had statistically larger proximal tunnel CSA (p = 0.03) as compared to women (7.71mm2, [7.01-8.42]). No difference was noted in laterality. Conclusion A reference value for median nerve CSA in the carpal tunnel is 8.60mm2. Adjustments may be required in pediatrics or older adults. The diagnostic threshold of 10.0mm2 for male patients should be cautiously applied as the upper limit of normative averages surpasses this threshold.
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Affiliation(s)
- Shawn C. Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Sandy C. Takata
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Buwen Yao
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lynn Kysh
- Institute for Nursing and Interprofessional Research, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Wendy J. Mack
- Division of Population and Public Health, University of Southern California, Los Angeles, CA, USA
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6
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Eby SF, Teramoto M, Lider J, Lash M, Caragea M, Cushman DM. Sonographic peripheral nerve cross-sectional area in adults, excluding median and ulnar nerves: A systematic review and meta-analysis. Muscle Nerve 2023; 68:20-28. [PMID: 36583383 DOI: 10.1002/mus.27783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION/AIMS Although electromyography remains the "gold standard" for assessing and diagnosing peripheral nerve disorders, ultrasound has emerged as a useful adjunct, providing valuable anatomic information. The objective of this study was to conduct a systematic review and meta-analysis evaluating the normative sonographic values for adult peripheral nerve cross-sectional area (CSA). METHODS Medline and Cochrane Library databases were systematically searched for healthy adult peripheral nerve CSA, excluding the median and ulnar nerves. Data were meta-analyzed, using a random-effects model, to calculate the mean nerve CSA and its 95% confidence interval (CI) for each nerve at a specific anatomical location (= group). RESULTS Thirty groups were identified and meta-analyzed, which comprised 16 from the upper extremity and 15 from the lower extremity. The tibial nerve (n = 2916 nerves) was reported most commonly, followed by the common fibular nerve (n = 2580 nerves) and the radial nerve (n = 2326 nerves). Means and 95% confidence interval (CIs) of nerve CSA for the largest number of combined nerves were: radial nerve assessed at the spiral groove (n = 1810; mean, 5.14 mm2 ; 95% CI, 4.33 to 5.96); common fibular nerve assessed at the fibular head (n = 1460; mean, 10.18 mm2 ; 95% CI, 8.91 to 11.45); and common fibular nerve assessed at the popliteal fossa (n = 1120; mean, 12.90 mm2 ; 95% CI, 9.12 to 16.68). Publication bias was suspected, but its influence on the results was minimal. DISCUSSION Two hundred thirty mean CSAs from 15 857 adult nerves are included in the meta-analysis. These are further categorized into 30 groups, based on anatomical location, providing a comprehensive reference for the clinician and researcher investigating adult peripheral nerve anatomy.
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Affiliation(s)
- Sarah F Eby
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Masaru Teramoto
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joshua Lider
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Madison Lash
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Marc Caragea
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Daniel M Cushman
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
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A systematic review: normative reference values of the median nerve cross-sectional area using ultrasonography in healthy individuals. Sci Rep 2022; 12:9217. [PMID: 35654926 PMCID: PMC9163181 DOI: 10.1038/s41598-022-13058-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022] Open
Abstract
Median nerve cross-sectional area (CSA) was used for screening and diagnosis of neuropathy, but few studies have suggested reference range. Hence, this systematic review was performed to evaluate a normative values of median nerve CSA at various landmarks of upper limb based on ultrasonography. PubMed and Web of science were used to search relevant articles from 2000 to 2020. Forty-one eligible articles (2504 nerves) were included to access median nerve CSA at different landmarks (mid-arm, elbow, mid-forearm, carpal tunnel (CT) inlet and CT outlet). Data was also stratified based on age, sex, ethnicity, geographical location, and method of measurement. Random effects model was used to calculate pooled weighted mean (95% confidence interval (CI), [upper bound, lower bound]) at mid-arm, elbow, mid-forearm, CT inlet and outlet which found to be 8.81 mm2, CI [8.10, 9.52]; 8.57 mm2 [8.00, 9.14]; 7.07 mm2 [6.41, 7.73]; 8.74 mm2 [8.45, 9.03] and 9.02 mm2 [8.08, 9.95] respectively. Median nerve CSA varies with age, geographical location, and sex at all landmarks. A low (I2 < 25%) to considerable heterogeneity (I2 > 75%) was observed, indicating the variation among the included studies. These findings show that median nerve CSA is varying not only along its course but also in other sub-variables.
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8
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Hannaford A, Vucic S, Kiernan MC, Simon NG. Review Article "Spotlight on Ultrasonography in the Diagnosis of Peripheral Nerve Disease: The Evidence to Date". Int J Gen Med 2021; 14:4579-4604. [PMID: 34429642 PMCID: PMC8378935 DOI: 10.2147/ijgm.s295851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Neuromuscular ultrasound is rapidly becoming incorporated into clinical practice as a standard tool in the assessment of peripheral nerve diseases. Ultrasound complements clinical phenotyping and electrodiagnostic evaluation, providing critical structural anatomical information to enhance diagnosis and identify structural pathology. This review article examines the evidence supporting neuromuscular ultrasound in the diagnosis of compressive mononeuropathies, traumatic nerve injury, generalised peripheral neuropathy and motor neuron disease. Extending the sonographic evaluation of nerves beyond simple morphological measurements has the potential to improve diagnostics in peripheral neuropathy, as well as advancing the understanding of pathological mechanisms, which in turn will promote precise therapies and improve therapeutic outcomes.
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Affiliation(s)
- Andrew Hannaford
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Steve Vucic
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Neil G Simon
- Northern Beaches Clinical School, Macquarie University, Sydney, Australia
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9
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Broser P, Lütschg J. Funktion und Struktur peripherer Nerven aus
neuropädiatrischer Sicht: Wie klinische, neurophysiologische und
Ultraschalluntersuchungen ergänzende diagnostische Informationen
liefern. KLIN NEUROPHYSIOL 2021. [DOI: 10.1055/a-1506-8603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungIn der vorliegenden Übersicht wird dargestellt, wie sich klinisch
neurophysiologische Methoden (Nervenleitgeschwindigkeit und Elektromyografie)
und Ultraschalluntersuchungen (US) von peripheren Nerven bei der
Abklärung von hereditären senso-motorischen Neuropathien (HMSN),
der Friedreichschen Ataxie, erworbenen Neuropathien (am Beispiel von Diabetes
mellitus) und traumatischen Nervenläsionen bei Kindern
ergänzen können. Bei allen Formen der HMSN 1 kommt es zu einer
Verlangsamung der Nervenleitgeschwindigkeit. Die Ultraschalluntersuchung zeigt
nur bei HMSN1A eine deutlich vergrösserte
Nervenquerschnittsfläche. Beim M. Friedreich können meist
keine sensiblen Potentiale ausgelöst werden und die US-Resultate sind
variabel. Bei traumatischen Nervenläsionen kann vor allem mithilfe der
US-Untersuchung entschieden werden, ob eine operative Nervenrevision indiziert
ist. Die erworbenen Neuropathien werden am Beispiel der diabetischen Neuropathie
dargestellt. Die US- und die ENG Resultate sind oft abnorm, auch wenn klinisch
keine Neuropathie-Symptome nachweisbar sind.
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Fisse AL, Katsanos AH, Gold R, Krogias C, Pitarokoili K. Cross-sectional area reference values for peripheral nerve ultrasound in adults: A systematic review and meta-analysis-Part II: Lower extremity nerves. Eur J Neurol 2021; 28:2313-2318. [PMID: 33794049 DOI: 10.1111/ene.14850] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Measurement of the cross-sectional area (CSA) of peripheral nerves using ultrasound is useful in the evaluation of focal lesions such as entrapment syndromes and inflammatory polyneuropathies. We performed a systematic review and meta-analysis of published CSA reference values for lower extremity nerves. METHODS We included available-to-date nerve ultrasound studies on healthy adults and provide meta-analysis for CSA of the following nerves: fibular nerve at fibular head, popliteal fossa; tibial nerve at popliteal fossa, malleolus; and sural nerve at the level of the two heads of gastrocnemius muscle. We report regression and correlation analyses for age, gender distribution, height, weight, and geographic continent. RESULTS We included 16 studies with 1001 healthy volunteers (mean age = 47.9 years) and 4023 examined nerve sites. Calculated mean pooled CSA of fibular nerve at fibular head was 8.4 mm2 (95% confidence interval [CI] = 6.8-9.9 mm2 , n = 1166), at popliteal fossa was 7.9 mm2 (95% CI = 6.6-9.2 mm2 , n = 995), of tibial nerve at popliteal fossa was 25.9 mm2 (95% CI = 17.5-34.4 mm2 , n = 771), at malleolus was 10.0 mm2 (95% CI = 7.7-12.4 mm2 , n = 779), and of sural nerve was 2.4 mm2 (95% CI = 1.7-3.1 mm2 , n = 312). Substantial heterogeneity across studies (I2 > 50%) was found only for tibial nerve at popliteal fossa. Subgroup analysis revealed a lower CSA of tibial nerve at popliteal fossa and sural nerve in studies conducted in Europe than in North America and New Zealand. CONCLUSIONS We provide the first meta-analysis on CSA reference values for the lower extremities with no or low heterogeneity of reported CSA values in all nerve sites except tibial nerve at popliteal fossa. Our data facilitate the goal of an international standardized evaluation protocol.
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Affiliation(s)
- Anna Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Christos Krogias
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
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Fisse AL, Katsanos AH, Gold R, Pitarokoili K, Krogias C. Cross-sectional area reference values for peripheral nerve ultrasound in adults: A systematic review and meta-analysis-Part III: Cervical nerve roots and vagal nerve. Eur J Neurol 2021; 28:2319-2326. [PMID: 33838065 DOI: 10.1111/ene.14862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/28/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Measurement of the cross-sectional area (CSA) of cervical nerve roots using ultrasound is useful in the evaluation of inflammatory polyneuropathies, and measurement of CSA of the vagal nerve might give information about involvement of the autonomic nervous system. We performed a systematic review and meta-analysis of published CSA reference values for cervical nerve roots and vagal nerve. METHODS We included available-to-date nerve ultrasound studies on healthy adults and provide meta-analysis for CSA of the following nerves: cervical nerve roots C5, C6, and C7 as well as vagal nerve in the carotid sheath at the carotid bifurcation level. We report regression and correlation analyses for age, gender, height, weight, and geographic continent. RESULTS We included 11 studies with 885 healthy volunteers (mean age = 42.7 years) and 3149 examined nerve sites. Calculated mean pooled CSA of C5 root was 5.6 mm2 (95% confidence interval [CI] = 4.6-6.7 mm2 , n = 911), of C6 root was 8.8 mm2 (95% CI = 7.4-10.3 mm2 , n = 909), of C7 root was 9.5 mm2 (95% CI = 8.0-10.9 mm2 , n = 909), and of vagal nerve was 2.2 mm2 (95% CI = 1.5-2.9 mm2 , n = 420). No heterogeneity was found across studies for any site. Subgroup analysis revealed no significant effects of age, gender, height, weight, and geographic continent on CSA for any of these nerve sites. CONCLUSIONS We provide the first meta-analysis on CSA reference values for the cervical nerve roots and the vagal nerve, with no heterogeneity of reported CSA values at all nerve sites. Our data facilitate the goal of an international standardized evaluation protocol.
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Affiliation(s)
- Anna Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Christos Krogias
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
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12
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Fisse AL, Katsanos AH, Gold R, Pitarokoili K, Krogias C. Cross-sectional area reference values for peripheral nerve ultrasound in adults: a systematic review and meta-analysis-Part I: Upper extremity nerves. Eur J Neurol 2021; 28:1684-1691. [PMID: 33527596 DOI: 10.1111/ene.14759] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/22/2020] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Measurement of the cross-sectional area (CSA) of peripheral nerves using ultrasound is useful in the evaluation of focal lesions like entrapment syndromes and inflammatory polyneuropathies. Here, a systematic review and meta-analysis of published CSA reference values for upper extremity nerves was performed. METHODS Available to date nerve ultrasound studies on healthy adults were included and a meta-analysis for CSA was provided of the following nerves: median nerve at the wrist, forearm, upper arm; ulnar nerve at the Guyon's canal, forearm, elbow, upper arm; radial nerve at the upper arm. Regression and correlation analyses for age, gender, height, weight, geographic continents and publication year are reported. RESULTS Seventy-four studies with 4186 healthy volunteers (mean age 42.7 years) and 18,226 examined nerve sites were included. The calculated mean pooled CSA of the median nerve at the wrist was 8.3 mm2 (95% confidence interval [95% CI] 7.9-8.7, n = 4071), at the forearm 6.4 mm2 (95% CI 5.9-6.9, n = 3021), at the upper arm 8.3 mm2 (95% CI 7.5-9.0, n = 1388), of the ulnar nerve at the Guyon's canal 4.1 mm2 (95% CI 3.6-4.6, n = 1688), at the forearm 5.2 mm2 (95% CI 4.8-5.7, n = 1983), at the elbow 5.9 mm2 (95% CI 5.4-6.5, n = 2551), at the upper arm 6.6 mm2 (95% CI 5.1-6.1, n = 1737) and of the radial nerve 5.1 mm2 (95% CI 4.0-6.2, n = 1787). Substantial heterogeneity across studies (I2 > 50%) was found only for the radial nerve. Subgroup analysis revealed a positive effect of age for the median nerve at the wrist and for height and weight for different sites of the ulnar nerve. CONCLUSION The first meta-analysis on CSA reference values for the upper extremities with no or only low heterogeneity of reported CSA values in most nerve sites is provided. Our data facilitate the goal of an international standardized evaluation protocol.
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Affiliation(s)
- Anna Lena Fisse
- Department of Neurology, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - Ralf Gold
- Department of Neurology, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Christos Krogias
- Department of Neurology, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
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13
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Expanding the genotype-phenotype correlation of childhood sensory polyneuropathy of genetic origin. Sci Rep 2020; 10:16184. [PMID: 32999401 PMCID: PMC7528082 DOI: 10.1038/s41598-020-73219-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/14/2020] [Indexed: 01/02/2023] Open
Abstract
Pure sensory polyneuropathy of genetic origin is rare in childhood and hence important to document the clinical and genetic etiologies from single or multi-center studies. This study focuses on a retrospective chart-review of neurological examinations and genetic and electrodiagnostic data of confirmed sensory polyneuropathy in subjects at a tertiary-care Children's Hospital from 2013 to 2019. Twenty subjects were identified and included. Neurological examination and electrodiagnostic testing showed gait-difficulties, absent tendon reflexes, decreased joint-position, positive Romberg's test and large fiber sensory polyneuropathy on sensory nerve conduction studies in all patients associated with lower-extremity spasticity (6), cardiac abnormalities or cardiomyopathy (5), developmental delay (4), scoliosis (3), epilepsy (3) and hearing-difficulties (2). Confirmation of genetic diagnosis in correlation with clinical presentation was obtained in all cases (COX20 n = 2, HADHA n = 2, POLG n = 1, FXN n = 4, ATXN2 n = 3, ATM n = 3, GAN n = 2, SPG7 n = 1, ZFYVE26 n = 1, FH n = 1). Our single-center study shows genetic sensory polyneuropathies associated with progressive neurodegenerative disorders such as mitochondrial ataxia, Friedreich ataxia, spinocerebellar ataxia type 2, ataxia telangiectasia, spastic paraplegia, giant axonal neuropathy, and fumarate hydratase deficiency. We also present our cohort data in light of clinical features reported for each gene-specific disease subtype in the literature and highlight the importance of genetic testing in the relevant clinical context of electrophysiological findings of peripheral sensory polyneuropathy.
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14
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Carroll AS, Simon NG. Current and future applications of ultrasound imaging in peripheral nerve disorders. World J Radiol 2020; 12:101-129. [PMID: 32742576 PMCID: PMC7364285 DOI: 10.4329/wjr.v12.i6.101] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/10/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
Neuromuscular ultrasound (NMUS) is a rapidly evolving technique used in neuromuscular medicine to provide complimentary information to standard electrodiagnostic studies. NMUS provides a dynamic, real time assessment of anatomy which can alter both diagnostic and management pathways in peripheral nerve disorders. This review describes the current and future techniques used in NMUS and details the applications and developments in the diagnosis and monitoring of compressive, hereditary, immune-mediated and axonal peripheral nerve disorders, and motor neuron diseases. Technological advances have allowed the increased utilisation of ultrasound for management of peripheral nerve disorders; however, several practical considerations need to be taken into account to facilitate the widespread uptake of this technique.
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Affiliation(s)
- Antonia S Carroll
- Brain and Mind Research Centre, University of Sydney, Camperdown 2050, NSW, Australia
- Department of Neurology, Westmead Hospital, University of Sydney, Westmead 2145, NSW, Australia
- Department of Neurology, St Vincent’s Hospital, Sydney, Darlinghurst 2010, NSW, Australia
| | - Neil G Simon
- Northern Clinical School, University of Sydney, Frenchs Forest 2086, NSW, Australia
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15
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Broser PJ, Lütschg J. Die Bedeutung neurophysiologischer Methoden in der Abklärung neuropädiatrischer und neuromuskulärer Erkrankungen. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-00819-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Abstract
Advances in high-resolution ultrasound have provided clinicians with unique opportunities to study diseases of the peripheral nervous system. Ultrasound complements the clinical and electrophysiology exam by showing the degree of abnormalities in myopathies, as well as spontaneous muscle activities in motor neuron diseases and other disorders. In experienced hands, ultrasound is more sensitive than MRI in detecting peripheral nerve pathologies. It can also guide needle placement for electromyography exam, therapeutic injections, and muscle biopsy. Ultrasound enhances the ability to detect carpal tunnel syndrome and other focal nerve entrapment, as well as pathological nerve enlargements in genetic and acquired neuropathies. Furthermore, ultrasound can potentially be used as a biomarker for muscular dystrophy and spinal muscular atrophy. The combination of electromyography and ultrasound can increase the diagnostic certainty of amyotrophic lateral sclerosis, aid in the localization of brachial plexus or peripheral nerve trauma and allow for surveillance of nerve tumor progression in neurofibromatosis. Potential limitations of ultrasound include an inability to image deeper structures, with lower sensitivities in detecting neuromuscular diseases in young children and those with mitochondrial myopathies, due to subtle changes or early phase of the disease. As well, its utility in detecting critical illness neuromyopathy remains unclear. This review will focus on the clinical applications of neuromuscular ultrasound. The diagnostic values of ultrasound for screening of myopathies, neuropathies, and motor neuron diseases will be presented.
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17
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Rattay TW, Just J, Röben B, Hengel H, Schüle R, Synofzik M, Söhn AS, Winter N, Dammeier N, Schöls L, Grimm A. Nerve ultrasound characterizes AMN polyneuropathy as inhomogeneous and focal hypertrophic. Orphanet J Rare Dis 2018; 13:194. [PMID: 30390710 PMCID: PMC6215661 DOI: 10.1186/s13023-018-0939-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/22/2018] [Indexed: 12/13/2022] Open
Abstract
Objective High-resolution nerve ultrasound (HRUS) is a painless tool to quickly evaluate peripheral nerve morphology in vivo. This study set out to characterize peripheral nerve involvement in X-linked adrenomyeloneuropathy (AMN) by HRUS. Methods Thirteen adults with genetically proven AMN were examined using the Ultrasound pattern sum score (UPSS) to evaluate morphological abnormalities of peripheral nerves, vagal nerves, as well as cervical nerve roots. Ultrasound results were correlated with clinical findings and nerve conduction studies. Results UPSS was increased in six out of 13 patients. Nerve enlargement was mostly inhomogeneous and regional. The median, ulnar, and vagal nerves presented with more prominent alterations than nerves of the lower limbs. The proximal-to-distal ratio was significantly enlarged for the median nerve. HRUS findings matched nerve conduction studies, but identified one patient with enlarged nerves and yet normal conduction velocities. Sonographic findings did not correlate with disease duration or disease severity as assessed by the spastic paraplegia rating scale. Conclusion HRUS reveals significant multifocal regional nerve swellings with reduced echo intensity as the morphological equivalent of electrophysiological peripheral nerve affection in AMN patients. Ultrasound and NCS characteristics in AMN seem to differ from other demyelinating neuropathies like CIDP or CMT1a. Trial registration German clinical-trial-register (DRKS) (DRKS-ID 00005253) Registered 15 October 2013. Electronic supplementary material The online version of this article (10.1186/s13023-018-0939-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tim W Rattay
- Center for Neurology, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Jennifer Just
- Center for Neurology, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Benjamin Röben
- Center for Neurology, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Holger Hengel
- Center for Neurology, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Rebecca Schüle
- Center for Neurology, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Matthis Synofzik
- Center for Neurology, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Anne S Söhn
- Institute of Medical Genetics and Applied Genomics, Tübingen University Hospital, Tübingen, Germany
| | - Natalie Winter
- Center for Neurology, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Nele Dammeier
- Center for Neurology, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Ludger Schöls
- Center for Neurology, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany. .,German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany.
| | - Alexander Grimm
- Center for Neurology, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
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