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Preisner F, Pitarokoili K, Lueling B, Motte J, Fisse AL, Grüter T, Godel T, Schwarz D, Heiland S, Gold R, Bendszus M, Kronlage M. Quantitative magnetic resonance neurography in chronic inflammatory demyelinating polyradiculoneuropathy: A longitudinal study over 6 years. Ann Clin Transl Neurol 2024; 11:593-606. [PMID: 38111964 DOI: 10.1002/acn3.51978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To evaluate magnetic resonance neurography (MRN) for the longitudinal assessment of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS Prospective examination of twelve CIDP patients by neurological assessment, MRN, and nerve conduction studies in 2016 and 6 years later in 2022. Imaging parameters were compared with matched healthy controls and correlated with clinical and electrophysiological markers. The MRN protocol included T2-weighted imaging, diffusion tensor imaging (DTI), T2 relaxometry, and magnetization transfer imaging (MTI). RESULTS Nerve cross-sectional area (CSA) was increased in CIDP patients compared to controls (plexus: p = 0.003; sciatic nerve: p < 0.001). Over 6 years, nerve CSA decreased in CIDP patients, most pronounced at the lumbosacral plexus (p = 0.015). Longitudinally, changes in CSA correlated with changes in the inflammatory neuropathy cause and treatment validated overall disability sum score (INCAT/ODSS) (p = 0.006). High initial nerve CSA was inversely correlated with changes in the INCAT/ODSS over 6 years (p < 0.05). The DTI parameter fractional anisotropy (FA) showed robust correlations with electrodiagnostic testing both cross-sectionally and longitudinally (p < 0.05). MTI as a newly added imaging technique revealed a significantly reduced magnetization transfer ratio (MTR) in CIDP patients (p < 0.01), suggesting underlying changes in macromolecular tissue composition, and correlated significantly with electrophysiological parameters of demyelination (p < 0.05). INTERPRETATION This study provides evidence that changes in nerve CSA and FA reflect the clinical and electrophysiological course of CIDP patients. Initial nerve hypertrophy might predict a rather benign course or better therapy response.
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Affiliation(s)
- Fabian Preisner
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Benjamin Lueling
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Tim Godel
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Moritz Kronlage
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
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Niu J, Zhang L, Hu N, Cui L, Liu M. The distribution pattern of nerve enlargement in clinical subtypes of chronic inflammatory demyelinating polyneuropathy. J Neuroimaging 2024; 34:127-137. [PMID: 37823703 DOI: 10.1111/jon.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND PURPOSE We aim to investigate nerve enlargement patterns and their correlation with clinical subtypes and treatment response using nerve ultrasound in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS Between March 2015 and December 2021, 135 CIDP patients were recruited. Nerve ultrasound and electrophysiological studies were performed on the median and ulnar nerves. The responses to intravenous immunoglobulin (IVIg) or prednisone were evaluated with the disability score. RESULTS There were 99 typical CIDP cases, 10 Lewis-Sumner syndrome (LSS) cases, 15 distal acquired demyelinating symmetric neuropathy (DADS) cases, nine pure motor CIDP cases, and two pure sensory CIDP cases. Sixty (61%) typical CIDP and seven (78%) pure motor CIDP patients had moderately increased or normal cross-sectional area (CSA), and 10 (67%) DADS and seven (70%) LSS patients had significantly increased CSA. The peripheral nerve showed a diffuse enlargement pattern in 46 (51%) typical CIDP, five (50%) LSS, three (25%) DADS, and three (33%) pure motor CIDP patients and a proximal regional enlargement pattern in 11 (12%) typical CIDP, one (10%) LSS, six (50%) DADS, and four (44%) pure motor CIDP patients. Patients with diffusely moderate enlargement patterns and those with proximal regional enlargement showed a higher response rate to glucocorticoids than to IVIg. CONCLUSIONS Various distribution patterns of nerve enlargement existed in CIDP. Although almost all patterns could be detected in each CIDP subtype, diffusely moderate enlargement was more common in typical CIDP and LSS, while proximal regional enlargement was more common in DADS and pure motor CIDP. Different enlargement patterns might indicate different treatment responses.
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Affiliation(s)
- Jingwen Niu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Nan Hu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Dhanapalaratnam R, Issar T, Poynten AM, Milner K, Kwai NCG, Krishnan AV. Diagnostic accuracy of nerve ultrasonography for the detection of peripheral neuropathy in type 2 diabetes. Eur J Neurol 2022; 29:3571-3579. [PMID: 36039540 PMCID: PMC9826521 DOI: 10.1111/ene.15534] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/05/2022] [Accepted: 07/13/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Nerve conduction studies (NCS) are the current objective measure for diagnosis of peripheral neuropathy in type 2 diabetes but do not assess nerve structure. This study investigated the utility of peripheral nerve ultrasound as a marker of the presence and severity of peripheral neuropathy in type 2 diabetes. METHODS A total of 156 patients were recruited, and nerve ultrasound was undertaken on distal tibial and distal median nerves. Neuropathy severity was graded using the modified Toronto Clinical Neuropathy Scale (mTCNS) and Total Neuropathy Score (TNS). Studies were undertaken by a single ultrasonographer blinded to nerve conduction results. RESULTS A stepwise increase in tibial nerve cross-sectional area (CSA) was noted with increasing TNS grade (p < 0.001) and each mTCNS quartile (p < 0.001). Regression analysis demonstrated a correlation between tibial nerve CSA and neuropathy severity (p < 0.001). Using receiver operator curve analysis, tibial nerve CSA of >12.88 mm yielded a sensitivity of 70.5% and specificity of 85.7% for neuropathy detection. Binary logistic regression revealed that tibial nerve CSA was a predictor of abnormal sural sensory nerve action potential amplitude (odds ratio = 1.239, 95% confidence interval [CI] = 1.142-1.345) and abnormal neuropathy score (odds ratio = 1.537, 95% confidence interval [CI] = 1.286-1.838). CONCLUSIONS Tibial nerve ultrasound has good specificity and sensitivity for neuropathy diagnosis in type 2 diabetes. The study demonstrates that tibial nerve CSA correlates with neuropathy severity. Future serial studies using both ultrasound and NCS may be useful in determining whether changes in ultrasound occur prior to development of nerve conduction abnormalities and neuropathic symptoms.
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Affiliation(s)
- Roshan Dhanapalaratnam
- Prince of Wales Clinical School, University of New South WalesSydneyNew South WalesAustralia
- Institute of Neurological Sciences, Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Tushar Issar
- Prince of Wales Clinical School, University of New South WalesSydneyNew South WalesAustralia
| | - Ann M. Poynten
- Prince of Wales Clinical School, University of New South WalesSydneyNew South WalesAustralia
- Department of EndocrinologyPrince of Wales HospitalSydneyNew South WalesAustralia
| | - Kerry‐Lee Milner
- Prince of Wales Clinical School, University of New South WalesSydneyNew South WalesAustralia
- Department of EndocrinologyPrince of Wales HospitalSydneyNew South WalesAustralia
| | - Natalie C. G. Kwai
- School of Medical SciencesUniversity of SydneySydneyNew South WalesAustralia
| | - Arun V. Krishnan
- Prince of Wales Clinical School, University of New South WalesSydneyNew South WalesAustralia
- Institute of Neurological Sciences, Prince of Wales HospitalSydneyNew South WalesAustralia
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