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Nasr-Eldin YK, Cartwright MS, Hamed A, Ali LH, Abdel-Nasser AM. Neuromuscular Ultrasound in Polyneuropathies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1181-1198. [PMID: 38504399 DOI: 10.1002/jum.16447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/21/2024]
Abstract
Neuromuscular ultrasound is a painless, radiation-free, high-resolution imaging technique for assessing the peripheral nervous system. It can accurately depict changes in the nerves and muscles of individuals with neuromuscular conditions, and it is therefore a robust diagnostic tool for the assessment of individuals with polyneuropathies. This review will outline the typical ultrasonographic changes found in a wide variety of polyneuropathies. In general, demyelinating conditions result in greater nerve enlargement than axonal conditions, and acquired conditions result in more patchy nerve enlargement compared to diffuse nerve enlargement in hereditary conditions. This review is data-driven, but more nuanced anecdotal findings are also described. The overall goal of this paper is to provide clinicians with an accessible review of the ultrasonographic approaches and findings in a wide variety of polyneuropathies.
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Affiliation(s)
| | - Michael S Cartwright
- Neurology Department, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ahmed Hamed
- Rheumatology and Rehabilitation Department, Minia University, Minia, Egypt
| | - Lamia Hamdy Ali
- Clinical Pathology Department, Minia University, Minia, Egypt
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Cuendet D, Valsecchi D, Najberg H, Maestretti G, Medlin F. Neuromuscular ultrasound changes in unilateral symptomatic subacute lumbosacral radiculopathy: A prospective simple blinded cohort study. Muscle Nerve 2024; 69:566-571. [PMID: 38390643 DOI: 10.1002/mus.28061] [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: 03/10/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION/AIMS Lumbosacral radiculopathy (LR) is a common disorder. Neuromuscular ultrasound (NMU) is a rapidly evolving technique for the investigation of peripheral nerve and muscle disorders, but studies using NMU in LR are lacking. The aim of the present study was to investigate ultrasonographic neuromuscular changes distant from root compression in patients with subacute to chronic compressive LR with motor impairment. METHODS Patients with unilateral subacute to chronic L4, L5, or S1 radiculopathy with motor impairment and confirmed by magnetic resonance imaging were included. The sciatic and femoral nerve cross-sectional areas (CSA), the CSA of lower limb muscles, and muscle fasciculation detection rate were assessed using a pre-specified neuromuscular ultrasound evaluation with blinded side-to-side comparison. RESULTS Of the 18 included patients, 66% were male and the mean age was 51 years. Overall, 16.7% had L4, 55.5% L5, and 27.8% S1 radiculopathy, mostly due to disc herniation (83%). Sciatic nerve CSA of the symptomatic side was increased (61.4 mm2 vs. 51.3 mm2; p = .001), and the fasciculation detection rate was higher in the affected muscles (delta = 13%, p = .007) compared to unaffected ones. Muscle CSA in affected and nonaffected muscles was decreased on the symptomatic side. DISCUSSION NMU evaluation in patients with symptomatic subacute to chronic LR revealed sciatic nerve enlargement distant from nerve root compression and higher fasciculation rates. These structural findings on NMU might be due to an axonal repair mechanism and an inflammatory response with endoneurial edema induced by ongoing nerve damage and potentially reflect progressive axonal loss.
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Affiliation(s)
- David Cuendet
- Neurology Unit, Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
| | - Daniele Valsecchi
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
- Neuro-spinal Unit, Department of Orthopedics surgery and Traumatology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Hugo Najberg
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
| | - Gianluca Maestretti
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
- Neuro-spinal Unit, Department of Orthopedics surgery and Traumatology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Friedrich Medlin
- Neurology Unit, Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
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Murciano Casas MP, Rodríguez-Piñero Durán M, Delgado Mendilivar JM, Expósito Tirado JA, Jiménez Sarmiento AS. [Analysis of the echographic parameters described in the study of carpal tunnel syndrome: A systematic review]. Rehabilitacion (Madr) 2024; 58:100822. [PMID: 37864963 DOI: 10.1016/j.rh.2023.100822] [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: 08/21/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 10/23/2023]
Abstract
Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy; the diagnosis is established by electrodiagnostic tests with until 34% of false positives/negatives. We present the following systematic review which objective is to analyze the most recent literature related to the ultrasound parameters described to study CTS. We selected studies that evaluated ultrasound parameters in patients with clinical suspicion following the Cochrane manual's recommendations. We include systematic reviews, meta-analyses, case-control studies and diagnostic tests, evaluating retrospective studies and bibliographic reviews with proper methodological quality. Articles published between 2005 and 2019. We included eight articles (two systematic reviews/meta-analyses, two case-control studies, one diagnostic test study, two literature reviews, and one retrospective). The parameters analyzed were cross-sectional area, wrist-forearm index, entry-exit index, thinning range, palmar bowing of the flexor retinaculum, and vascularity/mobility. Current evidence allows us to affirm that ultrasound is useful in screening for CTS.
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Affiliation(s)
- M P Murciano Casas
- Servicio de Rehabilitación y Medicina Física, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | | | | | - J A Expósito Tirado
- Servicio de Rehabilitación y Medicina Física, Hospital Virgen de Valme, Sevilla, España
| | - A S Jiménez Sarmiento
- Servicio de Rehabilitación y Medicina Física, Hospital Virgen de Valme, Sevilla, España
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Elkholy AR, Rezk EM, Shabaan N, Elkhouly RM, Shamhoot EA. The role of preoperative ultrasound in the management of peripheral nerve injuries. Clin Neurol Neurosurg 2024; 236:108083. [PMID: 38104445 DOI: 10.1016/j.clineuro.2023.108083] [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: 11/07/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Peripheral nerve injury refers to any damage or trauma to the nerves located outside the central nervous system. Ultrasonography is a reliable, cheap, and minimally invasive method in clinical practice to give physicians useful information about nerve injury. OBJECTIVES to assess the power of ultrasound in determining the presence, localization, and extent of neural damage in patients with clinical evidence of peripheral nerve lesions before surgery. METHODS This cross-sectional study was conducted on 78 patients (56 females and 22 males, aged from 9 to 52 years) who had different pathologies including entrapment, tumoral, post-traumatic, and post-surgical nerve injuries at the Neurosurgery and Physical Medicine, Rheumatology, and Rehabilitation Departments, Tanta University Hospitals. All studied patients had preoperative evaluation; neurological examination, electrodiagnostic studies, and sonographic examinations with linear array transducers (frequencies ranging from 7.5 to 16 MHz). RESULTS The most common pathological condition was entrapment neuropathy (39 patients) (50%). Ultrasound complemented the electrodiagnostic studies by determining the site of entrapment manifested by increased mean maximum cross-sectional area of the nerve proximal to the site of entrapment and nerve hypoechogenicity. In post-traumatic and iatrogenic neuropathies (35 patients) (44.9%), the ultrasound finding revealed neuroma in continuity in nine cases (11.5%), complete neurotmesis with stump neuroma in eighteen patients (23.1%), and eight cases (10.3%) showed perineural adhesion. In all cases, the nerve was hypoechoic at the site of injury. The presence of hyperechoic fibrous tissue could indicate perineural adhesion and the necessity for neurolysis. This study also included three (3.8%) cases had schwannoma, and one case (1.3%) had neurofibroma. Ultrasound was used to confirm the diagnosis by determining the tumor's size and vascular supply. CONCLUSIONS Ultrasonography is a diagnostic and surgical planning tool that is becoming more and more useful for the management of peripheral nerve injuries. Its high resolution and real-time capability provide safe and cost-effective scans that aid in determining the extent of injuries. For patients with peripheral nerve injuries, ultrasound is advised to be added to the routine clinical and neurophysiological evaluation. It is also advised to use ultrasound as a first-line imaging modality for tumors thought to be of nerve origin.
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Affiliation(s)
- Ahmed R Elkholy
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt
| | - Essam M Rezk
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt.
| | - Nehal Shabaan
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt
| | - Radwa M Elkhouly
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Tanta University, Egypt
| | - Ebrahim A Shamhoot
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt
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Gruber L, Loizides A, Gruber H, Skalla E, Haushammer S, Horlings C, Beer R, Helbok R, Löscher WN. Differentiation of Critical Illness Myopathy and Critical Illness Neuropathy Using Nerve Ultrasonography. J Clin Neurophysiol 2023; 40:600-607. [PMID: 35089907 DOI: 10.1097/wnp.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Intensive care unit-acquired weakness occurs frequently in intensive care unit patients, including critical illness myopathy (CIM) and critical illness polyneuropathy (CIPN). The authors present a prospective study to assess the ultrasound pattern sum score to differentiate between confirmed CIM, sensory neuropathy, and CIPN cases. METHODS Cross-sectional areas of 12 predefined nerve segments in 16 patients were sonographically examined. Single-nerve cross-sectional areas and ultrasound pattern sum score values were compared; results are given as P -values and receiver operating characteristic area under the curve (AUC). RESULTS In neuropathy, significant single-nerve cross-sectional area enlargement was observed in the median ( P = 0.04), ulnar ( P = 0.04), and fibular nerves ( P = 0.0003). The ultrasound pattern sum score could reliably differentiate between pure CIM and neuropathy ( P = 0.0002, AUC 0.92), CIM and sensory neuropathy ( P = 0.001, AUC 0.88), and CIM and CIPN ( P = 0.007, AUC 0.92), but not between sensory neuropathy and CIPN ( P = 0.599, AUC 0.48). CONCLUSIONS Nerve ultrasonography reliably identifies neuropathy in intensive care unit-acquired weakness, yet cannot differentiate between sensory neuropathy and CIPN. A standardized ultrasound algorithm can serve as a fast bedside test for the presence of neuropathy in intensive care unit-acquired weakness.
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Affiliation(s)
- Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Alexander Loizides
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Hannes Gruber
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Elisabeth Skalla
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Silke Haushammer
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Corinne Horlings
- Department of Neurology, School of Mental Health and Neuroscience, Maastricht University Medical Centre+, Maastricht, the Netherlands; and
| | - Ronny Beer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang N Löscher
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Khademi S, Kordi Yoosefinejad A, Motealleh A, Rezaei I, Abbasi L, Jalli R. The sono-elastography evaluation of the immediate effects of neurodynamic mobilization technique on median nerve stiffness in patients with carpal tunnel syndrome. J Bodyw Mov Ther 2023; 36:62-68. [PMID: 37949601 DOI: 10.1016/j.jbmt.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The stiffness of median nerve increases in carpal tunnel syndrome (CTS) even at mild stage of syndrome which could be regarded as a diagnostic criterion. The aim of this study was to evaluate the immediate effects of neurodynamic technique on median nerve stiffness and cross-sectional area (CSA) at wrist and elbow in individuals with CTS. MATERIAL AND METHODS It was a quasi-experimental study. Twenty patients were recruited for this study. They were included if aged 18-65 years and diagnosed with CTS based on electrodiagnostic and clinical findings. The exclusion criteria were previous surgeries at wrist or elbow. Patients were assessed by shear wave sono-elastography before and immediately after one session of neurodynamic mobilization technique (NDM). The primary outcome measure was the stiffness of the median nerve at wrist and the secondary outcomes were nerve stiffness at elbow and CSA of nerve at wrist and elbow. RESULTS Median nerve stiffness and CSA decreased significantly at wrist immediately after a session of NDM. These parameters also decreased at elbow but were not statistically significant. CONCLUSION One session of NDM reduced the stiffness and CSA of median nerve at wrist in patients with CTS as detected by sono-elastography verifying that sono-elastography is able to quickly detect the immediate biomechanical changes of the median nerve.
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Affiliation(s)
- Sahar Khademi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Kordi Yoosefinejad
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Motealleh
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Rezaei
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Abbasi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Jalli
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Serhal A, Lee SK, Michalek J, Serhal M, Omar IM. Role of high-resolution ultrasound and magnetic resonance neurography in the evaluation of peripheral nerves in the upper extremity. J Ultrason 2023; 23:e313-e327. [PMID: 38020515 PMCID: PMC10668945 DOI: 10.15557/jou.2023.0037] [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: 08/06/2023] [Accepted: 08/30/2023] [Indexed: 12/01/2023] Open
Abstract
Upper extremity entrapment neuropathies are common conditions in which peripheral nerves are prone to injury at specific anatomical locations, particularly superficial regions or within fibro-osseous tunnels, resulting in pain and potential disability. Although neuropathy is primarily diagnosed clinically by physical examination and electrophysiology, imaging evaluation with ultrasound and magnetic resonance neurography are valuable complementary non-invasive and accurate tools for evaluation and can help define the site and cause of nerve dysfunction which ultimately leads to precise and timely treatment. Ultrasound, which has higher spatial resolution, can quickly and comfortably characterize the peripheral nerves in real time and can evaluate for denervation related muscle atrophy. Magnetic resonance imaging on the other hand provides excellent contrast resolution between the nerves and adjacent tissues, also between pathologic and normal segments of peripheral nerves. It can also assess the degree of muscle denervation and atrophy. As a prerequisite for nerve imaging, radiologists and sonographers should have a thorough knowledge of anatomy of the peripheral nerves and their superficial and deep branches, including variant anatomy, and the motor and sensory territories innervated by each nerve. The purpose of this illustrative article is to review the common neuropathy and nerve entrapment syndromes in the upper extremities focusing on ultrasound and magnetic resonance neurography imaging.
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Affiliation(s)
- Ali Serhal
- Department of Radiology, Northwestern University, Chicago, USA
| | | | - Julia Michalek
- Department of Radiology, Northwestern Memorial Hospital, Chicago, USA
| | - Muhamad Serhal
- Department of Radiology, Northwestern University, Chicago, USA
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Toros T, Isin BK, Erol K, Cetinkol E. Role of ultrasonography for evaluation of nerve recovery in repaired median nerve lacerations. J Hand Surg Eur Vol 2023; 48:725-730. [PMID: 37203386 DOI: 10.1177/17531934231174603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
This study aimed to investigate whether ultrasonographic inspection of the repair site of median nerve lacerations may provide useful evidence about the functional outcome in the affected hand. Forty-three patients with complete transection of the median nerve at the distal forearm were examined at a median of 40.9 months after operation by detailed ultrasonographic imaging and clinical assessment of the affected hand by the Michigan Hand Questionnaire and Rosén-Lundborg Protocol to investigate the quality of nerve healing. The continuity of individual nerve fascicles was assessed and the cross-sectional area of the enlarged nerve at the repair site was measured and compared with the contralateral median nerve at the same level. An enlargement ratio for the repair site of each nerve was calculated and compared with the numeric results obtained from the two clinical tests. A statistically significant reverse correlation was observed between nerve enlargement and the functional results of the repaired nerve.Level of evidence: IV.
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Affiliation(s)
- Tulgar Toros
- Izmir University of Economics, Faculty of Medicine, Hand and Microsurgery & Orthopedics and Traumatology (EMOT) Hospital, Izmir, Turkey
| | - Beray Kelesoglu Isin
- Hand and Microsurgery & Orthopedics and Traumatology (EMOT) Hospital, Izmir, Turkey
| | - Kubilay Erol
- Hand and Microsurgery & Orthopedics and Traumatology (EMOT) Hospital, Izmir, Turkey
| | - Erkin Cetinkol
- Hand and Microsurgery & Orthopedics and Traumatology (EMOT) Hospital, Izmir, Turkey
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Kelley N, Hubbard J, Belton M. Cubital tunnel compression neuropathy in the presence of an anomalous venous complex: a case study. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:427-430. [PMID: 37588498 PMCID: PMC10426564 DOI: 10.1016/j.xrrt.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Naomi Kelley
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - James Hubbard
- Department of Orthopedic Surgery, Mercy Hospital St. Louis, St. Louis, MO, USA
| | - Matthew Belton
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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Breville G, Sukockiene E, Vargas MI, Lascano AM. Emerging biomarkers to predict clinical outcomes in Guillain-Barré syndrome. Expert Rev Neurother 2023; 23:1201-1215. [PMID: 37902064 DOI: 10.1080/14737175.2023.2273386] [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: 04/18/2023] [Accepted: 10/17/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is an immune-mediated poly(radiculo)neuropathy with a variable clinical outcome. Identifying patients who are at risk of suffering from long-term disabilities is a great challenge. Biomarkers are useful to confirm diagnosis, monitor disease progression, and predict outcome. AREAS COVERED The authors provide an overview of the diagnostic and prognostic biomarkers for GBS, which are useful for establishing early treatment strategies and follow-up care plans. EXPERT OPINION Detecting patients at risk of developing a severe outcome may improve management of disease progression and limit potential complications. Several clinical factors are associated with poor prognosis: higher age, presence of diarrhea within 4 weeks of symptom onset, rapid and severe weakness progression, dysautonomia, decreased vital capacity and facial, bulbar, and neck weakness. Biological, neurophysiological and imaging measures of unfavorable outcome include multiple anti-ganglioside antibodies elevation, increased serum and CSF neurofilaments light (NfL) and heavy chain, decreased NfL CSF/serum ratio, hypoalbuminemia, nerve conduction study with early signs of demyelination or axonal loss and enlargement of nerve cross-sectional area on ultrasound. Depicting prognostic biomarkers aims at predicting short-term mortality and need for cardio-pulmonary support, long-term patient functional outcome, guiding treatment decisions and monitoring therapeutic responses in future clinical trials.
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Affiliation(s)
- Gautier Breville
- Neurology Division, Neuroscience Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Egle Sukockiene
- Neurology Division, Neuroscience Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Maria Isabel Vargas
- Neuroradiology Division, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Agustina M Lascano
- Neurology Division, Neuroscience Department, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Wu WT, Chang KV, Hsu YC, Tsai YY, Mezian K, Ricci V, Özçakar L. Ultrasound Imaging and Guidance for Distal Peripheral Nerve Pathologies at the Wrist/Hand. Diagnostics (Basel) 2023; 13:diagnostics13111928. [PMID: 37296780 DOI: 10.3390/diagnostics13111928] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Ultrasound has emerged as a highly valuable tool in imaging peripheral nerve lesions in the wrist region, particularly for common pathologies such as carpal tunnel and Guyon's canal syndromes. Extensive research has demonstrated nerve swelling proximal to the entrapment site, an unclear border, and flattening as features of nerve entrapments. However, there is a dearth of information regarding small or terminal nerves in the wrist and hand. This article aims to bridge this knowledge gap by providing a comprehensive overview concerning scanning techniques, pathology, and guided-injection methods for those nerve entrapments. The median nerve (main trunk, palmar cutaneous branch, and recurrent motor branch), ulnar nerve (main trunk, superficial branch, deep branch, palmar ulnar cutaneous branch, and dorsal ulnar cutaneous branch), superficial radial nerve, posterior interosseous nerve, palmar common/proper digital nerves, and dorsal common/proper digital nerves are elaborated in this review. A series of ultrasound images are used to illustrate these techniques in detail. Finally, sonographic findings complement electrodiagnostic studies, providing better insight into understanding the whole clinical scenario, while ultrasound-guided interventions are safe and effective for treating relevant nerve pathologies.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
| | - Yu-Chun Hsu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan
| | - Yuan-Yuan Tsai
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital, Charles University, 12800 Prague, Czech Republic
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 20157, Turkey
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Kawanishi K, Kakimoto A, Anegawa K, Tsutsumi M, Yamaguchi I, Kudo S. Automatic Identification of Ultrasound Images of the Tibial Nerve in Different Ankle Positions Using Deep Learning. SENSORS (BASEL, SWITZERLAND) 2023; 23:4855. [PMID: 37430769 DOI: 10.3390/s23104855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 07/12/2023]
Abstract
Peripheral nerve tension is known to be related to the pathophysiology of neuropathy; however, assessing this tension is difficult in a clinical setting. In this study, we aimed to develop a deep learning algorithm for the automatic assessment of tibial nerve tension using B-mode ultrasound imaging. To develop the algorithm, we used 204 ultrasound images of the tibial nerve in three positions: the maximum dorsiflexion position and -10° and -20° plantar flexion from maximum dorsiflexion. The images were taken of 68 healthy volunteers who did not have any abnormalities in the lower limbs at the time of testing. The tibial nerve was manually segmented in all images, and 163 cases were automatically extracted as the training dataset using U-Net. Additionally, convolutional neural network (CNN)-based classification was performed to determine each ankle position. The automatic classification was validated using five-fold cross-validation from the testing data composed of 41 data points. The highest mean accuracy (0.92) was achieved using manual segmentation. The mean accuracy of the full auto-classification of the tibial nerve at each ankle position was more than 0.77 using five-fold cross-validation. Thus, the tension of the tibial nerve can be accurately assessed with different dorsiflexion angles using an ultrasound imaging analysis with U-Net and a CNN.
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Affiliation(s)
- Kengo Kawanishi
- Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan
- Department of Rehabilitation, Kano General Hospital, Osaka 531-0041, Japan
| | - Akihiro Kakimoto
- Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan
- Department of Radiological Sciences, Faculty of Health Sciences, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan
| | - Keisuke Anegawa
- Graduate School of Health Science, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan
| | - Masahiro Tsutsumi
- Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan
| | - Isao Yamaguchi
- Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan
- Department of Radiological Sciences, Faculty of Health Sciences, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan
| | - Shintarou Kudo
- Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan
- AR-Ex Medical Research Center, Tokyo 158-0082, Japan
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Canales-Lachén E, Asunsolo Á, Manrique OJ, Blázquez J, Holguín P, Maldonado AA. The Use of Ultrasound Imaging for Upper Extremity Lymphedema after Breast Cancer: A Systematic Review. J Reconstr Microsurg 2023; 39:102-110. [PMID: 36162421 DOI: 10.1055/s-0042-1750824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The aim of this study was to analyze the different applications of ultrasound (US) in upper extremity lymphedema (UEL) after breast cancer. METHODS A systematic review of the literature was performed in line with the PRISMA statement using MEDLINE/PubMed databases from January 1970 to December 2021. Articles describing the application of US in patients with UEL after breast cancer were included. The quality of the study, the level of reproducibility, and the different applications and type of US technique were analyzed. RESULTS In total, 30 articles with 1,193 patients were included in the final review. Five different applications were found: (1) diagnosis of UEL (14 studies found a direct correlation between lymphedema and morphological and/or functional parameters); (2) staging/severity of UEL (9 studies found a direct correlation between the clinical stage and the soft-tissue stiffness/texture/thickness); (3) therapeutic assessment (3 studies found an improvement in the circulatory status or in the muscle/subcutaneous thickness after conservative treatments); (4) prognosis assessment of UEL (1 study found a correlation between the venous flow and the risk of UEL); and (5) surgical planning (3 studies determined the location of the lymphatic vessel for lymphovenous anastomosis [LVA] surgery). CONCLUSION Morphological and functional parameters have been correlated with the diagnosis, stage, therapeutic effect, prognosis of UEL, and surgical planning of LVA.
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Affiliation(s)
| | - Ángel Asunsolo
- Department of Surgery, Medical and Social Science, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Oscar J Manrique
- Deparment of Plastic Surgery, University of Rochester Medical Center, Rochester, New York
| | - Javier Blázquez
- Department of Radiology, University Hospital Ramón y Cajal, Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | | | - Andrés A Maldonado
- Department of Surgery, Medical and Social Science, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain.,Department of Plastic Surgery, University Hospital Getafe, Madrid, Spain.,Department of Plastic, Hand and Reconstructive Surgery, BG Trauma Center Frankfurt am Main, Academic Hospital of the Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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14
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Kitaoji T, Noto YI, Kojima Y, Tsuji Y, Kitani-Morii F, Mizuno T, Nakagawa M. Compound muscle action potential duration ratio for differentiation between Charcot-Marie-Tooth disease and CIDP. Clin Neurophysiol 2023; 146:124-130. [PMID: 36608530 DOI: 10.1016/j.clinph.2022.12.004] [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: 10/18/2022] [Revised: 11/19/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To elucidate the utility of the proximal to distal compound muscle action potential (CMAP) duration ratio to distinguish between demyelinating Charcot-Marie-Tooth disease (CMT) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) compared with nerve ultrasound. METHODS Thirty-nine demyelinating CMT patients and 19 CIDP patients underwent nerve conduction studies (NCS) and nerve ultrasound. NCS parameters including CMAP duration ratio calculated by dividing the value at the proximal site by that at the distal site and nerve cross-sectional area (CSA) measured by ultrasound were compared between the two groups. The diagnostic sensitivity and specificity of each parameter were analysed. RESULTS CMT patients showed a significantly lower CMAP duration ratio than CIDP patients (p < 0.05). The area under the curve (AUC) value of the CMAP duration ratio exceeded 0.95 when CMT was considered "positive", and a cut-off value of 1.13 resulted in high diagnostic sensitivity and specificity (84.6 and 100 % for median nerve, 97.4 and 85.7 % for ulnar nerve, respectively), whereas the AUC value of nerve CSA ranged from 0.70 to 0.81. CONCLUSIONS The CMAP duration ratio could effectively distinguish between demyelinating CMT and CIDP. SIGNIFICANCE Adding the CMAP duration ratio to a routine NCS may improve the accuracy of the diagnosis of demyelinating CMT.
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Affiliation(s)
- Takamasa Kitaoji
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Yuta Kojima
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Yukiko Tsuji
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Fukiko Kitani-Morii
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Molecular Pathobiology of Brain Disease, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Toshiki Mizuno
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Masanori Nakagawa
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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15
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Ibrahim HR. Diagnostic value of shear wave ultrasound elastography of tibial nerve in patients with diabetic peripheral neuropathy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00779-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Diabetic peripheral neuropathy (DPN) is a major complication of Diabetes mellitus. So this study aimed at investigation of the value of tibial nerve stiffness measured by shear wave ultrasound elastography (SWE) for detection of DPN. This case–control study involved 50 patients with DPN, 50 patients with diabetes mellitus but without DPN, and 50 healthy controls. Clinical examination, nerve conduction study of both tibial nerves, high resolution ultrasound and SWE to assess cross sectional area "CSA" of tibial nerves, and tibial nerves mean stiffness, respectively. ROC curve analysis was also performed.
Results
Mean tibial nerve stiffness by SWE was higher in patients with DPN compared to other groups (P value < 0.001). The CSA of the tibial nerve in the DPN group was significantly larger than that in the other groups (P value = 0.01). The cutoff value by ROC curve analysis for tibial nerve stiffness to differentiate patients with DPN and control group was 70.6 kPa (P value < 0.001, 95.4% sensitivity, 94.7% specificity, AUC = 0.963), while 86.5 kPa was the optimal cutoff point to differentiate patients with DPN and other groups with a 94.6% sensitivity, 93.8% specificity, AUC of 0.975 and P value < 0.001. Higher diagnostic accuracy was found when combination of SWE and high resolution US (high resolution US + shear wave; 0.987, P value < 0.001).
Conclusions
Tibial nerve stiffness was increased in patients with DPN. SWE can be used as an effective complementary method in diagnosis of DPN with high sensitivity and accuracy.
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16
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Greenfield AL, Parrikh M, Kanesa-Thasan R. Ultrasonographic Evaluation of Peripheral Nerves: Technical Considerations. Semin Musculoskelet Radiol 2022; 26:105-113. [PMID: 35609572 DOI: 10.1055/s-0042-1742606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Advances in ultrasonographic (US) technology featuring high-resolution transducers have revolutionized US over recent years as a modality increasingly used in the evaluation of musculoskeletal structures and peripheral nerves. A wide variety of nerve pathologies can be detected, such as neoplastic and tumorlike lesions, entrapment syndromes, posttraumatic injuries, and inflammatory conditions. US can serve as an imaging tool for guiding percutaneous treatments, such as injection therapies or hydrodissection, and assist with perioperative nerve marking and visualization of peripheral nerves in the operating room. This article describes the normal US appearance of peripheral nerves, US imaging techniques, common peripheral nerve pathologies, and interventional applications.
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Affiliation(s)
- Antje L Greenfield
- Section of Musculoskeletal Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mannan Parrikh
- Section of Musculoskeletal Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Riti Kanesa-Thasan
- Section of Musculoskeletal Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
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17
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Crump NH, Cartwright MS. A Retrospective Study of Ultrasound Accuracy for the Diagnosis of Chronic Inflammatory Demyelinating Polyneuropathy. J Clin Neurophysiol 2022; 39:312-316. [PMID: 33009042 DOI: 10.1097/wnp.0000000000000782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Ultrasound is emerging as a useful tool for the evaluation of immune-mediated neuropathies because it can provide high-resolution anatomic information to complement electrodiagnostic data. Nerve enlargements are commonly found in chronic inflammatory demyelinating polyneuropathy (CIDP), and their presence likely useful in diagnosis, particularly if multifocal. METHODS In this study, the authors undertook a retrospective chart review to identify ultrasound findings in patients with CIDP previously studied in a single busy neurodiagnostic laboratory. RESULTS Of the 50 cases identified from 2000 to 2017, individuals with a confirmed diagnosis of CIDP (21 cases) were more likely to have multiple sites of enlargement, as well as more pronounced nerve enlargement, than patients who were subsequently found to have an alternate cause of neuropathy (22 cases). The presence of any moderately enlarged nerve segment predicted definite CIDP with sensitivity of 81% and specificity 77%. CONCLUSION This study demonstrates that ultrasound can be of diagnostic utility in patients with suspected CIDP, even when conducted in a nonstandardized real-world setting.
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Affiliation(s)
- Nicholas H Crump
- Departments of Neurology and Medicine, Austin Health and University of Melbourne, Victoria, Australia ; and
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
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18
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Gürün E, Akdulum İ, Akyüz M, Oktar SÖ. Shear wave elastography evaluation of brachial plexus in multiple sclerosis. Acta Radiol 2022; 63:520-526. [PMID: 33730859 DOI: 10.1177/02841851211002828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neuroinflammatory disease characterized by inflammation involving the peripheral nerves. Shear wave elastography (SWE) is potentially a method of choice for detecting peripheral nerve involvement. PURPOSE To compare the degree of thickening and nerve elasticity of brachial plexus (BP) nerve roots and evaluate the usefulness of sonoelastography in patients with clinically diagnosed MS without brachial plexopathy. MATERIAL AND METHODS Thirty-two patients with MS and 32 controls were included in the study. Bilateral C5, C6, and C7 mean nerve root diameters, and mean elasticity values in kiloPascal (kPa) were measured in the patient and control groups. The relationship between the age, height, and weight values and nerve diameter-elasticity values of the patient and control groups was compared. RESULTS The elasticity values of the C5 and C6 nerve roots were increased, and the nerve root thickness was decreased in the MS group compared to that in the control (P < 0.05). There was no difference between the C7 mean nerve root elasticity (kPa) and diameter measurements in the patient and control groups (P > 0.05). CONCLUSION Our study showed an increase in the BP nerve root elasticity values (kPa) in patients with MS compared to that of the control group and a decrease in diameter values thought to be related to the possible chronic atrophic process. The results are consistent with the demyelinating process of the peripheral nervous system (PNS) due to MS.
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Affiliation(s)
- Enes Gürün
- Department of Radiology, Gazi University, Ankara, Turkey
- Current affiliation: İskilip Atıf Hoca State Hospital, Çorum, Turkey
| | - İsmail Akdulum
- Department of Radiology, Gazi University, Ankara, Turkey
| | - Melih Akyüz
- Department of Radiology, Gazi University, Ankara, Turkey
- Current affiliation: Rush University Medical Center, Chicago, IL, USA
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19
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Vogel E, Ashley N, Pandya T, Sebring A. Assessing the Effects of Scapular Positioning on the Morphology of the Median Nerve During Upper Limb Tension Test 1 (ULTT1). JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221085566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The upper limb tension test 1 (ULTT1) is commonly used by physical therapists for patients with complaints of radiating symptoms in their upper extremity following the path of the median nerve. Clinicians typically perform similar testing positions for patients, except for scapular position, which may vary between scapular blocking and scapular depression. This may alter the test results based on this positioning. The purpose of this study was to determine if there is a significant difference in median nerve morphology during the ULTT1 between resting and two scapular testing positions. Materials and Methods: Thirty healthy participants, 18 to 65 years of age, were tested using the ULTT1 in both blocked and depressed scapular positions. The height and width of the median nerve were measured by diagnostic sonography. Paired t tests were utilized to compare baseline, blocked, and depressed scapular positions with the ULTT1. Results: No statistically significant difference in height or width was found between resting, blocked, or depressed scapular positioning. Conclusion: There were inconclusive results regarding the morphology of the median nerve in this study. Key Takeaways Inconclusive results on nerve morphology comparing two scapular positions during the ULTT1. Research may be conducted on symptomatic patients to assist with more reliable test findings related to ULTT1.
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Affiliation(s)
- Erin Vogel
- Briar Cliff University, Sioux City, IA, USA
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20
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Papadopoulou M, Bakola E, Papapostolou A, Stefanou MI, Moschovos C, Salakou S, Zis P, Zouvelou V, Kimiskidis VK, Chroni E, Tsivgoulis G. Autonomic dysfunction in amyotrophic lateral sclerosis: A neurophysiological and neurosonology study. J Neuroimaging 2022; 32:710-719. [PMID: 35344230 DOI: 10.1111/jon.12993] [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: 02/09/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting upper and lower motor neurons. Some ALS patients exhibit concomitant nonmotor signs, and thus ALS is considered a multisystem disorder. The aim of this study is to investigate autonomous nervous system involvement in ALS. METHODS We investigated 21 ALS patients and 28 age-matched controls. ALS patients were assessed for disease severity with the Revised-ALS Functional Rating Scale (ALSFSR) and for the presence of autonomic symptoms with the Composite Autonomic Symptom Score scale. Sympathetic nervous system was evaluated by sympathetic skin response (SSR) and parasympathetic nervous system by ultrasonography of vagus nerve (VN) at the level of the thyroid gland. RESULTS SSR latencies were shorter and SSR amplitudes were higher in controls compared to ALS patients. The cross-sectional area (CSA) of the VN was significantly smaller in ALS patients (mean CSA right/left: 1.73±0.62 mm2 /1.47±0.53 mm2 ) compared to controls (mean CSA right/left: 2.91±0.79 mm2 /2.30±0.80 mm2 ), right: p <. 001, left: p <. 001. There was a significant negative correlation between disease duration and CSA of left-VN (r = -0.493, p = .023). This correlation was attenuated between disease duration and CSA of right-VN (r = -0.419, p = .059). ALSFSR-R was positively correlated to CSA of right-VN (p = .006, r = 0.590). CSA of VN did not correlate with bulbar involvement. CONCLUSIONS This study confirms the presence of autonomic dysfunction in ALS patients and provides evidence of VN atrophy that correlates with disease severity and duration and is independent of bulbar involvement. Degeneration of dorsal nucleus neurons of the VN is hypothesized.
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Affiliation(s)
- Marianna Papadopoulou
- Department of Physiotherapy, Laboratory of Neuromuscular and Cardiovascular Study of Motion, University of West Attica, Athens, Greece.,Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Eleni Bakola
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Apostolos Papapostolou
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Maria Ioanna Stefanou
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Christos Moschovos
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Stavroula Salakou
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Panagiotis Zis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.,Medical School, University of Cyprus, Nicosia, Cyprus.,Medical School, University of Sheffield, Sheffield, UK
| | - Vasiliki Zouvelou
- First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginitio University Hospital, Athens, Greece
| | - Vasilios K Kimiskidis
- First Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elisabeth Chroni
- Department of Neurology, School of Medicine, University of Patras, Rio-Patras, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
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21
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Shinohara I, Inui A, Mifune Y, Nishimoto H, Yamaura K, Mukohara S, Yoshikawa T, Kato T, Furukawa T, Hoshino Y, Matsushita T, Kuroda R. Diagnosis of Cubital Tunnel Syndrome Using Deep Learning on Ultrasonographic Images. Diagnostics (Basel) 2022; 12:diagnostics12030632. [PMID: 35328185 PMCID: PMC8947597 DOI: 10.3390/diagnostics12030632] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 02/04/2023] Open
Abstract
Although electromyography is the routine diagnostic method for cubital tunnel syndrome (CuTS), imaging diagnosis by measuring cross-sectional area (CSA) with ultrasonography (US) has also been attempted in recent years. In this study, deep learning (DL), an artificial intelligence (AI) method, was used on US images, and its diagnostic performance for detecting CuTS was investigated. Elbow images of 30 healthy volunteers and 30 patients diagnosed with CuTS were used. Three thousand US images were prepared per each group to visualize the short axis of the ulnar nerve. Transfer learning was performed on 5000 randomly selected training images using three pre-trained models, and the remaining images were used for testing. The model was evaluated by analyzing a confusion matrix and the area under the receiver operating characteristic curve. Occlusion sensitivity and locally interpretable model-agnostic explanations were used to visualize the features deemed important by the AI. The highest score had an accuracy of 0.90, a precision of 0.86, a recall of 1.00, and an F-measure of 0.92. Visualization results show that the DL models focused on the epineurium of the ulnar nerve and the surrounding soft tissue. The proposed technique enables the accurate prediction of CuTS without the need to measure CSA.
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Affiliation(s)
| | - Atsuyuki Inui
- Correspondence: ; Tel.: +81-78-382-5111; Fax: +81-78-351-6944
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22
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Reddy YM, K. Murthy J, Suresh L, Jaiswal S, Pidaparthi L, S. Kiran ES. Diagnosis and severity evaluation of ulnar neuropathy at the elbow by ultrasonography: A case-control study. J Med Ultrasound 2022; 30:189-195. [DOI: 10.4103/jmu.jmu_152_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/31/2021] [Accepted: 08/09/2021] [Indexed: 11/04/2022] Open
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23
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Robla-Costales J, Rodríguez-Aceves C, Martínez-Benia F, Socolovsky M. State of the Art and Advances in Peripheral Nerve Surgery. Adv Tech Stand Neurosurg 2022; 45:245-283. [PMID: 35976453 DOI: 10.1007/978-3-030-99166-1_8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This review is intended to describe and actualize the basic knowledge of the three basic entities that affect the peripheral nerve system and can be treated by surgery: nerve trauma, chronic nerve compressions, and tumors.Regarding trauma, emphasis is given on the timing of surgery, given the fact that the moment in which the surgery is performed and the employed microsurgical reconstruction technique are the most important factors in the final result. Open lesions with associated nerve injury should be managed with an early exploration carried out before 7 days. Closed injuries are usually deferred, with few exceptions, from 3 to 6 months after the trauma.In turn, chronic compressions require an appropriate clinical, neurophysiological, and imaging diagnosis. Isolated sensory symptoms can be treated actively though without surgery: motor signs like atrophy should be regarded as a sign for immediate surgery, as a deferred treatment might cause an irreversible nerve and muscular damage. Endoscopic approaches are a valuable tool for treatment in selected neuropathies.Finally, nerve tumors demand a thorough preoperative evaluation, as benign tumors are treated in a very different way when compared to malignant lesions. Benign tumors can usually be safely and completely resected without sacrificing the nerve of origin. When malignancy is confirmed, extensive resection to optimize patient survival is the main objective, potentially at the expense of neurological function. This may then be followed by adjuvant radiation and/or chemotherapy, depending on the nature of the tumor and the completeness of resection attained. The role of nerve biopsy remains controversial, and several modern diagnostic techniques might be helpful.
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Affiliation(s)
| | - Carlos Rodríguez-Aceves
- Neurological Center, The American British Cowdray Medical Center campus Santa Fe, Mexico City, Mexico
| | - Fernando Martínez-Benia
- Department of Neurosurgery, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Mariano Socolovsky
- Department of Neurosurgery, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina.
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24
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Vasculitic Tibial Mononeuropathy Associated with Inherited Immune Dysregulation: A Review of Tibial Mononeuropathies with Electrodiagnostic Considerations. Case Rep Neurol Med 2021; 2021:7161757. [PMID: 34804620 PMCID: PMC8604612 DOI: 10.1155/2021/7161757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022] Open
Abstract
Compressive tibial mononeuropathies are uncommon and can be caused by conditions including posterior compartment syndrome, soleal sling syndrome, and tarsal tunnel syndrome. Therefore, it is critical to consider noncompressive etiologies when a tibial mononeuropathy is suspected. This is a patient with a history of rare inherited immune dysregulation that presented to the electrodiagnostic laboratory with severe neuropathic pain in the right foot associated with plantarflexion weakness, concerning for a tibial mononeuropathy. However, the patient's clinical presentation and results on electrodiagnostic testing were not consistent with any of the above entities. Therefore, noncompressive etiologies of tibial mononeuropathies such as vasculitis had to be considered. The patient subsequently underwent sural nerve biopsy which confirmed small-vessel vasculitis as the cause of the tibial mononeuropathy. She was then started on appropriate immunosuppressive treatment which resulted in significant pain relief and was discharged home. This case highlights the importance of considering noncompressive causes of tibial nerve injury. Compressive and vasculitic tibial mononeuropathies along with their electrodiagnostic considerations are reviewed. Furthermore, this case highlights the critical role of the electromyographer and ability to maximize the impact on patient care through a solid foundation in anatomy, pathophysiology, and electrodiagnosis blended with clinical acumen.
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25
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Limbekar NS, Soong MC, Vytopil MM, Blanchet DT, Paci GM, Ho DT. High-Resolution Ultrasound in the Diagnosis and Surgical Management of Ulnar Neuropathy at the Elbow. Orthopedics 2021; 44:285-288. [PMID: 34590945 DOI: 10.3928/01477447-20210819-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
High-resolution ultrasound (HRU) has recently demonstrated the potential to facilitate diagnosis and treatment of upper extremity compression neuropathy. The authors hypothesized that HRU can improve preoperative evaluation of ulnar neuropathy at the elbow (UNE) and that changes in ulnar nerve cross-sectional area (CSA) after cubital tunnel release may correlate with outcomes. Nineteen adult patients diagnosed with UNE who were scheduled for surgical decompression by a single hand surgeon were enrolled. Electrodiagnostic (EDX) testing, HRU of the ulnar nerve, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and McGowan grade were obtained pre- and postoperatively. Fourteen patients completed the study. Statistically significant improvements were found in CSA measurements and QuickDASH scores. High-resolution ultra-sound was found to confirm UNE in all 7 patients with positive results on EDX, and additionally detected UNE in 3 of 6 patients with negative results on EDX and in 1 patient with equivocal (nonlocalized) EDX testing. All 4 of these additional HRU-detected cases improved clinically and by CSA measurements after surgery. In this series, HRU was superior to EDX testing in the diagnosis of UNE and demonstrated objective improvement in ulnar nerve CSA after successful cubital tunnel release. This modality, which is better tolerated, less costly, and less time-consuming than EDX testing or magnetic resonance imaging, should therefore be considered in the diagnosis and surgical management of UNE, particularly in cases with negative or equivocal results on EDX testing, or when outcomes are suboptimal. [Orthopedics. 2021;44(5):285-288.].
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26
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Mahran SA, Galluccio F, Khedr TM, Elsonbaty A, Allam AES, Garcia Martos A, Osman DMM, Matucci-Cerinic M, Guiducci S, Galal MAA. Peripheral neuropathy in systemic lupus erythematosus: what can neuromuscular ultrasonography (NMUS) tell us? A cross-sectional study. Lupus Sci Med 2021; 8:e000521. [PMID: 34312211 PMCID: PMC8314698 DOI: 10.1136/lupus-2021-000521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate peripheral nerve involvement in patients with SLE with neuromuscular ultrasonography (NMUS) and understand its role in investigating SLE-related peripheral neuropathy. METHODS This is an observational cross-sectional study on patients with SLE and healthy controls. Five nerves in each patient were examined bilaterally with NMUS, and the cross-sectional area (CSA) of each nerve at certain sites was estimated. The mean CSA at each site, for each nerve, in each group was statistically analysed and compared between groups. RESULTS 370 nerves were evaluated in 37 patients. By nerve conduction study (NCS), 36 patients had polyneuropathy (80.6% mixed type, 19.4% sensory). Significant mean CSA enlargement was present among the ulnar nerve at the Guyon's canal and mid-humerus (both p=0.001); tibial nerve at the distal leg and proximal to the tarsal tunnel (p=0.003 and p=0.001, respectively); and peroneal nerve at the popliteal fossa (p=0.042). The mean CSA showed high specificity compared with NCS. CONCLUSION Our study shows that CSA could be a complementary tool to NCS for studying peripheral neuropathy in SLE. Furthermore, NMUS provides data on the different pathophysiological aspects of nerve involvement in SLE. Future studies using more than one sonographic parameter in combination with NCS and nerve histopathology are recommended to further investigate SLE-related neuropathy.Trial registration number NCT04527172.
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Affiliation(s)
- Safaa A Mahran
- Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University, Assiut, Egypt
| | - Felice Galluccio
- Medical-Geriatric Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
- MoMaRC Morphological Madrid Research Center, Ultradissection group, Madrid, Spain
| | - Tayseer Mohamed Khedr
- Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University, Assiut, Egypt
| | - Amira Elsonbaty
- Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University, Assiut, Egypt
| | - Abdallah El-Sayed Allam
- MoMaRC Morphological Madrid Research Center, Ultradissection group, Madrid, Spain
- Department of Physical Medicine, Rheumatology and Rehabilitation, Tanta University Faculty of Medicine, Tanta, Egypt
| | | | - Doaa M M Osman
- Department of Public Health and Community, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Serena Guiducci
- Medical-Geriatric Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Marwa A A Galal
- Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University, Assiut, Egypt
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Singh KP, Goindi AS, Gupta K. Reference values for the cross-sectional area of normal radial nerve at two levels using high-resolution ultrasonography. J Ultrason 2021; 21:e112-e126. [PMID: 34258036 PMCID: PMC8264814 DOI: 10.15557/jou.2021.0020] [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: 02/02/2021] [Accepted: 04/20/2021] [Indexed: 11/25/2022] Open
Abstract
Aim of the study High-resolution ultrasound is less often used to evaluate the radial nerves. The radial nerve is often involved in entrapment syndromes. The aim of the study is to establish the reference values for the cross-sectional area of the normal radial nerve on high-resolution ultrasonography, and to identify relationships between the cross-sectional area and the subject’s age, gender, height, weight, body mass index, and hand dominance. Material and methods The study was conducted on 200 subjects of both sexes, between 18 and 75 years of age, who did not have history of peripheral neuropathy or trauma to the upper limb. High-resolution real-time sonographic examination of the radial nerves was performed in both arms at two different levels. Level 1 was taken just proximal to the nerve bifurcation, and level 2 just after the nerve exits the spiral grove. Results The mean cross-sectional area measured at level 2 (4.3 ± 0.4 mm2) was greater than that measured at level 1 (2.3 ± 0.3 mm2). No significant relationship was seen with age and hand dominance (p >0.05), but the cross-sectional area values at above mentioned levels were larger in males than in females (p <0.05). In addition, the cross-sectional areas of the radial nerves showed a positive correlation with height, weight, and body mass index (p <0.05). Conclusion The established ultrasonographic reference values along with basic clinical data will aid in the diagnosis, response to treatment, and prognostic evaluation of peripheral neuropathies.
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Affiliation(s)
| | | | - Kamlesh Gupta
- Radiodiagnosis, SGRD University of Health Sciences, India
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Kuga J, Hironaka A, Ochi K, Sugimoto T, Nakamori M, Nezu T, Maruyama H. Impact of anatomical variations on ultrasonographic reference values of lower extremity peripheral nerves. Muscle Nerve 2021; 63:890-896. [PMID: 33797086 DOI: 10.1002/mus.27238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/18/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION/AIMS Cross-sectional area (CSA) reference values using ultrasonography vary widely for lower extremity peripheral nerves. In addition, there is a lack of data on the muscular branches of the tibial nerve and the anatomical variations of the sural nerve. We aimed to evaluate the ultrasonographic reference values for lower extremity peripheral nerves considering different anatomical variations and physical factors. METHODS The CSA of the lower extremity nerve was measured at 10 sites. In addition to establishing reference values, differences in the CSA owing to anatomical variations were verified. The relationship between CSA and physical factors, such as age, height, weight, body mass index, and ankle circumference, was also examined. RESULTS A total of 100 healthy Japanese volunteers were recruited. The mean CSA of the sural nerve significantly differed depending on its formation pattern (1.4-1.8 mm2 ). The mean decreases in CSAs from the proximal to distal tibial and fibular nerves within the popliteal region significantly differed based on the fine branching pattern. The maximum value of the mean decreases in CSAs in the tibial and fibular nerves reached 7.2 and 2.5 mm2 , respectively. With respect to physical factors, age and ankle circumferences were associated with CSA at several measurement sites. DISCUSSION Fine branching from the tibial and fibular nerves and sural nerve formation may affect CSA measurements. The establishment of accurate CSA reference values requires consideration of anatomical variations in the peripheral nerves of the lower extremity.
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Affiliation(s)
- Junichiro Kuga
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Akemi Hironaka
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kazuhide Ochi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takamichi Sugimoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Abstract
Peripheral nerve imaging is a helpful and sometimes essential adjunct to clinical history, physical examination, and electrodiagnostic studies. Advances in imaging technology have allowed the visualization of nerve structures and their surrounding tissues. The clinical applications of ultrasound and magnetic resonance imaging (MRI) in the evaluation of peripheral nerve disorders are growing exponentially. This article reviews basics of ultrasound and MRI as they relate to nerve imaging, reviews advantages and limitations of each imaging modality, reviews the applications of ultrasound and MRI in disorders of peripheral nerve, and discusses emerging advances in the field.
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Affiliation(s)
- Natalia L Gonzalez
- Department of Neurology, Neuromuscular Division, Duke University, Duke University Hospital, 3403 DUMC, Duke South Clinic 1L, Durham, NC 27710, USA.
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University, Duke University Hospital, 3403 DUMC, Duke South Clinic 1L, Durham, NC 27710, USA
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Tang X, Zhu B, Tian M, Guo R, Huang S, Tang Y, Qiu L. Preliminary study on the influencing factors of shear wave elastography for peripheral nerves in healthy population. Sci Rep 2021; 11:5582. [PMID: 33692411 PMCID: PMC7946935 DOI: 10.1038/s41598-021-84900-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/23/2021] [Indexed: 02/08/2023] Open
Abstract
This study took shear wave elastography (SWE) technology to measure the shear wave velocity (SWV) of peripheral nerve in healthy population, which represents the stiffness of the peripheral nerves, and research whether these parameters (location, age, sex, body mass index (BMI), the thickness and cross-sectional area(CSA) of the nerve) would affect the stiffness of the peripheral nerves. 105 healthy volunteers were enrolled in this study. We recorded the genders and ages of these volunteers, measured height and weight, calculated BMI, measured nerve thickness and CSA using high-frequency ultrasound (HFUS), and then, we measured and compared the SWV of the right median nerve at the middle of the forearm and at the proximal entrance of the carpal tunnel. The SWV of the median nerve of the left side was measured to explore whether there exist differences of SWV in bilateral median nerve. Additionally, we also measured the SWV of the right tibial nerve at the ankle canal to test whether there is any difference in shear wave velocity between different peripheral nerves. This study found that there existed significant differences of SWV between different sites in one nerve and between different peripheral nerves. No significant difference was found in SWV between bilateral median nerves. Additionally, the SWV of peripheral nerves was associated with gender, while not associated with age or BMI. The mean SWV of the studied male volunteers in median nerve were significantly higher than those of female (p < 0.05). Peripheral nerve SWE measurement in healthy people is affected by different sites, different nerves and genders, and not associated with age, BMI, nerve thickness or CSA.
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Affiliation(s)
- Xinyi Tang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Bihui Zhu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Mei Tian
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Ruiqian Guo
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Songya Huang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Yuanjiao Tang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Li Qiu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China.
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Shen J, Yang F, Chen W, Wang F, Liang C, Qiu Y, Xu W. The Efficacy of Ultrasound for Visualizing Radial Nerve Lesions with Coexistent Plate Fixation of Humeral Shaft Fractures. Injury 2021; 52:516-523. [PMID: 33257017 DOI: 10.1016/j.injury.2020.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/14/2020] [Accepted: 11/15/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Ultrasound has been commonly employed for depicting the morphology of the lesions in patients with radial nerve neuropathy, including entrapment, tumor, trauma, and iatrogenic injury. However, few studies have evaluated the efficacy of ultrasound for visualizing radial nerve lesions with coexistent plate fixation of humeral shaft fractures. This study aimed to address this special clinical issue. METHODS We retrospectively examined the efficacy of ultrasound for visualizing radial nerve lesions with coexistent plate fixation of humeral shaft fractures based on intraoperative findings in patients who were treated in our hospital from January 2007 to June 2019. RESULTS Forty-six patients were included, and there was a 100% concordance between the ultrasound and intraoperative findings on radial nerve lesions. Ultrasonography revealed four types of lesions: radial nerve in continuity in thirty-one patients, neuroma in continuity in four patients, radial nerve stuck under the plate in three patients, and radial nerve transection in eight patients. The lesion radial nerve in continuity comprised two situations according to intraoperative electrodiagnostic test results, which could not be differentiated by ultrasonography, radial nerve in continuity treated with neurolysis in twenty-five patients and radial nerve in continuity treated with nerve graft in six patients. CONCLUSION Ultrasonography can accurately depict radial nerve lesions with coexistent plate fixation of humeral shaft fractures. It provides a basis for determining the extent of nerve damage in all patients except those with the lesion radial nerve in continuity, which is conducive to making treatment decisions as early as possible.
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Affiliation(s)
- Jun Shen
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangjing Yang
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weimin Chen
- Department of Ultrasound in Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fei Wang
- Department of Hand and Upper Extremity Surgery, Jing' an District Central Hospital, Shanghai, China
| | - Chunmin Liang
- Limb Function Reconstruction Center, Jing' an District Central Hospital, Shanghai, China
| | - Yanqun Qiu
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing' an District Central Hospital, Shanghai, China; Limb Function Reconstruction Center, Jing' an District Central Hospital, Shanghai, China; National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China; State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China; Research unit of synergistic reconstruction of upper and lower limbs after brain injury, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing' an District Central Hospital, Shanghai, China; Limb Function Reconstruction Center, Jing' an District Central Hospital, Shanghai, China; National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China; State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China; Research unit of synergistic reconstruction of upper and lower limbs after brain injury, Chinese Academy of Medical Sciences, Shanghai, China
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Changes of clinical, neurophysiological and nerve ultrasound characteristics in CIDP over time: a 3-year follow-up. J Neurol 2021; 268:3011-3019. [PMID: 33638679 DOI: 10.1007/s00415-021-10485-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate, in a prospective study, high-resolution ultrasound (HRUS) changes of nerve segments in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and their relationships with clinical and electrodiagnostic (EDX) characteristics. METHODS Twenty-three consecutive patients with CIDP were included in a 3-year follow-up (FU) study. Each patient underwent neurologic examination, EDX and HRUS study. HRUS was performed on median, ulnar and peroneal nerves, yielding a total of 319 scanned nerve segments. INCAT and MRC-sum scores, motor nerve conduction velocity (NCV), compound muscle action potential (cMAP) amplitude, and nerve cross-sectional area (NCSA) were collected at baseline and at FU end, and were used for statistical analysis. Twenty-two healthy individuals, matched to patients for age and BMI, served as controls. RESULTS NCSA was higher in patients than in controls (p < 0.0001) and showed significant direct correlation with disease severity, and inverse correlation with NCV and cMAP amplitude, both at baseline and at FU end. Disease duration, clinical scores and EDX were predictors of NCSA enlargement at both time points. During FU, NCSA increased in 51% of nerve segments (p = 0.006), in correlation with INCAT increase and with NCV and cMAP reduction. Considering EDX changes in subgroups that reflect the different types of nerve damage, NCSA significantly increased in those nerve segments that from normal EDX switched to prevalent myelinopathic EDX characteristics. CONCLUSIONS Peripheral nerve size tends to increase over time in patients with CIDP, in correlation with clinical and EDX changes, in particular in those nerve segments that undergo a predominantly demyelinating damage.
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Paiva Filho HR, Elias BAB, Salomão Junior MSB, Paiva VGN, Oliveira EF, Rocha MA. Is there an association between electroneuromyography and ultrasound in the diagnosis of carpal tunnel syndrome? Rev Bras Ortop 2021; 56:69-73. [PMID: 33627902 PMCID: PMC7895613 DOI: 10.1055/s-0040-1713390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/17/2020] [Indexed: 11/22/2022] Open
Abstract
Objective
To verify whether there is an association between the results of the severity in electroneuromyography and the positivity in ultrasound in the diagnosis of carpal tunnel syndrome.
Methods
Sixty-eight patients were included in the study, 61 women and 7 men, with a mean age of 54.4 years. The ultrasound results (positive or negative) were crossed with the results of electroneuromyography (mild, moderate or severe), and the existence of association was verified.
Results
One hundred and thirty-six hands with suspicion or symptoms of carpal tunnel syndrome were evaluated. Positive ultrasound diagnosis was observed in 72 hands and negative in 64; 123 hands presented positive electroneuromyography for carpal tunnel syndrome, and there were 13 negative results. The severe degree in electroneuromyography was prevalent.
Conclusion
There was a statistically significant association between electroneuromyography and ultrasonography (
p
< 0.05), and ultrasound positivity was higher for more severe levels of carpal tunnel syndrome given by electroneuromyography.
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Affiliation(s)
- Henver Ribeiro Paiva Filho
- Serviço de Cirurgia da Mão, Hospital de Clínicas, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | - Bruno Adriano Borges Elias
- Serviço de Cirurgia da Mão, Hospital de Clínicas, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | | | | | - Elias Felix Oliveira
- Serviço de Cirurgia da Mão, Hospital de Clínicas, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | - Murilo Antônio Rocha
- Serviço de Cirurgia da Mão, Hospital de Clínicas, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
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Ding Q, Li J, Guan Y, Wu S, Niu J, Shen D, Hu Y, Wu Y, Liu M, Cui L. Nerve ultrasound studies in POEMS syndrome. Muscle Nerve 2021; 63:758-764. [PMID: 33604886 DOI: 10.1002/mus.27209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The aim of our study was to assess the ultrasonographic features of peripheral nerves in patients with POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) syndrome. METHOD 34 POEMS syndrome patients and 26 healthy control (HC) participants were recruited prospectively. Cross-sectional area (CSA) was measured in nerves of limbs, trunks of brachial plexus, and cervical nerve roots RESULTS: The CSAs were mildly enlarged at the arm segment of median nerve, elbow segment of ulnar nerve and upper trunk, moderately enlarged at the forearm segment of both median and ulnar nerve, upper trunk of brachial plexus, and C6, C7 cervical nerve roots, and markedly enlarged at the arm segment of ulnar nerve, middle and lower trunk of brachial plexus, as well as C5 cervical root. DISCUSSION The CSAs of upper limb nerves were larger in POEMS syndrome patients than in HCs, and the enlargements were most prominent proximally.
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Affiliation(s)
- Qingyun Ding
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuzhou Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuang Wu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingwen Niu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Youfang Hu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yinmin Wu
- 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
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Huang H, Wu S. Application of High-Resolution Ultrasound on Diagnosing Diabetic Peripheral Neuropathy. Diabetes Metab Syndr Obes 2021; 14:139-152. [PMID: 33469331 PMCID: PMC7813464 DOI: 10.2147/dmso.s292991] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/24/2020] [Indexed: 12/20/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus (DM). The typical manifestation is a length-dependent "glove and sock" sensation. At present, diagnosis is mainly dependent on clinical manifestations. Since the pathogenesis is not clear, there are no effective treatment measures. Management consists mainly of glucose control, peripheral nerve nutrition, and other measures to delay the progress of the disease; early diagnosis is therefore crucial to improving prognosis and quality of life for patients with DPN. Due to the lack of obvious symptoms in 50% of patients and the low sensitivity of neuro-electrophysiology to small fibers, the missed diagnosis rate is high. High-resolution ultrasound (HRU), as a convenient noninvasive tool, has been proven by many studies to have excellent clinical value in diagnosing DPN. With the development of related new technology, HRU shows promise for the screening, diagnosing, and follow-up of DPN, which could serve as a biomarker and provide new diagnostic insights. In this paper, we review the ability of HRU to detect nerve cross-sectional area and blood flow, and echo and other image changes, and in showing the characteristics of peripheral nerve morphological changes in patients with DPN. We also explore the application of two other recent technological developments-shear wave elastography (SWE) and ultrasound scoring systems-in improving the diagnostic efficiency of HRU in peripheral neuropathy.
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Affiliation(s)
- Hailun Huang
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou550001, People’s Republic of China
| | - Shan Wu
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou550001, People’s Republic of China
- Correspondence: Shan Wu Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guizhou550001, People’s Republic of ChinaTel +86 13312231575 Email
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Neuromuscular Ultrasound in the Pediatric Population. Diagnostics (Basel) 2020; 10:diagnostics10121012. [PMID: 33255940 PMCID: PMC7760629 DOI: 10.3390/diagnostics10121012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022] Open
Abstract
The diagnosis and evaluation of neuromuscular disorders traditionally involves electrodiagnostic (EDx) testing, including nerve conduction studies (NCSs) and electromyography (EMG). These tools can cause pain and discomfort, an important consideration when performed on children. Neuromuscular ultrasound is noninvasive, cost-effective, and increasingly utilized for the detection of neuromuscular pathology. Studies investigating the performance and clinical implementation of ultrasound have primarily been performed in adult populations. Ultrasound in children has the potential to guide EDx testing and ultimately improve diagnostic efficiency and accuracy. This review aims to describe key features of neuromuscular ultrasound in the pediatric population based on the available studies, including our own institutional experience.
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Hamdi H, Brun G, Zanello M, Dibué M, Beltaifa Y, Lagarde S, Trébuchon A, Bartolomei F, Carron R. VNS implantation in a NF1 patient: massive nerve hypertrophy discovered intra-operatively preventing successful electrode placement. Case report. Acta Neurochir (Wien) 2020; 162:2509-2512. [PMID: 32809069 DOI: 10.1007/s00701-020-04535-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: 05/20/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
For the vast majority of surgeons, no specific investigation is necessary before vagal nerve stimulation (VNS) implantation. We report our intraoperative unexpected finding of a massively enlarged vagus nerve in a patient with neurofibromatosis type 1 (NF1). The nerve hypertrophy prevented wrapping the coils of the helical electrode. The patient had no signs of vagus nerve dysfunction preoperatively (no hoarseness or dysphonia). This exceptional mishap is undoubtedly related to NF1-associated peripheral nerve sheath tumors. Even though it is not advisable to routinely perform any imaging prior to VNS, in such specific context, preoperative imaging work-up, especially cervical ultrasound, might be judicious to rule out any asymptomatic enlarged left vagus nerve.
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Affiliation(s)
- Hussein Hamdi
- Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Aix Marseille University, Marseille, France
- APHM, INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France
- Functional Neurosurgery and Stereotaxy Unit, Neurological Surgery Department, Tanta University, Tanta, Egypt
| | - Gilles Brun
- Department of Neuroradiology, Timone University Hospital, Aix Marseille University, Marseille, France
| | - Marc Zanello
- Department of Neurosurgery, Sainte-Anne Hospital, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Maxine Dibué
- Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany
| | - Yassine Beltaifa
- Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Aix Marseille University, Marseille, France
| | - Stanislas Lagarde
- Epileptology Department, Timone Hospital, APHM, INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France
| | - Agnes Trébuchon
- Epileptology Department, Timone Hospital, APHM, INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France
| | - Fabrice Bartolomei
- Epileptology Department, Timone Hospital, APHM, INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France
| | - Romain Carron
- Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Aix Marseille University, Marseille, France.
- APHM, INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France.
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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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Omejec G, Podnar S. Contribution of ultrasonography in evaluating traumatic lesions of the peripheral nerves. Neurophysiol Clin 2020; 50:93-101. [DOI: 10.1016/j.neucli.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/31/2020] [Accepted: 01/31/2020] [Indexed: 01/09/2023] Open
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Uerschels AK, Krogias C, Junker A, Sure U, Wrede KH, Gembruch O. Modern treatment of perineuriomas: a case-series and systematic review. BMC Neurol 2020; 20:55. [PMID: 32054523 PMCID: PMC7017529 DOI: 10.1186/s12883-020-01637-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022] Open
Abstract
Background Perineuriomas are rare benign peripheral nerve sheath tumours of perineurial cell origin and can be classified into intraneural and extraneural perineuriomas. They most commonly present a mononeuropathy of gradual onset and slow progression, resulting in progressive neurological deficits like hypoesthesia or motor weakness. Therapy is still variable. Aim of the study was to compare our surgical treatment and our follow-up regime including high-resolution nerve sonography with the current literature to evaluate best treatment of perineuriomas. Methods Retrospective analysis of our dataset “peripheral nerve lesion” to identify patients suffering from perineuriomas between 01.01.2012 until 31.12.2018. Surgical treatment and the follow-up examination of three patients were described. Additionally, a systematic review including PubMed, the Cochrane Collaboration Library, Scopus and Google Scholar was performed for literature published between January 1, 1990 and October 31, 2019 independently by 2 authors. Results In the first case, the left ulnar nerve was affected. In the second case, the left peroneal nerve and in the third case the right median nerve was affected. High-resolution nerve sonography was performed in each case. All patients underwent interfascicular neurolysis combined with a targeted fascicular biopsy under electrophysiological monitoring. Neurological deficits improved subsidized by rehabilitation. Surgical therapy and the neurological outcome were compared with literature. Systematic review revealed 22 articles, which met the inclusion criteria. Therefore, demographics, surgical treatment and neurological outcome of 77 patients were analysed. Conclusions Perineuriomas are rare benign nerve sheath tumours with a slow progression, sometimes difficult to diagnose. Decompression and neurolysis may improve neurological deficits. High resolution nerve sonography might serve as a helpful additional diagnostic tool in this process.
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Affiliation(s)
- Anne-Kathrin Uerschels
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Andreas Junker
- Department of Neuropathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Zhu Y, Jin Z, Luo Y, Wang Y, Peng N, Peng J, Wang Y, Yu B, Lu C, Zhang S. Evaluation of the Crushed Sciatic Nerve and Denervated Muscle with Multimodality Ultrasound Techniques: An Animal Study. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:377-392. [PMID: 31699548 DOI: 10.1016/j.ultrasmedbio.2019.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 06/10/2023]
Abstract
This study was aimed at evaluating the value of multimodality ultrasound techniques in the detection of crushed sciatic nerve and denervated muscle in rabbits. Fifty healthy male New Zealand white rabbits were randomly divided into five groups (n = 10 in each group): four crushed injury groups at 1, 2, 4 and 8 wk post-sciatic nerve crushed injury, and a control group without crush injury. The crushed sciatic nerve and denervated muscle were measured with conventional ultrasound, shear wave elastography and contrast-enhanced ultrasonography, and the results were compared with the histopathological parameters. The inter- and intra-reader reliability of multimodality ultrasound was assessed with intra-class correlation coefficients. Our results revealed that the sciatic nerve thickened at 2 wk post-crushed injury (p < 0.01), but recovered to almost normal thickness at 8 wk post-injury. Stiffness of the crushed nerve gradually increased (p < 0.01), and intraneural blood volume decreased (area under the curve, peak intensity, time to peak, p < 0.01 each) over time. Histopathological evaluation revealed obvious collagen hyperplasia and poor regenerated microvascular and sparse axonal regeneration and remyelination. Compared with that of the control group, the elastic modulus of the denervated muscle significantly increased (p < 0.05), which may be related to the increased intramuscular collagen (p < 0.01) and decreased muscle fiber cross-sectional area (p < 0.01). There were no significant differences in contrast-enhanced ultrasonography parameters (area under the curve, peak intensity, time to peak) of the denervated muscle between the crush injury groups and the control group (p >0.05). All ultrasound results had excellent inter- and intra-reader consistency (intraclass correlation coefficient >0.80). In conclusion, multimodality ultrasound techniques could provide quantitative information on the morphologic changes, mechanical properties and blood perfusion of crushed nerve and denervated muscle, which may be of great importance in clinical practice.
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Affiliation(s)
- Yaqiong Zhu
- Medical College of Nankai University, Tianjin, China; Departments of Ultrasound, Chinese PLA General Hospital, Beijing, China; Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Chinese PLA General Hospital, Beijing, China
| | - Zhuang Jin
- Departments of Ultrasound, Chinese PLA General Hospital, Beijing, China; General hospital of Northern Theater Command, Shenyang, Liaoning province, China
| | - Yukun Luo
- Departments of Ultrasound, Chinese PLA General Hospital, Beijing, China.
| | - Yuexiang Wang
- Departments of Ultrasound, Chinese PLA General Hospital, Beijing, China.
| | - Nan Peng
- Department of Geriatric Rehabilitation, Chinese PLA General Hospital, Beijing, China
| | - Jiang Peng
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China; Key Lab of Musculoskeletal Trauma & War Injuries, Chinese PLA General Hospital, Beijing, China
| | - Yu Wang
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China; Key Lab of Musculoskeletal Trauma & War Injuries, Chinese PLA General Hospital, Beijing, China
| | - Bo Yu
- Departments of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Changfeng Lu
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China; Key Lab of Musculoskeletal Trauma & War Injuries, Chinese PLA General Hospital, Beijing, China
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Emril DR, Zakaria I, Amrya M. Agreement Between High-Resolution Ultrasound and Electro-Physiological Examinations for Diagnosis of Carpal Tunnel Syndrome in the Indonesian Population. Front Neurol 2019; 10:888. [PMID: 31507510 PMCID: PMC6718122 DOI: 10.3389/fneur.2019.00888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/31/2019] [Indexed: 01/15/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a disorder of the wrist due to narrowing of the carpal tunnel. It can be caused by trauma or tumors in the tunnel resulting in compression of the median nerve. This disorder is often diagnosed with early symptoms such as tingling, numbness, and weakness that subsequently lead to hand muscle atrophy. While ultrasonography (USG) is one of the diagnostic methods of CTS, neurophysiological diagnosis, such as with nerve conduction study (NCS), is standard in clinics where the necessary equipment is available. This cross-sectional study aimed to compare USG diagnostic values with NCS results to determine USG efficacy for diagnosis of CTS. Data on medical history, physical examination, ultrasound results, and NCS examination from patients who had been diagnosed with CTS at a regional general hospital in Indonesia were collected. In total, 46 patients participated in the study and data were compared using 2 × 2 table analyses and the kappa statistic. Results showed USG sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and accuracy values of 88.5, 65, 76.6, 81.25, 2.52, 0.17, and 78.2%, respectively (p < 0.005). Comparison between NCS and the USG assessment obtained a kappa coefficient of κ = 0.71 and showed high agreement (κ = 0.410.60). In conclusion, the diagnostic value of USG compared to NCS is acceptable. Therefore, USG examination is a feasible CTS diagnostic alternative for clinicians who do not have access to an electrodiagnostic facility.
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Affiliation(s)
- Dessy R Emril
- Department of Neurology, Faculty of Medicine, Universitas Syiah Kuala, Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia
| | - Iskandar Zakaria
- Department of Radiology, Faculty of Medicine, Universitas Syiah Kuala, Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia
| | - Mirza Amrya
- Department of Neurology, Faculty of Medicine, Universitas Syiah Kuala, Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia
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Wee TC, Simon NG. Ultrasound elastography for the evaluation of peripheral nerves: A systematic review. Muscle Nerve 2019; 60:501-512. [PMID: 31269240 DOI: 10.1002/mus.26624] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/24/2019] [Accepted: 06/29/2019] [Indexed: 02/06/2023]
Abstract
Peripheral nerve disorders are commonly encountered in clinical practice. Electrodiagnostic studies remain the cornerstone of the evaluation of nerve disorders. More recently, ultrasound has played an increasing complementary role in the neuromuscular clinic. Ultrasound elastography is a technique that measures the elastic properties of tissues. Given the histological changes that occur in diseased peripheral nerves, nerve ultrasound elastography has been explored as a noninvasive way to evaluate changes in nerve tissue composition. Studies to date suggest that nerve stiffness tends to increase in the setting of peripheral neuropathy, regardless of etiology, consistent with loss of more compliant myelin, and replacement with connective tissue. The aim of this systematic review is to summarize the current literature on the use of ultrasound elastography in the evaluation of peripheral neuropathy. Limitations of ultrasound elastography and gaps in current literature are discussed, and prospects for future clinical and research applications are raised.
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Affiliation(s)
- Tze Chao Wee
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore
| | - Neil G Simon
- St Vincent's Clinical School, University of New South Wales, Darlinghurst, New South Wales, Australia
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Liechti R, Mittas S, Lorenzana D, Peyer AK, Wilder-Smith E, Link BC, Taha S, Memeti E, Babst R, Beeres FJP. Evaluation of radial nerve continuity early after humeral shaft fracture fixation using high-resolution nerve ultrasonography: a pilot study of feasibility. J Shoulder Elbow Surg 2019; 28:1033-1039. [PMID: 30713061 DOI: 10.1016/j.jse.2018.11.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/28/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study evaluated the feasibility and reliability of high-resolution ultrasonography (HRUS) of the radial nerve in the early, postoperative period after operative stabilization of humeral shaft fractures. METHODS This study enrolled patients between September 2015 and April 2018 with a humeral shaft fracture who were assessed with HRUS within 2 weeks after surgery. Based on the ultrasound artifacts, the examiners subjectively defined quality of ultrasound as "bad" or "good." The cross-sectional area of the radial and the posterior interosseous nerve was recorded at predefined locations. The radial nerve was scanned axially in the whole course to identify nerve continuity. RESULTS Of 44 patients who underwent operations for humeral shaft fracture, HRUS was used to assess 15 patients at an average 4.8 ± 2.6 days (range, 2-11 days) after surgery. The examiners defined ultrasound quality as "good" in 13 of 15 patients (~87%). Primary radial nerve palsy (RNP) was identified in 3 of the 15 patients, and 4 sustained secondary RNP. Nerve continuity was demonstrated by HRUS in every patient. In patients with RNP, nerve continuity was secondarily confirmed by surgical exploration or functional and electrophysiological recovery. CONCLUSION Early postoperative HRUS of the radial nerve after osteosynthesis of humeral shaft fractures is a feasible and reliable method to identify radial nerve continuity. In case of pathology, this assessment tool can additionally provide valuable information concerning location and etiology of the RNP.
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Affiliation(s)
- Rémy Liechti
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
| | - Stephan Mittas
- Department of Neurology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - David Lorenzana
- Department of Anesthesiology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Anne-Kathrin Peyer
- Department of Neurology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Einar Wilder-Smith
- Department of Neurology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Björn-Christian Link
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Stephanie Taha
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Elza Memeti
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Frank J P Beeres
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
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Aslan M, Aslan A, Emeksiz HC, Candan F, Erdemli S, Tombul T, Gunaydın GD, Kabaalioğlu A. Assessment of Peripheral Nerves With Shear Wave Elastography in Type 1 Diabetic Adolescents Without Diabetic Peripheral Neuropathy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1583-1596. [PMID: 30444266 DOI: 10.1002/jum.14848] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/24/2018] [Accepted: 09/30/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate the utility of shear wave elastography (SWE) in detecting morphologic abnormalities of the median nerve and posterior tibial nerve in transverse and longitudinal axes in adolescents with type 1 diabetes mellitus (DM) without diabetic peripheral neuropathy (DPN). METHODS The median nerves and posterior tibial nerves of 25 adolescents with diagnosis and follow-up of type 1 DM without DPN and 32 healthy volunteers were evaluated with SWE by 2 observers on the transverse and longitudinal axes. The cross-sectional area and thickness of the nerves and disease duration were noted, and probable associations of these parameters with SWE features were analyzed. Interobserver and intraobserver correlations were also examined. The statistical significance level was set at P < .05. RESULTS Both the median nerve and posterior tibial nerve were smaller, thinner, and stiffer in the patient group for both observers on both axes. The disease duration weakly correlated with median nerve SWE features (r = 0.245-0391). The thickness and cross-sectional area had no correlations with SWE features. CONCLUSIONS The median nerve and posterior tibial nerve in adolescents with type 1 DM without DPN have morphologic abnormalities that can be displayed by SWE regardless of the imaging axis. Shear wave elastography may have a potential role in subclinical DPN, but the reliability of the findings is not as high as desirable.
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Affiliation(s)
- Mine Aslan
- Departments of Radiology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Kadikoy, Turkey
| | - Ahmet Aslan
- Departments of Radiology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Kadikoy, Turkey
| | - Hamdi Cihan Emeksiz
- Pediatric Endocrinology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Kadikoy, Turkey
| | - Fatma Candan
- Neurology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Kadikoy, Turkey
| | - Servet Erdemli
- Departments of Radiology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Kadikoy, Turkey
| | - Temel Tombul
- Neurology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Kadikoy, Turkey
| | - Gülçin Durukan Gunaydın
- Departments of Radiology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Kadikoy, Turkey
| | - Adnan Kabaalioğlu
- Departments of Radiology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Kadikoy, Turkey
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Lee RKL, Griffith JF, Ng AWH, Tipoe GL, Chan AWH, Wong CWY, Tse WL, Ho PC. Cross-sectional area of the median nerve at the wrist: Comparison of sonographic, MRI, and cadaveric measurements. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:122-127. [PMID: 30597562 DOI: 10.1002/jcu.22647] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 07/13/2018] [Accepted: 09/05/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND This study compares median nerve cross-sectional area (CSA) measurements at the wrist obtained with ultrasound (US) and magnetic resonance imaging (MRI) using cadaveric measurements as the gold standard. METHODS Median nerve CSA was measured using US and MRI in 9 cadaveric wrists obtained from 5 subjects at 5 locations: distal forearm, proximal to tunnel inlet, at tunnel inlet, at tunnel outlet, and distal to tunnel outlet and then on identical cadaveric transverse sections obtained with a bandsaw. All US, MRI, and cadaveric measurements were repeated to determine reliability. Median nerves of 10 patients with clinical carpal tunnel syndrome (CTS) were measured with US and MRI using an identical method US. RESULTS Median nerve CSA MRI measurements correlated better (Pearson correlation: 0.80-0.95, P < .05) with cadaveric measurements than with US measurements (Pearson correlation: 0.61-0.79, P < .05). Median nerve CSA US measurements (8.6-12.5 mm2 , P < .05) were smaller at all levels than MRI (11.3-14.7 mm2 ) or cadaveric (11.0-14.9 mm2 ) measurements while MRI and cadaver measurements were similar at all levels. Median nerve CSA MRI measurements in CTS patients were larger than US measurements at all levels. CONCLUSION Median nerve CSA measurements by MRI are larger than US measurements and correlated better with cadaveric measurements. Median nerve CSA criteria used for diagnosing CTS on US are not likely to be applicable to MRI.
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Affiliation(s)
- Ryan K L Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin NT, Hong Kong
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin NT, Hong Kong
| | - Alex W H Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin NT, Hong Kong
| | - George L Tipoe
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong Island, Hong Kong
| | - Anthony W H Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin NT, Hong Kong
| | - Clara W Y Wong
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Wing Lim Tse
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Pak Cheong Ho
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Shatin, NT, Hong Kong
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He Y, Xiang X, Zhu BH, Qiu L. Shear wave elastography evaluation of the median and tibial nerve in diabetic peripheral neuropathy. Quant Imaging Med Surg 2019; 9:273-282. [PMID: 30976551 DOI: 10.21037/qims.2019.02.05] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background To evaluate the value of shear wave elastography (SWE) in the detection of diabetic peripheral neuropathy (DPN) of the median and tibial nerves. Methods The study included 40 DPN patients, 40 diabetic mellitus (DM) patients without DPN, and 40 healthy subjects. High-resolution ultrasonography (US) and SWE were performed on the median nerve (MN) and tibial nerve (TN), and cross-sectional area (CSA) and nerve stiffness were measured. ROC analysis was also performed. Results The patients with DPN demonstrated higher stiffness of the median and tibial nerve compared with that of healthy volunteers and DM patients (P<0.001). Bilateral analysis showed that there was no significant difference in nerve stiffness between the left and right median nerves and tibial nerves in DPN patients (P>0.05). The stiffness of median nerve and tibial nerve in each one side also had no significant difference in patients with DPN (P>0.05). The CSA of the tibial nerve in the DPN group was significantly larger than that in the other groups (P<0.001), while there was no significant difference of median nerve CSA among the three groups (P>0.05). The area under curve (AUC) of SWE (MN: 0.899, TN: 0.927) to diagnose DPN was significantly greater than that of CSA (TN: 0.798). The optimal cut-off value in SWE of the tibial nerve and median nerve for diagnosis of DPN was 4.11 and 4.06 m/s, respectively, with a good sensitivity and specificity. Conclusions Median and tibial nerve stiffness was significantly higher in patients with DPN. These findings suggest that SWE-based stiffness measurement of the nerve was a better method than CSA, and it can be used as another effective assistant method in the diagnosis of DPN.
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Affiliation(s)
- Ying He
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xi Xiang
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bi-Hui Zhu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Li Qiu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
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Lothet EH, Bishop TJ, Walker FO, Cartwright MS. Ultrasound-Derived Nerve Cross-Sectional Area in Extremes of Height and Weight. J Neuroimaging 2018; 29:406-409. [PMID: 30582247 DOI: 10.1111/jon.12590] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND PURPOSE There is a lack of consensus in the literature as to which body habitus parameter most influences nerve cross-sectional area (CSA). This study was specifically designed to determine if height or weight is more influential. METHODS Fifteen young healthy participants, 8 extremely tall and 7 heavy, with no peripheral nerve symptoms were recruited. The tall cohort consisted of males who were 74 inches or taller and females who were 68 inches or taller. The heavy cohort consisted of males who were 274 lbs or heavier and females who were 200 lbs or heavier. Measurements were obtained bilaterally at 7 sites using neuromuscular ultrasound: median nerve at the wrist and mid-forearm, ulnar at the elbow, radial at the spiral groove, fibular at the knee, tibial at the ankle, and sural at the ankle. The nerve CSA at each site was measured by tracing of the nerve using the "freehand" trace function of the ultrasound device. RESULTS Weight tightly correlated with nerve CSA (R2 = .69, P < .001), while height did not significantly predict CSA (R2 = .10, P = .244). Nerve CSA for tall participants did not systematically deviate from an historical control group. Conversely, with exception of the tibial and sural nerves at the ankle, all nerve CSAs for heavy participants were higher than in the control group. CONCLUSION Weight was found to be the body habitus parameter that most influences nerve CSA. This will inform clinicians when using nerve imaging to evaluate participants at either extreme of weight.
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Affiliation(s)
- Emilie H Lothet
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Timothy J Bishop
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Francis O Walker
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
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Liu W, Sui X, Ye L, Zhao L. Ultrasonographic evaluation of radial nerve injuries associated with pediatric chronic monteggia lesions. Muscle Nerve 2018; 59:326-330. [PMID: 30390392 DOI: 10.1002/mus.26376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/27/2018] [Accepted: 10/30/2018] [Indexed: 11/05/2022]
Abstract
INTRODUCTION To determine the ultrasonographic evaluation of the radial nerve (RN) before correction of chronic pediatric Monteggia lesions in patients with suspected nerve injury. METHODS Twelve consecutive children with Monteggia lesions were investigated. The cross-sectional area (CSA) of the nerve and the nerve-to-skin (N-S) distance were determined by ultrasonography at 3 levels: 5 cm proximal to the humeroradial joint (L_prox), a horizontal line through the humeroradial joint (L_mid), and 2.5 cm distal to the humeroradial joint (L_dist). RESULTS The CSA was greater on the injured side than on the unaffected side at L_prox and at L_mid (P < 0.01), but no difference was noted for posterior interosseous nerve (PIN) at L_dist (P = 0.445). The N-S values were greater on the unaffected side than on the injured side (P < 0.01), but there was no difference at L_dist in superficial RN and PIN. DISCUSSION Ultrasonography allowed the preoperative assessment of the severity of RN injuries in chronic pediatric Monteggia lesions. Muscle Nerve 59:326-330, 2019.
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Affiliation(s)
- Weiyong Liu
- Department of Ultrasound, Anhui Province Hospital, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Xiufang Sui
- Department of Ultrasound, Anhui Province Hospital, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Lei Ye
- Department of Ultrasound, Anhui Province Hospital, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Li Zhao
- Department of Pediatric Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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50
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Sarafraz H, Hadian MR, Ayoobi Yazdi N, Olyaei G, Bagheri H, Jalaie S, Rasouli O. Test-retest reliability of nerve and muscle morphometric characteristics utilizing ultrasound imaging in individuals with unilateral sciatica and controls. Chiropr Man Therap 2018; 26:47. [PMID: 30410724 PMCID: PMC6219045 DOI: 10.1186/s12998-018-0215-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 09/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Ultrasound imaging has been suggested for studying the structure and function of nerves and muscles; however, reliability studies are limited to support the usage. The main aim of this study was to explore the intrarater within-session reliability of evaluating the sciatic nerve and some related muscles morphology by ultrasound imaging. Methods Three B-mode images from two scans (transverse and longitudinal) were acquired from the multifidus, biceps femoris, soleus and medial gastrocnemius muscles bilaterally from 15 participants with sciatica and 15 controls in one session, 1-h apart. The data were collected from March to July 2017. Contraction ratio was measured only by longitudinal scan, while the echo intensity was measured using maximum rectangular region of interest in two scans (transverse and longitudinal) for all muscles. Cross-sectional area, direct (tracing) and indirect (ellipsoid formula) methods were used to measure the sciatic nerve. Intraclass correlation coefficient (ICC 3,1), standard error of measurement and minimal detectable change were calculated. Results Good to high ICCs (0.80–0.96) were found for muscle contraction ratio in the longitudinal scans in all the muscles in both sciatica and control groups. For echo intensity measurements ICCs ranged from moderate to high, with higher ICCs seen with the maximum region of interest in the transverse scans. The minimal detectable change values ranged between 0.11 and 0.53 cm for contraction ratio. Conclusions Ultrasound imaging has high intrarater within-session reliability for assessing the sciatic nerve Cross-sectional area and muscle contraction ratios. Transverse scans with the maximum region of interest result in higher reliability. The sciatic Cross-sectional area is most accurately measured utilizing the direct tracing method rather than the indirect ellipsoid method.
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Affiliation(s)
- Hadi Sarafraz
- 1Department of Physiotherapy, School of Rehabilitation, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran.,Department of Neurology, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohammad Reza Hadian
- 3Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, International Campus (TUMS, IC-TUMS), Brain and Spinal Injury Research Center (BASIR), Tehran, Iran
| | - Niloofar Ayoobi Yazdi
- 4Radiology, Advanced Diagnostic and Interventional Radiology (ADIR) research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Olyaei
- 5Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, (TUMS), Tehran, Iran
| | - Hossein Bagheri
- 5Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, (TUMS), Tehran, Iran
| | - Shohreh Jalaie
- 6Biostatistics, Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, (TUMS), Tehran, Iran
| | - Omid Rasouli
- 7Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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