1
|
Ludi Z, Liau MYQ, Yong BSJ, Auyong ASY, Lynette QHT, Yeo SJ, Tan KSE, Mogali SR, Chandrasekaran R, Perumal V, Vallabhajosyula R. Morphometry of the sural nerve in diabetic neuropathy: a systematic review. J Ultrasound 2024; 27:225-239. [PMID: 38457087 PMCID: PMC11178711 DOI: 10.1007/s40477-024-00875-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/16/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE The aim of this systematic review is to evaluate the usefulness of sural nerve ultrasonography in diagnosing diabetes mellitus (DM) and diabetic polyneuropathy (DPN), the latter of which is a common long-term complication for diabetic patients that frequently involves the sural nerve. METHODOLOGY A meta-analysis of the cross-sectional areas (CSAs) of sural nerves in healthy individuals and patients with diabetes mellitus based on a total of 32 ultrasonographic-based studies from 2015 to 2023 was performed. Sub-analyses were performed for factors such as geographical location and measurement site. RESULTS The meta-analysis showed that the mean CSA of the sural nerve was significantly larger in DM patients with DPN only compared to healthy individuals across all regions and when pooled together. An age-dependent increase in the CSA of healthy sural nerves is apparent when comparing the paediatric population with adults. CONCLUSION Sural nerve ultrasonography can distinguish diabetic adults with DPN from healthy adults based on cross-sectional area measurement. Future studies are needed to clarify the relationships between other parameters, such as body metrics and age, with sural nerve CSAs. Cut-offs for DPN likely need to be specific for different geographical regions.
Collapse
Affiliation(s)
- Zhang Ludi
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Matthias Yi Quan Liau
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Bryan Song Jun Yong
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Amanda Sze Yen Auyong
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Quah Hui Ting Lynette
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Samuel Jianjie Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Khin Swee Elizabeth Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Sreenivasulu Reddy Mogali
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Ramya Chandrasekaran
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Vivek Perumal
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Ranganath Vallabhajosyula
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore.
| |
Collapse
|
2
|
Puma A, Grecu N, Badea RȘ, Morisot A, Zugravu R, Ioncea MB, Cavalli M, Lăcătuș O, Ezaru A, Hacina C, Villa L, Raffaelli C, Azulay N, Sacconi S. Typical CIDP, distal variant CIDP, and anti-MAG antibody neuropathy: An ultra-high frequency ultrasound comparison of nerve structure. Sci Rep 2024; 14:4643. [PMID: 38409319 PMCID: PMC10897478 DOI: 10.1038/s41598-024-54452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
To date, little is known about the usefulness of ultra-high frequency ultrasound (UHF-US, 50-70 MHz) in clinical practice for the diagnosis of dysimmune neuropathies. We present a prospective study aimed at comparing UHF-US alterations of nerves and fascicles in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), distal CIDP (d-CIDP) and anti-MAG neuropathy and their relationships with clinical and electrodiagnostic (EDX) features. 28 patients were included (twelve CIDP, 6 d-CIDP and 10 anti-MAG) and ten healthy controls. Each patient underwent neurological examination, EDX and UHF-US study of median and ulnar nerves bilaterally. UHF-US was reliable in differentiating immune neuropathies from controls when using mean and/or segmental nerve and/or fascicle cross-sectional area (CSA); furthermore, fascicle ratio (fascicle/nerve CSA) was a reliable factor for differentiating d-CIDP from other types of polyneuropathies. The fascicle CSA appears to be more increased in CIDP and its variant than in anti-MAG neuropathy. UHF-US offers information beyond simple nerve CSA and allows for a better characterization of the different forms of dysimmune neuropathies.
Collapse
Affiliation(s)
- Angela Puma
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France.
- Faculty of Medicine, UMR7370 CNRS, LP2M, Labex ICST, Université Nice Côte d'Azur, Nice, France.
| | - Nicolae Grecu
- Neurology Department, University Emergency Hospital Bucharest, 169 Splaiul Independentei, 050098, Bucharest, Romania
| | - Raluca Ș Badea
- Neurology Department, University Emergency Hospital Bucharest, 169 Splaiul Independentei, 050098, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, 8 Bulevardul Eroii Sanitari, 050474, Bucharest, Romania
| | - Adeline Morisot
- Department of Public Health, University Hospital of Nice, Nice, France
| | - Roxana Zugravu
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
- Neurology Department, University Emergency Hospital Bucharest, 169 Splaiul Independentei, 050098, Bucharest, Romania
| | - Mihai B Ioncea
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
- Neurology Department, University Emergency Hospital Bucharest, 169 Splaiul Independentei, 050098, Bucharest, Romania
| | - Michele Cavalli
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
| | - Oana Lăcătuș
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
- Neurology Department, University Emergency Hospital Bucharest, 169 Splaiul Independentei, 050098, Bucharest, Romania
| | - Andra Ezaru
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
- Service Médicine Polyvalente, Pôle Spécialités Médicales, CH Grasse, 28 Chemin de Clavary, 06180, Grasse, France
| | - Chorfa Hacina
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
| | - Luisa Villa
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
| | - Charles Raffaelli
- Ultrasound Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
| | - Nicolas Azulay
- Ultrasound Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
| | - Sabrina Sacconi
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
| |
Collapse
|
3
|
Dziadkowiak E, Nowakowska-Kotas M, Rałowska-Gmoch W, Budrewicz S, Koszewicz M. Molecular, Electrophysiological, and Ultrasonographic Differences in Selected Immune-Mediated Neuropathies with Therapeutic Implications. Int J Mol Sci 2023; 24:ijms24119180. [PMID: 37298132 DOI: 10.3390/ijms24119180] [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: 03/31/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
The spectrum of immune-mediated neuropathies is broad and the different subtypes are still being researched. With the numerous subtypes of immune-mediated neuropathies, establishing the appropriate diagnosis in normal clinical practice is challenging. The treatment of these disorders is also troublesome. The authors have undertaken a literature review of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), Guillain-Barre syndrome (GBS) and multifocal motor neuropathy (MMN). The molecular, electrophysiological and ultrasound features of these autoimmune polyneuropathies are analyzed, highlighting the differences in diagnosis and ultimately treatment. The immune dysfunction can lead to damage to the peripheral nervous system. In practice, it is suspected that these disorders are caused by autoimmunity to proteins located in the node of Ranvier or myelin components of peripheral nerves, although disease-associated autoantibodies have not been identified for all disorders. The electrophysiological presence of conduction blocks is another important factor characterizing separate subgroups of treatment-naive motor neuropathies, including multifocal CIDP (synonyms: multifocal demyelinating neuropathy with persistent conduction block), which differs from multifocal motor neuropathy with conduction block (MMN) in both responses to treatment modalities and electrophysiological features. Ultrasound is a reliable method for diagnosing immune-mediated neuropathies, particularly when alternative diagnostic examinations yield inconclusive results. In overall terms, the management of these disorders includes immunotherapy such as corticosteroids, intravenous immunoglobulin or plasma exchange. Improvements in clinical criteria and the development of more disease-specific immunotherapies should expand the therapeutic possibilities for these debilitating diseases.
Collapse
Affiliation(s)
- Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Marta Nowakowska-Kotas
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Wiktoria Rałowska-Gmoch
- Department of Neurology, The St. Jadwiga's Regional Specialist Neuropsychiatric Centre, Wodociągowa 4, 45-221 Opole, Poland
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| |
Collapse
|
4
|
Yun CJ, Crump N, Puckett M, Cartwright MS. Focused Neuromuscular Ultrasound Approach for the Diagnosis of Chronic Inflammatory Demyelinating Polyneuropathy. J Clin Neurophysiol 2023; 40:378-381. [PMID: 37143208 DOI: 10.1097/wnp.0000000000000905] [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: 11/26/2022] Open
Abstract
PURPOSE Previous ultrasonographic studies of individuals with chronic inflammatory demyelinating polyneuropathy (CIDP) have shown nerve enlargement at several sites. This prospective study compares only the bilateral median and ulnar nerves of individuals with CIDP with reference values to determine the clinical usefulness of this focused approach as a diagnostic tool. METHODS The cross-sectional area, echogenicity, and vascularity of the bilateral median and ulnar nerves of 25 subjects with CIDP were measured using ultrasound. Nineteen had typical CIDP based on the European Federation of Neurological Societies and the Peripheral Nerve Society guidelines, whereas six had atypical CIDP and were diagnosed based on clinical impression. RESULTS Focal nerve enlargement was found in at least one segment in all subjects. Subjects with typical CIDP had larger cross-sectional areas compared with subjects with atypical CIDP. CONCLUSION A focused ultrasound study, involving only the median and ulnar nerves, is sensitive for the detection of nerve enlargement in CIDP. Measuring the cross-sectional area of the median and ulnar nerves is clinically feasible and may help establish the diagnosis of CIDP.
Collapse
Affiliation(s)
- Chelsea J Yun
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | | | | | | |
Collapse
|
5
|
Gunio D, Babaa A, Bencardino JT. Imaging of Nerve Disorders in the Elbow. Semin Musculoskelet Radiol 2022; 26:123-139. [PMID: 35609574 DOI: 10.1055/s-0042-1743407] [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
Neuropathies of the elbow represent a spectrum of disorders that involve more frequently the ulnar, radial, and median nerves. Reported multiple pathogenic factors include mechanical compression, trauma, inflammatory conditions, infections, as well as tumor-like and neoplastic processes. A thorough understanding of the anatomy of these peripheral nerves is crucial because clinical symptoms and imaging findings depend on which components of the affected nerve are involved. Correlating clinical history with the imaging manifestations of these disorders requires familiarity across all diagnostic modalities. This understanding allows for a targeted imaging work-up that can lead to a prompt and accurate diagnosis.
Collapse
Affiliation(s)
- Drew Gunio
- Division of Clinical Radiology, Department of Radiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Ahmad Babaa
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
6
|
Brünger J, Motte J, Grüter T, Mork H, Bulut Y, Carolus A, Athanasopoulos D, Yoon MS, Gold R, Pitarokoili K, Fisse AL. Nerve Ultrasound Distinguishes Non-Inflammatory Axonal Polyneuropathy From Inflammatory Polyneuropathy With Secondary Axonal Damage. Front Neurol 2022; 12:809359. [PMID: 35153986 PMCID: PMC8831897 DOI: 10.3389/fneur.2021.809359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/24/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Chronic inflammatory demyelinating polyneuropathy (CIDP) may have a similar clinical and electrophysiological presentation to non-inflammatory axonal polyneuropathies (NIAPs) when secondary axonal damage occurs. We aimed to investigate if nerve ultrasound can help to differentiate CIDP with additional secondary axonal damage from NIAP. Methods In a retrospective analysis, the cross-sectional area (CSA) of the peripheral nerves measured by ultrasound at six suitable nerve sites was compared in 95 patients with CIDP and 82 patients with NIAP. We developed the adjusted Bochum ultrasound score (aBUS) ranging from 0 to 6 resulting from the number of sites with enlarged CSA (median, ulnar, radial, and sural nerve). Results The mean CSA of patients with CIDP was enlarged at all six nerve sites compared with the mean CSA of patients with NIAP. A total of 21 patients with CIDP did not meet 2010 electrophysiological diagnostic criteria (European Academy of Neurology/Peripheral Nerve Society Guideline, EFNS/PNS criteria) for CIDP at examination timepoint but only in further follow-up, while 25 patients with NIAP fulfilled electrophysiological EFNS/PNS criteria for CIDP as “possible” or “probable” CIDP. To increase diagnostic power, we included aBUS measured by ultrasound in patients classified as “possible” or “probable” resulting in an improved specificity of 94% and a sensitivity of 59%, compared to a specificity of the EFNS/PNS criteria alone of 60% and sensitivity of 78%. Conclusion Using nerve ultrasound and the aBUS as a complementary method to distinguish CIDP from NIAP in case of secondary axonal damage can facilitate the diagnosis of CIDP.
Collapse
Affiliation(s)
- Jil Brünger
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
- *Correspondence: Jil Brünger
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Hannah Mork
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Yesim Bulut
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Anne Carolus
- Clinic for Neurosurgery, University Medical Center Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Diamantis Athanasopoulos
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Min-Suk Yoon
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
- Department of Neurology, Evangelisches Krankenhaus Hattingen, Hattingen, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
7
|
Hannaford A, Vucic S, Kiernan MC, Simon NG. Review Article "Spotlight on Ultrasonography in the Diagnosis of Peripheral Nerve Disease: The Evidence to Date". Int J Gen Med 2021; 14:4579-4604. [PMID: 34429642 PMCID: PMC8378935 DOI: 10.2147/ijgm.s295851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Neuromuscular ultrasound is rapidly becoming incorporated into clinical practice as a standard tool in the assessment of peripheral nerve diseases. Ultrasound complements clinical phenotyping and electrodiagnostic evaluation, providing critical structural anatomical information to enhance diagnosis and identify structural pathology. This review article examines the evidence supporting neuromuscular ultrasound in the diagnosis of compressive mononeuropathies, traumatic nerve injury, generalised peripheral neuropathy and motor neuron disease. Extending the sonographic evaluation of nerves beyond simple morphological measurements has the potential to improve diagnostics in peripheral neuropathy, as well as advancing the understanding of pathological mechanisms, which in turn will promote precise therapies and improve therapeutic outcomes.
Collapse
Affiliation(s)
- Andrew Hannaford
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Steve Vucic
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Neil G Simon
- Northern Beaches Clinical School, Macquarie University, Sydney, Australia
| |
Collapse
|
8
|
Liu M, Liu Y, Peng C, Wang H, Xu Y, Jiao S, Ding Y. Effects of massage and acupuncture on the range of motion and daily living ability of patients with frozen shoulder complicated with cervical spondylosis. Am J Transl Res 2021; 13:2804-2812. [PMID: 34017443 PMCID: PMC8129293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study was designed to study the effects of massage and acupuncture on patients with frozen shoulder complicated with cervical spondylosis through range of motion (ROM) and daily living ability. METHODS A total of 164 patients with frozen shoulder treated in our hospital from June 2016 to April 2019 were recruited and divided into a control group and an observation group. There were 100 cases in the observation group, all of whom were treated with massage combined with acupuncture. Another 64 cases were enrolled in the control group, all of whom were treated with acupuncture alone. The recovery of myodynamia, rating scale of the American Shoulder and Elbow Surgeons (ASES), score of American Spinal Injury Association (ASIA), ROM score, vascular cell adhesion molecule 1 (VCAM-1) and intercellular adhesion molecule 1 (ICAM-1), complication rate, total effective rate, and patient satisfaction were assessed. RESULTS After treatment, patients in the observation group had better recovery of myodynamia than the control group. They also had lower VAS scores, higher life function score and total ASES scores, higher ASIA scores, higher ROM scores, lower VCAM-1 and ICAM-1 expression, lower complication rate, higher total effective rate, and higher patient satisfaction. CONCLUSION Massage combined with acupuncture can better improve the ROM of joints and daily living ability of patients with frozen shoulder complicated with cervical spondylosis.
Collapse
Affiliation(s)
- Mingyu Liu
- The Ninth Hospital of WuhanWuhan 430081, Hubei Province, China
| | - Yuebin Liu
- Department of Rehabilitation Medicine, The Ninth Hospital of WuhanWuhan 430081, Hubei Province, China
| | - Cong Peng
- Department of Rehabilitation Medicine, The Ninth Hospital of WuhanWuhan 430081, Hubei Province, China
| | - Huanmei Wang
- Department of Rehabilitation Medicine, The Ninth Hospital of WuhanWuhan 430081, Hubei Province, China
| | - Yuqin Xu
- Department of Rehabilitation Medicine, The Ninth Hospital of WuhanWuhan 430081, Hubei Province, China
| | - Shengrong Jiao
- Department of Rehabilitation Medicine, The Ninth Hospital of WuhanWuhan 430081, Hubei Province, China
| | - Yong Ding
- Department of Tuina and Rehabilitation Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Hubei Province Academy of Traditional Chinese Medicine, Hubei University of Chinese MedicineWuhan 430061, Hubei Province, China
| |
Collapse
|
9
|
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.
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Transbulbar B-Mode Sonography for Clinical Phenotyping Multiple Sclerosis. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8112177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to assess putative differences in optic nerve sheath diameter (ONSD) and associated clinical/paraclinical variables between relapsing remitting (RR) and secondary progressive (SP) multiple sclerosis (MS) patients. We examined 60 relapse-free MS patients and 35 healthy controls by means of transbulbar B-mode sonography (TBS). Expanded disability status scale (EDSS) values were from 3 to 4 indicated patients with a transitional RR to SP phenotype. Mean ONSD was significantly lower in MS patients. Mean ONSD measured at 5 mm from the eyeball (ONSD5) was significantly lower in SP than in RR patients, while ONSD measured at 3 mm from the eyeball (ONSD3) was statistically higher in RR than in the transitional group. The myelination index (MI), i.e., the ratio of ONSD3 to ONSD5, was used to assess the relative myelination of the optic nerve (ON). Higher ONSD5 and MI (0.90) corresponded to patients with the RR phenotype having a mean EDSS of 2.0; lower MI (0.84) clustered the transitional patients having a mean EDSS of 3.7. Finally, lower MI with low ONSD3 identified the SP phenotype having a mean EDSS ≥ 4.0. The TBS in MS highlights chronic optic neuropathy, caused by early subclinical axonal loss and demyelination.
Collapse
|
12
|
Mawuntu AH, Mahama CN, Khosama H, Estiasari R, Imran D. Early detection of peripheral neuropathy using stimulated skin wrinkling test in human immunodeficiency virus infected patients: A cross-sectional study. Medicine (Baltimore) 2018; 97:e11526. [PMID: 30045275 PMCID: PMC6078746 DOI: 10.1097/md.0000000000011526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Peripheral neuropathy is a common condition of human immunodeficiency virus (HIV)-infected patients, which often remains undetected. We assessed the performance of stimulated skin wrinkling-eutectic mixture of local anesthetic (SSW-EMLA) test compared with brief peripheral neuropathy screening (BPNS) to detect HIV neuropathy.This is a cross-sectional study conducted in HIV-positive patients. A modified skin wrinkling grading was used to assess SSW-EMLA effect. BPNS-detectable neuropathy was assessed by a combination of neuropathy severity scoring scale (subjective) and objective method of sensory and tendon reflex examination. The SSW-EMLA test accuracy with reference to BPNS was assessed using sensitivity and specificity and predictive values.In a total of 99 HIV patients, 61.6% were males and the majority age group were between 30 and 40 years (52%). The neuropathy detection was SSW-EMLA test 36.4% versus BPNS 15.2% (P = .04). The sensitivity of SSW-EMLA test was 60.0% [95% confidence interval (95% CI) 34.5-81.7], specificity 67% (95% CI 63.3-3-71.7), and overall accuracy of 66.7% (95% CI 58.9-73.2).The SSW-EMLA test detected many more peripheral neuropathy cases than BPNS in HIV patients and has potential as an alternative test for screening for HIV neuropathy in resource-constraint hospitals in Indonesia.
Collapse
Affiliation(s)
- Arthur H.P. Mawuntu
- Neurology Department Faculty of Medicine Sam Ratulangi University/R.D. Kandou Hospital, North Sulawesi
| | - Corry N. Mahama
- Neurology Department Faculty of Medicine Sam Ratulangi University/R.D. Kandou Hospital, North Sulawesi
| | - Herlyani Khosama
- Neurology Department Faculty of Medicine Sam Ratulangi University/R.D. Kandou Hospital, North Sulawesi
| | - Riwanti Estiasari
- Neurology Department, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Darma Imran
- Neurology Department, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| |
Collapse
|
13
|
Décard BF, Pham M, Grimm A. Ultrasound and MRI of nerves for monitoring disease activity and treatment effects in chronic dysimmune neuropathies – Current concepts and future directions. Clin Neurophysiol 2018; 129:155-167. [DOI: 10.1016/j.clinph.2017.10.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/03/2017] [Accepted: 10/07/2017] [Indexed: 02/07/2023]
|
14
|
Fabrizi GM, Tamburin S, Cavallaro T, Cabrini I, Ferrarini M, Taioli F, Magrinelli F, Zanette G. The spectrum of Charcot-Marie-Tooth disease due to myelin protein zero: An electrodiagnostic, nerve ultrasound and histological study. Clin Neurophysiol 2017; 129:21-32. [PMID: 29136549 DOI: 10.1016/j.clinph.2017.09.117] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/13/2017] [Accepted: 09/29/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Nerve ultrasound (US) data on myelin protein zero (MPZ)-related Charcot-Marie-Tooth disease (CMT) are lacking. To offer a comprehensive perspective on MPZ-related CMTs, we combined nerve US with clinics, electrodiagnosis and histopathology. METHODS We recruited 36 patients (12 MPZ mutations), and correlated nerve US to clinical, electrodiagnostic measures, and sural nerve biopsy. RESULTS According to motor nerve conduction velocity (MNCV) criteria, nine patients were categorized as "demyelinating" CMT1B, 17 as "axonal" CMT2I/J, and 10 as dominant "intermediate" CMTDID. Sural nerve biopsy showed hypertrophic de-remyelinating neuropathy with numerous complex onion bulbs in one patient, de-remyelinating neuropathy with scanty/absent onion bulbs in three, axonal neuropathy in two, mixed demyelinating-axonal neuropathy in five. Electrodiagnosis significantly differed in CMT1B vs. CMT2I/J and CMTDID subgroups. CMT1B had slightly enlarged nerve cross sectional area (CSA) especially at proximal upper-limb (UL) sites. CSA was negatively correlated to UL MNCV and not increased at entrapment sites. Major sural nerve pathological patterns were uncorrelated to UL nerve US and MNCV. CONCLUSIONS Sural nerve biopsy confirmed the wide pathological spectrum of MPZ-CMT. UL nerve US identified two major patterns corresponding to the CMT1B and CMT2I/J-CMTDID subgroups. SIGNIFICANCE Nerve US phenotype of MPZ-CMT diverged from those in other demyelinating peripheral neuropathies and may have diagnostic value.
Collapse
Affiliation(s)
- Gian Maria Fabrizi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy.
| | - Tiziana Cavallaro
- Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Ilaria Cabrini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Moreno Ferrarini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Federica Taioli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Francesca Magrinelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Giampietro Zanette
- Neurology Division, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| |
Collapse
|
15
|
Kronlage M, Bäumer P, Pitarokoili K, Schwarz D, Schwehr V, Godel T, Heiland S, Gold R, Bendszus M, Yoon MS. Large coverage MR neurography in CIDP: diagnostic accuracy and electrophysiological correlation. J Neurol 2017. [PMID: 28620719 DOI: 10.1007/s00415-017-8543-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The objective of this study was to evaluate large coverage magnetic resonance neurography (MRN) in chronic inflammatory demyelinating polyneuropathy (CIDP). In this prospective study, 18 patients with CIDP and 18 healthy controls were examined by a standardized MRN protocol at 3 T. Lumbosacral plexus was imaged by a T2-weighted 3D sequence and peripheral nerves of the upper and lower extremity by axial T2-weighted turbo spin-echo sequences. Lesions were characterized by nerve cross-sectional area (CSA) and T2-weighted signal (nT2). Additionally, T2 relaxometry of the sciatic nerve was performed using a multi-spin-echo sequence. All patients received a complementary electrophysiological exam. Patients with CIDP exhibited increased nerve CSA and nT2 compared to controls (p < 0.05) in a proximally predominating pattern. Receiver operating characteristic analysis revealed the best diagnostic accuracy for CSA of the lumbosacral plexus (AUC = 0.88) and nT2 of the sciatic nerve (AUC = 0.88). CSA correlated with multiple electrophysiological parameters of demyelinating neuropathy (F wave latency, nerve conduction velocity) of sciatic and median nerve, while nT2 only correlated with F wave latency of sciatic and not median nerve. T2 relaxometry indicated that MR signal increase in CIDP was due to an increase in proton-spin-density (p < 0.05), and not due to the increase in T2 relaxation time. Both nT2 and CSA might aid in the diagnosis of CIDP, but CSA correlates more robustly with established electrophysiological parameters for CIDP. Since the best diagnostic accuracy was shown for proximal nerve locations, MRN may be a useful complementary tool in selected CIDP cases.
Collapse
Affiliation(s)
- Moritz Kronlage
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Philipp Bäumer
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Bochum, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Véronique Schwehr
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tim Godel
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Bochum, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Min-Suk Yoon
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Bochum, Germany
| |
Collapse
|