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Puma A, Grecu N, Villa L, Butori C, Besson T, Cambieri C, Cavalli M, Azulay N, Sacconi S, Raffaelli C. Ultra-high-frequency ultrasound imaging of sural nerve: A comparative study with nerve biopsy in progressive neuropathies. Muscle Nerve 2020; 63:46-51. [PMID: 32939798 DOI: 10.1002/mus.27073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Nerve ultrasound has been used increasingly in clinical practice as a complementary test for diagnostic assessment of neuropathies, but nerve biopsy remains invaluable in certain cases. The aim of this study was to compare ultra-high-frequency ultrasound (UHF-US) to histologic findings in progressive polyneuropathies. METHODS Ten patients with severe, progressive neuropathies underwent ultrasound evaluation of the sural nerve before nerve biopsy. Ultrasound data were compared with histologic results in a retrospective manner. RESULTS Sural nerves were easily identified on UHF-US. Nerve hyperechogenicity correlated with inflammatory infiltrates on biopsy. Nerve fascicles could be identified and measured on ultrasound in the majority of patients. DISCUSSION Hyperechogenicity on UHF-US may be a marker of nerve inflammation in neuropathies. Furthermore, the UHF-US probe allows for evaluation of sensory nerves in spite of their small size, providing valuable information on their size and on their internal structure.
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Affiliation(s)
- Angela Puma
- Peripheral Nervous System and Muscle Department, CHU Nice, Université Côte d'Azur, Nice, France.,Faculty of Medicine, UMR7370 CNRS, LP2M, Labex ICST, Université Nice Côte d'Azur, Nice, France
| | - Nicolae Grecu
- Peripheral Nervous System and Muscle Department, CHU Nice, Université Côte d'Azur, Nice, France
| | - Luisa Villa
- Peripheral Nervous System and Muscle Department, CHU Nice, Université Côte d'Azur, Nice, France.,Pathology Department, CHU Nice, Université Côte d'Azur, Nice, France
| | - Catherine Butori
- Pathology Department, CHU Nice, Université Côte d'Azur, Nice, France
| | - Thomas Besson
- Faculty of Medicine, UMR7370 CNRS, LP2M, Labex ICST, Université Nice Côte d'Azur, Nice, France
| | - Chiara Cambieri
- Peripheral Nervous System and Muscle Department, CHU Nice, Université Côte d'Azur, Nice, France.,Department of Human Neuroscience, Centre of Rare Neuromuscular Diseases, Sapienza University of Rome, Rome, Italy
| | - Michele Cavalli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Nicolas Azulay
- Ultrasound Department, CHU Nice, Université Côte d'Azur, Nice, France
| | - Sabrina Sacconi
- Peripheral Nervous System and Muscle Department, CHU Nice, Université Côte d'Azur, Nice, France.,Faculty of Medicine, INSERM U1081, CNRS UMR 7284, Institute for Research on Cancer and Aging of Nice, Université Côte d'Azur, Nice, France
| | - Charles Raffaelli
- Ultrasound Department, CHU Nice, Université Côte d'Azur, Nice, France
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Puma A, Azulay N, Grecu N, Suply C, Panicucci E, Cambieri C, Villa L, Raffaelli C, Sacconi S. Comparison of high-frequency and ultrahigh-frequency probes in chronic inflammatory demyelinating polyneuropathy. J Neurol 2019; 266:2277-2285. [PMID: 31175432 DOI: 10.1007/s00415-019-09392-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES High-frequency ultrasound (HFUS 18-20 MHz) performed on patients with chronic inflammatory demyelinating polyneuropathy (CIDP) shows a focal enlargement, particularly in the proximal segments of upper-arm motor nerves. Ultrahigh frequency ultrasound (UHFUS 30-70 MHz), having a higher spatial resolution, enables a better characterization of nerve structures. The aim of this study was to compare the two ultrasound probes in the evaluation of motor nerve characteristics in CIDP patients. METHODS Eleven patients with definite or probable CIDP underwent an ultrasound evaluation of median and ulnar nerves, bilaterally. Nerve and fascicle cross-sectional area (CSA), vascularization, and echogenicity were assessed. RESULTS Nerve and fascicle CSA were increased in the proximal segments, especially in the median nerve, in 9/11 patients and in 10/11 patients at the HFUS and UHFUS evaluations, respectively. A statistically significant difference between CSA values obtained with the two probes was found only for fascicle values. UHFUS allowed for a more precise estimation of fascicle size and number than the HFUS. We were able to identify nerve vascularization in 4/11 patients at UHFUS only. CONCLUSION UHFUS gives more detailed information on the changes in the internal nerve structure in CIDP patients. In particular, it permits to better characterize fascicle size and morphology, and to have a precise estimation of their number. Its frequency range also allows to evaluate nerve vascularization. SIGNIFICANCE Ultrasound evaluation could become an adjunctive diagnostic tool for CIDP. Further studies are needed to validate the examined parameters as biomarkers for the evaluation and follow-up of CIDP patients.
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Affiliation(s)
- Angela Puma
- Peripheral Nervous System, Muscle and ALS Department, CHU Nice, Université Côte D'Azur, Nice, France.
- UMR7370 CNRS, LP2M, Labex ICST, Faculty of Medicine, Université Nice Côte d'Azur, Nice, France.
| | - N Azulay
- Ultrasound Department, CHU Nice, Université Côte d'Azur, Nice, France
| | - N Grecu
- Peripheral Nervous System, Muscle and ALS Department, CHU Nice, Université Côte D'Azur, Nice, France
| | - C Suply
- Peripheral Nervous System, Muscle and ALS Department, CHU Nice, Université Côte D'Azur, Nice, France
| | - E Panicucci
- Peripheral Nervous System, Muscle and ALS Department, CHU Nice, Université Côte D'Azur, Nice, France
| | - C Cambieri
- Peripheral Nervous System, Muscle and ALS Department, CHU Nice, Université Côte D'Azur, Nice, France
- Department of Human Neuroscience, Centre of Rare Neuromuscular Diseases, Sapienza University of Rome, Rome, Italy
| | - L Villa
- Peripheral Nervous System, Muscle and ALS Department, CHU Nice, Université Côte D'Azur, Nice, France
- Pathology Department, CHU Nice, Université Côte d'Azur, Nice, France
| | - C Raffaelli
- Ultrasound Department, CHU Nice, Université Côte d'Azur, Nice, France
| | - S Sacconi
- Peripheral Nervous System, Muscle and ALS Department, CHU Nice, Université Côte D'Azur, Nice, France
- Institute for Research on Cancer and Aging of Nice (IRCAN), INSERM U1081, CNRS UMR 7284, Faculty of Medicine, Université Côte d'Azur (UCA), Nice, France
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Brill NA, Tyler DJ. Quantification of human upper extremity nerves and fascicular anatomy. Muscle Nerve 2017; 56:463-471. [PMID: 28006854 PMCID: PMC5712902 DOI: 10.1002/mus.25534] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/04/2016] [Accepted: 12/20/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION In this study we provide detailed quantification of upper extremity nerve and fascicular anatomy. The purpose is to provide values and trends in neural features useful for clinical applications and neural interface device design. METHODS Nerve cross-sections were taken from 4 ulnar, 4 median, and 3 radial nerves from 5 arms of 3 human cadavers. Quantified nerve features included cross-sectional area, minor diameter, and major diameter. Fascicular features analyzed included count, perimeter, area, and position. RESULTS Mean fascicular diameters were 0.57 ± 0.39, 0.6 ± 0.3, 0.5 ± 0.26 mm in the upper arm and 0.38 ± 0.18, 0.47 ± 0.18, 0.4 ± 0.27 mm in the forearm of ulnar, median, and radial nerves, respectively. Mean fascicular diameters were inversely proportional to fascicle count. CONCLUSION Detailed quantitative anatomy of upper extremity nerves is a resource for design of neural electrodes, guidance in extraneural procedures, and improved neurosurgical planning. Muscle Nerve 56: 463-471, 2017.
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Affiliation(s)
- Natalie A Brill
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio, 44104, USA
| | - Dustin J Tyler
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio, 44104, USA
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
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