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Jomier F, Bousson V, Viala K, Péréon Y, Magot A, Cauquil C, Bouhour F, Vial C, Bedat-Millet AL, Taithe F, Bresch S, Siri A, Kubis N, Lozeron P. Prospective study of the additional benefit of plexus magnetic resonance imaging in the diagnosis of chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2019; 27:181-187. [PMID: 31348848 DOI: 10.1111/ene.14053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Hypertrophy/signal hyperintensity and/or gadolinium enhancement of plexus structures on magnetic resonance imaging (MRI) are observed in two-thirds of cases of typical chronic inflammatory demyelinating polyneuropathy (CIDP). The objective of our study was to determine the additional benefit of plexus MRI in patients referred to tertiary centers with baseline clinical and electrophysiological characteristics suggestive of typical or atypical CIDP. METHODS A total of 28 consecutive patients with initial suspicion of CIDP were recruited in nine centers and followed for 2 years. Plexus MRI data from the initial assessment were reviewed centrally. Physicians blinded to the plexus MRI findings established the final diagnosis (CIDP or neuropathy of another cause). The proportion of patients with abnormal MRI was analyzed in each group. RESULTS Chronic inflammatory demyelinating polyneuropathy was confirmed in 14 patients (50%), as were sensorimotor CIDP (n = 6), chronic immune sensory polyradiculoneuropathy (n = 2), motor CIDP (n = 1) and multifocal acquired demyelinating sensory and motor neuropathy (n = 5). A total of 37 plexus MRIs were performed (17 brachial, 19 lumbosacral and 8 in both localizations). MRI was abnormal in 5/37 patients (14%), all of whom were subsequently diagnosed with CIDP [5/14(36%)], after an atypical baseline presentation. With plexus MRI results masked, non-invasive procedures confirmed the diagnosis of CIDP in all but one patient [1/14 (7%)]. Knowledge of the abnormal MRI findings in the latter could have prevented nerve biopsy being performed. CONCLUSION Systematic plexus MRI in patients with initially suspected CIDP provides little additional benefit in confirming the diagnosis of CIDP.
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Affiliation(s)
- F Jomier
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière, Paris, France
| | - V Bousson
- Service de Radiologie Ostéoarticulaire, AP-HP, Hôpital Lariboisière, Paris, France
| | - K Viala
- Département de Neurophysiologie Clinique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Y Péréon
- Centre de Référence Maladies Neuromusculaires, CHU Nantes, Nantes, France.,Université de Nantes, Nantes, France
| | - A Magot
- Centre de Référence Maladies Neuromusculaires, CHU Nantes, Nantes, France
| | - C Cauquil
- Service de Neurologie, CHU Bicêtre, Le Kremlin-Bicêtre, France.,Centre National de Référence pour la Neuropathie Amyloïde Familiale, CHU Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - F Bouhour
- Service de Neurologie, Hospices Civils de Lyon, Lyon, France
| | - C Vial
- Service de Neurologie, Hospices Civils de Lyon, Lyon, France
| | | | - F Taithe
- Service de Neurologie, CHU Gabriel Montpied, Clermont Ferrand, France.,Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - S Bresch
- Service de Neurologie, CHU de Nice, Nice, France
| | - A Siri
- Service de Neurologie, CHRU de Nancy, Nancy, France
| | - N Kubis
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière, Paris, France.,U1148-Laboratory for Vascular and Translational Science, INSERM, Université de Paris, Paris, France
| | - P Lozeron
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière, Paris, France.,U1148-Laboratory for Vascular and Translational Science, INSERM, Université de Paris, Paris, France
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