Alexander Grimm1, Bernhard F Décard2, Hubertus Axer3, Peter Fuhr2. 1. Department of Neurology, Basel University Hospital, Basel, Switzerland. Electronic address: alexander.grimm@usb.ch. 2. Department of Neurology, Basel University Hospital, Basel, Switzerland. 3. Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
Abstract
OBJECTIVE: Ultrasound differentiation of neuropathies is a great challenge. We, therefore, suggest a standardized score to operationalize differentiation between several acute and subacute onset neuropathies. METHOD: We retrospectively analyzed the ultrasound data of 61 patients with acute or subacute neuropathies, e.g. chronic immune-mediated neuropathies, Guillain-Barré syndrome (GBS), and axonal/vasculitic neuropathies. We compared these data to 28 healthy controls. Based on these results an ultrasound pattern sum score (UPSS) with three sub-scores (UPS-A for the sensorimotor nerves, UPS-B for the cervical roots and the vagal nerve and UPS-C for the sural nerve) was developed. Afterwards, the applicability of the score was prospectively validated in 10 patients with chronic neuropathies and in 14 patients with unknown acute and subacute PNP before performing additional tests. RESULTS: UPS-A and UPSS were significantly higher in CIDP than in other neuropathies and controls (p<0.001). UPS-B was significantly more often pathologic in GBS than in CIDP and other neuropathies (p<0.001). Using receiver operation characteristics curve analysis boundary values for each score were defined. Positive predictive value (PPV) of these scores for CIDP and GBS was >85%. Vasculitic neuropathies showed an intermediate type of UPSS compared to other axonal neuropathies (p<0.001). In the prospective application the pattern score could be used with good accuracy in several types of neuropathy. CONCLUSION: UPS-A and UPSS operationalize to diagnose acute and subacute-onset CIDP and its variants with high sensitivity, specificity, and PPV. An increased UPS-B with normal UPSS and other sub scores may point to the diagnosis of GBS with high PPV and enables the differentiation from CIDP. SIGNIFICANCE: Using the UPSS and its sub-scores gives a new diagnostic power to the method of the peripheral nerve ultrasound.
OBJECTIVE: Ultrasound differentiation of neuropathies is a great challenge. We, therefore, suggest a standardized score to operationalize differentiation between several acute and subacute onset neuropathies. METHOD: We retrospectively analyzed the ultrasound data of 61 patients with acute or subacute neuropathies, e.g. chronic immune-mediated neuropathies, Guillain-Barré syndrome (GBS), and axonal/vasculitic neuropathies. We compared these data to 28 healthy controls. Based on these results an ultrasound pattern sum score (UPSS) with three sub-scores (UPS-A for the sensorimotor nerves, UPS-B for the cervical roots and the vagal nerve and UPS-C for the sural nerve) was developed. Afterwards, the applicability of the score was prospectively validated in 10 patients with chronic neuropathies and in 14 patients with unknown acute and subacute PNP before performing additional tests. RESULTS: UPS-A and UPSS were significantly higher in CIDP than in other neuropathies and controls (p<0.001). UPS-B was significantly more often pathologic in GBS than in CIDP and other neuropathies (p<0.001). Using receiver operation characteristics curve analysis boundary values for each score were defined. Positive predictive value (PPV) of these scores for CIDP and GBS was >85%. Vasculitic neuropathies showed an intermediate type of UPSS compared to other axonal neuropathies (p<0.001). In the prospective application the pattern score could be used with good accuracy in several types of neuropathy. CONCLUSION: UPS-A and UPSS operationalize to diagnose acute and subacute-onset CIDP and its variants with high sensitivity, specificity, and PPV. An increased UPS-B with normal UPSS and other sub scores may point to the diagnosis of GBS with high PPV and enables the differentiation from CIDP. SIGNIFICANCE: Using the UPSS and its sub-scores gives a new diagnostic power to the method of the peripheral nerve ultrasound.
Authors: Kai F Loewenbrück; Markus Dittrich; Josef Böhm; Jürgen Klingelhöfer; Petra Baum; Jochen Schäfer; Heinz Reichmann; Andreas Hermann; Alexander Storch Journal: J Neurol Date: 2017-11-28 Impact factor: 4.849
Authors: Kai F Loewenbrück; Markus Dittrich; Josef Böhm; Jürgen Klingelhöfer; Petra Baum; Jochen Schäfer; Rainer Koch; Alexander Storch Journal: J Neurol Date: 2016-08-08 Impact factor: 4.849
Authors: Alexander Grimm; Maria Rasenack; Ioanna M Athanasopoulou; Nele Maria Dammeier; Christina Lipski; Stefan Wolking; Debora Vittore; Bernhard F Décard; Hubertus Axer Journal: J Neurol Date: 2015-11-11 Impact factor: 4.849