H Stephan Goedee1, W Ludo van der Pol2, Jan-Thies H van Asseldonk2, Hessel Franssen2, Nicolette C Notermans2, Alexander J F E Vrancken2, Michael A van Es2, Stavros Nikolakopoulos2, Leo H Visser2, Leonard H van den Berg2. 1. From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands. h.s.goedee-2@umcutrecht.nl. 2. From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
Abstract
OBJECTIVE: To determine the diagnostic value of high-resolution ultrasound (HRUS) for detection of chronic inflammatory demyelinating polyneuropathy (CIDP), Lewis-Sumner syndrome (LSS), and multifocal motor neuropathy (MMN). METHODS: Between January 2013 and January 2015, we enrolled 75 consecutive treatment-naive patients with chronic inflammatory neuropathies and 70 disease controls. We performed extensive nerve conduction and standardized HRUS studies bilaterally of large arm and leg nerves and brachial plexus. We determined optimal sonographic cutoff values of nerve size and used receiver operating characteristic analysis and logistic regression models to identify nerve combinations with optimal diagnostic performance. RESULTS: Enlargement of median nerve at forearm >10 mm2, upper arm >13 mm2, and any trunk of brachial plexus >8 mm2 was 99% specific for chronic inflammatory neuropathies. A shortened HRUS protocol for detecting this abnormal nerve enlargement showed high sensitivity (83%-95%), positive predictive value (100%), and negative predictive value (98%) in discriminating CIDP, LSS, and MMN from clinical mimics. CONCLUSIONS: Sonographic enlargement of proximal median nerve segments in the arms and brachial plexus is a key feature of chronic inflammatory neuropathies, which helps to reliably distinguish them from axonal neuropathies and amyotrophic lateral sclerosis. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, in absence of clinical features that suggest a hereditary demyelinating neuropathy, sonographic enlargement of proximal median nerve segments and brachial plexus accurately identifies patients with chronic inflammatory neuropathies.
OBJECTIVE: To determine the diagnostic value of high-resolution ultrasound (HRUS) for detection of chronic inflammatory demyelinating polyneuropathy (CIDP), Lewis-Sumner syndrome (LSS), and multifocal motor neuropathy (MMN). METHODS: Between January 2013 and January 2015, we enrolled 75 consecutive treatment-naive patients with chronic inflammatory neuropathies and 70 disease controls. We performed extensive nerve conduction and standardized HRUS studies bilaterally of large arm and leg nerves and brachial plexus. We determined optimal sonographic cutoff values of nerve size and used receiver operating characteristic analysis and logistic regression models to identify nerve combinations with optimal diagnostic performance. RESULTS: Enlargement of median nerve at forearm >10 mm2, upper arm >13 mm2, and any trunk of brachial plexus >8 mm2 was 99% specific for chronic inflammatory neuropathies. A shortened HRUS protocol for detecting this abnormal nerve enlargement showed high sensitivity (83%-95%), positive predictive value (100%), and negative predictive value (98%) in discriminating CIDP, LSS, and MMN from clinical mimics. CONCLUSIONS: Sonographic enlargement of proximal median nerve segments in the arms and brachial plexus is a key feature of chronic inflammatory neuropathies, which helps to reliably distinguish them from axonal neuropathies and amyotrophic lateral sclerosis. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, in absence of clinical features that suggest a hereditary demyelinating neuropathy, sonographic enlargement of proximal median nerve segments and brachial plexus accurately identifies patients with chronic inflammatory neuropathies.
Authors: Angela Puma; N Azulay; N Grecu; C Suply; E Panicucci; C Cambieri; L Villa; C Raffaelli; S Sacconi Journal: J Neurol Date: 2019-06-07 Impact factor: 4.849
Authors: Rocio Garcia-Santibanez; Craig M Zaidman; R Brian Sommerville; Glenn Lopate; Conrad C Weihl; Alan Pestronk; Robert C Bucelli Journal: J Neurol Date: 2018-04-09 Impact factor: 4.849