Characteristic MRI features of chronic inflammatory demyelinating polyradiculoneuropathy

Abe, Yuichi; Terashima, Hiroshi; Hoshino, Hideki; Sassa, Kaori; Sakai, Tetsuro; Ohtake, Akira; Kubota, Masaya; Yamanouchi, Hideo

doi:10.1016/j.braindev.2015.01.006

Cited by 21 publications

(11 citation statements)

References 8 publications

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“…Raising the upper reference limit for CSF protein to greater than 45 mg/dL increases its specificity in diagnosing CIDP without compromising its sensitivity (specifically using cutoffs of 50 mg/dL for patients <50 years and 60 mg/dL for patients ≥50 years) 19 . Magnetic resonance imaging (MRI) and ultrasound findings are not a major focus of this review, although nerve root thickening and plexus enlargement on MRI 20 as well as proximal median nerve and brachial plexus enlargement on ultrasound, 21,22 respectively, may be helpful in the diagnostic workup.…”

Section: Edx Features and Ancillary Testingmentioning

confidence: 99%

Chronic inflammatory demyelinating polyradiculoneuropathy—Diagnostic pitfalls and treatment approach

2020

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Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is characterized by progressive weakness and sensory loss, often affecting patientsʼ ability to walk and perform activities of daily living independently. With the lack of a diagnostic biomarker, the diagnosis relies on clinical suspicion, clinical findings, and the demonstration of demyelinating changes on electrodiagnostic (EDx) testing and nerve pathology. As a result, patients can often be misdiagnosed with CIDP and unnecessarily treated with immunotherapy. Interpreting the EDx testing and cerebrospinal fluid findings in light of the clinical phenotype, recognizing atypical forms of CIDP, and screening for CIDP mimickers are the mainstays of the approach to patients suspected of having CIDP, and are detailed in this review. We also review the currently available treatment options, including intravenous immunoglobulin (IVIg), corticosteroids (CCS), and plasma exchange (PE), and discuss how to approach treatment‐refractory cases. Finally, we emphasize the need to adopt objective outcome measures to monitor treatment response.

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Section: Edx Features and Ancillary Testingmentioning

confidence: 99%

Chronic inflammatory demyelinating polyradiculoneuropathy—Diagnostic pitfalls and treatment approach

2020

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“…Testing of multiple limbs is more sensitive than testing of unilateral or lower limbs in optimizing electrodiagnostic testing for CIDP, particularly in atypical CIDP (Chin, Deng, Bril, et al, 2015; Rajabally, Jacob, & Hbahbih, 2005; Vo, Hanineva, Chin, et al, 2015). Additional tests that may be needed to support a diagnosis of CIDP are elevated CSF protein with a leukocyte count less than 10/mm 3 , magnetic resonance imaging (MRI) of the lumbosacral or cervical nerve roots or the brachial or lumbosacral plexuses, nerve biopsy, and clinical improvement after immunomodulatory treatment (Abe, Terashima, Hoshino, et al, 2015; EFNS/PNS, 2010; Midroni, de Tilly, Gray, et al, 1999). Newer techniques for detecting proximal demyelination as well as treatment response include ultrasonography (Di Pasquale, Morino, Loreti, et al, 2015; Guidon, 2015; Jang, Cho, Yang, et al, 2014; Kerasnoudis, Pitarokoili, Behrendt, et al, 2014; Kerasnoudis, Pitarokoili, Behrendt, et al, 2015; Kerasnoudis, Pitarokoili, Gold, et al, 2015), magnetic stimulation of the cauda equine (Maccabee, Eberle, Stein, et al, 2011), somatosensory evoked potentials (Devic, Petiot, & Mauguiere, 2015), MRI gadolinium enhancement of the spinal nerve roots (Midroni et al, 1999), and magnetic resonance neurography with 3-dimensional reconstruction to determine patterns of nerve hypertrophy and to differentiate the pathophysiology of CIDP subtypes (Shibuya, Sugiyama, Ito, et al, 2015).…”

Section: Diagnosis Of Cidpmentioning

confidence: 99%

The dilemma of diabetes in chronic inflammatory demyelinating polyneuropathy

Bril

Blanchette

Noone

et al. 2016

Journal of Diabetes and its Complications

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Purpose We reviewed the literature on chronic inflammatory demyelinating polyneuropathy (CIDP) in diabetes mellitus (DM) and explored real-world data on the prevalence and treatment of CIDP within DM. Methods: A literature search of Scopus was performed for the terms chronic inflammatory demyelinating polyradiculoneuropathy, chronic inflammatory demyelinating polyneuropathy, CIDP, and prevalence, incidence, epidemiology, or diabetes; peripheral neuropathy and prevalence or diabetes. We also searched through the reference lists of the resulting publications for additional findings that may have been missed. Additional publications on guidelines for the diagnosis of CIDP and diabetic neuropathy were also included. A descriptive analysis of the 2009–2013 PharMetrics Plus™ Database was performed to estimate the prevalence and treatment of CIDP within the DM population. Results There is an increasing body of literature suggesting that the prevalence of CIDP tends to be higher in diabetic patients, especially in those of older age. Our real-world data seem to support published findings from the literature. For the total cohort (N = 101,321,694), the percent prevalence of CIDP (n = 8,173) was 0.008%; DM (n = 4,026,740) was 4%. The percent prevalence of CIDP without DM (n = 5,986) was 0.006%; CIDP with DM (n = 2,187) was 9-fold higher at 0.054%. For patients >50 years old, there was a significantly higher percentage of CIDP with DM than CIDP without DM. Approximately 50% of CIDP patients were treated with IVIg, 23%–24% with steroids, 1%–2% with PE, and 20%–23% received no treatment. Conclusions In addition to the growing evidence of higher prevalence of CIDP in DM, our findings reinforce the need for heightened awareness of the association of CIDP and DM.

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“…Numerous pathologies, both focal (inflammation, trauma, tumors) and diffuse (diabetes, vasculitis, chronic idiopathic demyelinating polyneuropathy) can affect the LSP (Yikilmaz et al, ; Massie et al, ; Garozzo et al, ; Ahlawat et al, ; Abe et al, ). Over time, pathological involvement of the LSP can alter nerve root thickness.…”

Section: Introductionmentioning

confidence: 99%

Lumbosacral plexus root thickening: Establishing normal root dimensions using magnetic resonance neurography

et al. 2018

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Disorders affecting the lumbosacral plexus (LSP) can alter root diameter. Our aim was to determine normal LSP nerve root dimensions using magnetic resonance neurography (MRN). Eleven asymptomatic patients (ages: 18-53, mean: 34 years) underwent MRN of the LSP on a 3 T scanner with an 8-channel torso-PA coil. IDEAL T2-weighted images were acquired and nerve root dimensions were measured from the second lumbar (L2) to the first sacral (S1) vertebrae on the coronal plane, 5 mm from the dorsal root ganglion (DRG). Root size was recorded by three separate groups of radiologists with different levels of expertise. Additional LSP-MRN images were acquired from a fresh-frozen cadaver specimen using the same scanner and parameters identical to those described above. Subsequently, two experienced anatomists dissected and measured the LSP roots at exactly the same distance from the DRG, using an electronic caliper. Mean root size values recorded (± standard deviation) in the asymptomatic patients were as follows: L2: 3.12 mm (±0.92), L3: 4.29 mm (±0.95), L4: 5.13 mm (±0.79), L5: 5.29 mm (±0.9), and S1: 5.38 mm (±0.7). The correlation coefficients were 0.72 between the patient and cadaver MRN results and 0.79 between the patient and dissected cadaver MRN results. Inter-observer agreements were 0.73 among the radiologist groups and 0.87 between the anatomists conducting dissections. We believe MRN provides reliable assessments of LSP root thickness. More extensive studies should be conducted to confirm the results described here. Clin. Anat. 31:782-787, 2018. © 2018 Wiley Periodicals, Inc.

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Characteristic MRI features of chronic inflammatory demyelinating polyradiculoneuropathy

Cited by 21 publications

References 8 publications

Chronic inflammatory demyelinating polyradiculoneuropathy—Diagnostic pitfalls and treatment approach

Chronic inflammatory demyelinating polyradiculoneuropathy—Diagnostic pitfalls and treatment approach

The dilemma of diabetes in chronic inflammatory demyelinating polyneuropathy

Lumbosacral plexus root thickening: Establishing normal root dimensions using magnetic resonance neurography

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