Influence of Demographic Factors on Nerve Ultrasound of Healthy Participants in a Multiethnic Asian Population

Abstract

Background: High-resolution nerve ultrasound provides morphological information of peripheral nerves. We aimed to determine the normal ultrasonographic reference values of nerve cross-sectional area (CSA) in multiethnic Malaysian healthy participants. Methods: Nerve ultrasound of the median, ulnar, radial, tibial, fibular, and sural nerves was performed in 84 healthy participants at anatomical-defined locations. The CSA at each scanned site was measured by tracing circumferentially inside the hyperechoic rim of each nerve. Comparisons were made between genders and ethnic groups. Correlations with age, ethnicity, gender, height, weight, and body mass index (BMI) were evaluated. Results: CSA values and reference ranges in healthy participants were generated. Nerve CSA was significantly different in different gender ( P = 0.002–0.032) and ethnic groups ( P = 0.006–0.038). Men had larger nerve CSA than women, and Malay participants had larger nerve CSA compared to other ethnic groups. Nerve CSA had significant correlations to age, height, weight, and BMI ( r = 0.220–0.349, P = 0.001–0.045). Conclusion: This study provides normative values for CSA of peripheral nerves in a multiethnic Malaysian population, which serves as reference values in the evaluation of peripheral nerve disorders. The ethnic differences in nerve CSA values should be considered during nerve ultrasound.

Sonographic peripheral nerve cross‐sectional area in adults, excluding median and ulnar nerves: A systematic review and meta‐analysis

“…Only eight studies (11.4%) included any information regarding participant race/ethnicity, but it is becoming increasingly evident this may affect peripheral nerve size. 13 In addition, although sex and age are known to affect peripheral nerve size, only one study stratified nerve measurements based on these parameters, thus limiting our ability to correct for sex or age in the meta-analysis. Furthermore, although tracing within the hyperechoic epineural rim is the most commonly used method for determining the sonographic CSA of nerves, two studies did not do so, 35,79 and nine others omitted CSA technique information entirely.…”

“…10 Normal, healthy nerve size is known to vary with a number of factors, including anatomical location, sex, 11 body size, 12 age, 12 and race/ethnicity. 13 Sonographic measures of nerve size are also operator-dependent. 8 In addition to this known variability, changes in nerve size are seen across a range of peripheral nerve disorders, including compressive neuropathies, trauma, neuroma, and generalized neuropathies.…”

“…23 It is critical to establish the range of normal values for adult peripheral nerve CSA throughout the musculoskeletal system to facilitate future research identifying clinical correlations and diagnostic criteria. 13 Given the known variations in peripheral nerve size across healthy individuals, [11][12][13] it can be difficult to readily identify whether the CSA of a particular peripheral nerve is within or exceeds normal anatomical variation. Thus, drawing upon all available studies reporting healthy adult sonographic peripheral nerve CSA will provide a valuable resource for the neuromuscular sonographer in the clinic and the laboratory.…”

Sonographic reference values of nerve size in children: A systematic review and meta‐analysis

“…One study 33 showed that the CSA of the median nerve at the wrist was smaller in the Indian participants than the Dutch participants. Another study 34 showed that nerve CSA in Malay participants was larger than in Chinese and Indian participants. The most conservative approach is for each laboratory to determine their own reference values.…”

Can neurophysiology and nerve ultrasound differentiate acute-onset CIDP from GBS with treatment-related fluctuations?

“…9 Reference nerve ultrasound data were derived from established values from our laboratory. 18 The study was approved by the UMMC research ethics committee and all patients provided informed consent.…”