Nerve Ultrasound as Helpful Tool in Polyneuropathies

Kramer, Magdalena; Grimm, Alexander; Winter, Natalie; Dörner, Marc; Grundmann-Hauser, Kathrin; Stähl, Jutta; Wittlinger, Julia; Kegele, Josua; Kronlage, Cornelius; Willikens, Sophia

doi:10.3390/diagnostics11020211

Cited by 29 publications

(30 citation statements)

References 155 publications

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“…However, this fraction might even be underestimated as high cutoff values for enlarged CSAs in comparison to other studies were applied 23 . Nevertheless, comparable studies on patients with CIDP found pathologic ultrasound findings with similar frequencies (64–89%) 24–26 . In our study, abnormalities on nerve ultrasound were observed in four out of seven patients with Sjögren's syndrome and clinical signs of neuropathy but without neurophysiologic evidence of neuropathy.…”

Section: Discussionsupporting

confidence: 77%

“…23 Nevertheless, comparable studies on patients with CIDP found pathologic ultrasound findings with similar frequencies (64-89%). [24][25][26] In our study, abnormalities on nerve ultrasound were observed in four out of seven patients with Sjögren's syndrome and clinical signs of neuropathy but without neurophysiologic evidence of neuropathy. This finding suggests that nerve ultrasound might give additional information on the existence of a Sjögren's syndrome-associated neuropathy in cases of nerve conduction studies failing to detect nerve damage.…”

Section: Discussionsupporting

confidence: 51%

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Nerve ultrasound findings in Sjögren's syndrome‐associated neuropathy

Seeliger

Bönig

Gingele

et al. 2021

Journal of Neuroimaging

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Background and Purpose:The phenotype of Sjögren's syndrome-associated neuropathy has been better characterized in recent years. However, Sjögren's syndrome-associated neuropathy remains an underdiagnosed entity with only few insights considering the pathomechanisms of nerve damage. Nerve ultrasound has proven to be a useful and efficient tool in detecting nerve damage of autoimmune origin. We, therefore, aimed to evaluate this method for Sjögren's syndrome-associated neuropathy. Methods:Patients with Sjögren's syndrome and clinical signs of neuropathy underwent sonographic examination of both median and ulnar nerves. Nerve thickening was classified for cross-sectional areas of >12 mmš at the median nerve and for >10 mmš at the ulnar nerve. Fascicle thickening was documented for cross-sectional areas ≥5 mmš at the median and ≥3 mmš at the ulnar nerve.Results: Forty-three patients were included in the analysis (median age 60 years [interquartile range 53-73 years], female rate 60%). 31/43 patients (72%) showed abnormalities on nerve ultrasound, while nerve thickening was found more frequently than fascicle thickening (90% vs. 52% of patients with sonographic abnormalities, respectively). Abnormal findings were observed more frequently at the median nerve and in proximal localization. Abnormal findings on nerve conduction studies were evident in 36/43 patients (84%). Nerve conduction studies revealed a tendency of demyelinating nerve damage patterns being associated with abnormal findings on nerve ultrasound. Conclusions:In addition to nerve conduction studies, nerve ultrasound may have a supporting role in the diagnosis of Sjögren's syndrome-associated neuropathy. Also, our data support an immune-mediated inflammatory demyelinating pathogenesis of Sjögren's syndrome-associated neuropathy.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 51%

Nerve ultrasound findings in Sjögren's syndrome‐associated neuropathy

Seeliger

Bönig

Gingele

et al. 2021

Journal of Neuroimaging

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“…Since UPSS scores have not yet been validated using independent samples, further studies assessing several additional nerve sites is warranted to refine the total score. In addition, various ultrasound scoring tools are available and have been shown applicable with high accuracy ( 1 , 26 ), tools in addition to UPSS should be considered in the future.…”

Section: Discussionmentioning

confidence: 99%

Cross-Sectional Area Reference Values for Sonography of Peripheral Nerves in Taiwanese Adults

Hsieh

Chang

et al. 2021

Front. Neurol.

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Background: Neuromuscular ultrasound is a complementary technology that aids in the diagnosis of peripheral neuropathy. The interpretation of neuromuscular ultrasound results requires the use of accurate normative cross-sectional area (CSA) reference values. This study aims to provide CSA reference values specific to Taiwanese adults for Sonography of peripheral nerves in the upper and lower extremities.Methods: The study cohort included 66 healthy subjects (36 women; 30 men). A linear probe was used to measure the CSA of the median, ulnar, radial, tibial, sural, and peroneal nerves at multiple sites. These data were analyzed to determine standard ranges for the CSA at each site (reference range = mean ± 2 × SD) and identify correlations between the CSA and patient characteristics.Results: Normative CSA ranges were determined for all the assessed nerve sites, revealing that the nerve sizes in this Taiwanese population were smaller than Caucasian populations but comparable to those reported for other Asian cohorts. Men tended to have larger nerves than women, even after adjusting for height and weight. The size of ulnar nerve in the cubital tunnel and the peroneal nerve in the popliteal fossa correlated negatively with increasing age. The nerve size correlated positively with increasing weight and BMI at several sites, correlation of median nerve in the forearm with weight and BMI was significant after multiple testing. Significant correlation was also found between size of ulnar nerve in cubital tunnel and decreasing height.Conclusion: We provide reference ranges for neuromuscular ultrasound CSA values for the upper and lower extremities that are specific to the Taiwanese population. These reference values may be useful for evaluating peripheral neuropathy in Taiwanese subjects.

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“…15 While enlargement is very focal in entrapments, tumors and trauma, it is diffuse, multifocal and more proximal in non-Hansen's polyneuropathies. 16,17 Therefore, the peculiar enlargement pattern identified in this paper appears unique to leprosy. Nagappa et al showed that the median nerve in leprosy was maximally enlarged proximal to wrist crease with gradual tapering proximally while it enlarged most at the distal wrist crease in carpal tunnel syndrome.…”

Section: Discussionmentioning

confidence: 50%

Sonographic characteristics of median nerve neuropathy in Hansen’s disease: a case-control study

Reddy

Murthy

Pidaparthi

et al. 2021

LEPROSY

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Background and objectives High-resolution ultrasonography (HRUS) has become a vital imaging tool in the management of leprosy. This case-control study analyzed the sonographic data on median nerves in leprosy and healthy controls to identify the features characteristic of leprosy. Methods Newly diagnosed and treatment naïve Hansen's patients of both sexes and aged >16 years were included in the study. The control group included prospectively enrolled healthy subjects. Nerve conduction studies were performed in all. HRUS of the median nerve was performed using a Philips HD15 machine. HRUS parameters studied included cross-sectional area (CSA) of the nerve, fascicular architecture and abnormal blood flow (by colour Doppler). CSA was measured at the wrist (S1), 5 cm above the wrist (S2), 10 cm above the wrist (S3), mid-forearm (S4) and at the elbow (S5). Results 30 median nerves from 22 cases of leprosy and 30 nerves from 15 healthy subjects were compared. Among cases, 8 were borderline tuberculoid, 9 borderline lepromatous, 3 lepromatous leprosy, and 2 indeterminate leprosy. Abnormal motor (76.7%) and sensory conduction (96.7%) was noted in the patient group. The mean CSA was 18.5 mm 2 at S1, 20.3 mm 2 at S2, 14.1 mm 2 at S3, 9.1 mm 2 at S4, and 8.1 mm 2 at S5. The CSA at S1 and S2 were significantly higher compared to other sites. CSA values were significantly higher in patients compared to controls. The fascicular architecture was distorted in patients -grade II (33.3%), III (40.0%) and IV (20%), and hypervascularity was noted in 26.6%.

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Nerve Ultrasound as Helpful Tool in Polyneuropathies

Cited by 29 publications

References 155 publications

Nerve ultrasound findings in Sjögren's syndrome‐associated neuropathy

Nerve ultrasound findings in Sjögren's syndrome‐associated neuropathy

Cross-Sectional Area Reference Values for Sonography of Peripheral Nerves in Taiwanese Adults

Sonographic characteristics of median nerve neuropathy in Hansen’s disease: a case-control study

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