The Diagnostic Role of Neuromuscular Ultrasound in Chronic Inflammatory Demyelinating Polyneuropathy
DOI:
https://doi.org/10.17140/NOJ-1-101Keywords:
Neuromuscular, documentation, PolyneuropathyAbstract
The immune-neuropathies are a heterogenous group of peripheral nerve disorders. Their diagnostic classification is mainly based on the documentation of the distribution pattern of peripheral nerve impairment and the results of nerve conduction studies.
Nerve conduction studies remain nowadays fundamental not only for the diagnosis
of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), but also for the followup and measurement of response to immune-treatment. The challenge though of acquiring
the best static and dynamic image of the relevant nerve structures, led to the development
of high frequency ultrasound technology. Neuromuscular ultrasound has been able to detect
thickened or swollen roots, peripheral nerves or plexus, findings that are consistent with ongoing inflammation, especially in cases of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). Similar findings have been described also in other immune-mediated neuropathies such as Guillain–Barré Syndrome (GBS), Multifocal Motor Neuropathy (MMN)
and Multifocal Acquired Demyelinating Sensory and Motor Neuropathy (MADSAM).
This review provides a timely update on the ultrasound findings of chronic inflammatory demyelinating polyneuropathy
References
Solbiati L, De Pra L, Ierace T et al. High-resolution sonog-raphy of the recurrent laryngeal nerve: anatomic and patho-logic considerations. AJR Am J Roentgenol. 1985; 145(5): 989-993.
Fornage BD, Rifkin MD. Ultrasound examination of the hand and foot. Radiol Clin North Am. 1988; 26(1): 109-129.
Hughes RAC. Peripheral neuropathy. BMJ. 2002; 324: 466- 469.
Cartwright MS, Passmore LV, Yoon JS, Brown ME, Caress JB, Walker FO. Cross-sectional area reference values for nerve ultrasonography. Muscle Nerve. 2008; 37(5): 566-571. doi: 10.1002/mus.21009
Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS. Cross sectional area reference values for sonography of peripheral nerves and brachial plexus. Clin Neurophysiol. 2013; 124(9): 1881-1888. doi: 10.1016/j.clinph.2013.03.007
Padua L, Martinoli C, Pazzaglia C, et al. Intra- and in-ternerve cross-sectional area variability: new ultrasound mea-sures. Muscle Nerve. 2012; 45(5): 730-733. doi: 10.1002/ mus.23252
Kerasnoudis A, Klasing A, Behrendt V, Gold R, Yoon MS. Intra- and internerve cross-sectional area variability: new ul-trasound measures. Muscle Nerve. 2012; 47(1): 146-147.
Chiò A, Cocito D, Bottacchi E, et al. Idiopathic chronic in-flammatory demyelinating polyneuropathy: an epidemiologi-cal study in Italy. J Neurol Neurosurg Psychiatry. 2007; 78: 1349-1353.
Iijima M, Koike H, Hattori N, et al. Prevalence and inci--dence rates of chronic inflammatory demyelinating polyneuropathy in the Japanese population. J Neurol Neurosurg Psychiatry. 2008; 79: 1040-1043. doi: 10.1136/jnnp.2007.128132
Hughes R. Chronic Inflammatory Demyelinating Polyradic-uloneuropathy. J Clin Immunol. 2010.
Taniguchi N, Itoh K, Wang Y, et al. Sonographic detection of diffuse peripheral nerve hypertrophy in chronic inflammatory demyelinating polyneuropathy. J Clin Ultrasound. 2000; 28(9): 488-491.
Duggins AJ, McLeod JG, Pollard JD, et al. Spinal root and plexus hypertrophy in chronic inflammatory demyelinating polyneuropathy. Brain. 1999; 122(Pt7): 1383-1390.
Mizuno K, Nagamatsu M, Hattori N, et al. Chronic in-flammatory demyelinating polyradiculoneuropathy with dif-fuse and massive peripheral nerve hypertrophy: distinctive clinical and magnetic resonance imaging features. Muscle Nerve. 1998; 21(6): 805-808. doi: 10.1002/(SICI)1097-4598- (199806)21:6<805::AID-MUS16>3.0.CO;2-R
Naganuma M, Doi S, Shima K, et al. Chronic inflammatory demyelinating polyradiculoneuropathy associated with multifo-cal nerve hypertrophy: report of a case with MRI study. Rinsho Shinkeigaku. 1991; 31(11): 1186-1191.
Matsuda M, Ikeda S, Sakurai S, et al. Hypertrophic neuritis due to chronic inflammatory demyelinating polyradiculoneurop-athy (CIDP): a postmortem pathological study. Muscle Nerve. 1996; 19(2): 163-169.
Matsuoka N, Kohriyama T, Ochi K, et al. Detection of cer-vical nerve root hypertrophy by ultrasonography in chronic in-flammatory demyelinating polyradiculoneuropathy. J Neurol Sci. 2004; 219(1-2): 15-21. doi: http://dx.doi.org/10.1016/j. jns.2003.11.011
Imamura K, Tajiri Y, Kowa H, Nakashima K. Peripheral nerve hypertrophy in chronic inflammatory demyelinating polyradiculoneuropathy detected by ultrasonography. Intern Med. 2009; 48(7): 581-582. doi: http://dx.doi.org/10.2169/ internalmedicine.48.1924
Jang JH, Yoo JK, Kim BJ. Ultrasonographic findings in chronic inflammatory demyelinating polyneuropathy. Am J Phys Med Rehabil. 2012; 91(6): 546-547.
Kerasnoudis A. Ultrasound findings in a case of chronic inflammatory demyelinating polyneuropathy. Muscle Nerve. 2013; 47(3): 443-446.
Kerasnoudis A. Ultrasonographic findings in chronic in-flammatory demyelinating polyneuropathy. Am J Phys Med Rehabil. 2014; 93(1): 94.
Zaidman CM, Al-Lozi M, Pestronk A. Peripheral nerve size in normal and patients with polyneuropathy: an ultrasound study. Muscle Nerve. 2009; 40(6): 960-966.
Kerasnoudis A, Gold R, Klasing A, Behrendt V, Yoon MS. Correlation of morphological changes in CIDP with the disease duration. 85. Kongress der Deutschen Geselschaft für Neurolo-gie (DGN). 27.09.12, Hamburg Germany. P555.
Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS. Correlation of Nerve Ultrasound, Electrophysiological and Clinical Findings in Chronic Inflammatory Demyelinating Poly-neuropathy. J Neuroimaging. 2014. doi: 10.1111/jon.12079
Smith EC, Hobson-Webb LD, Massey E. Nerve ultrasound in motor conduction block: pre- and post treatment findings. Muscle Nerve. 2008; 38: 1369.
Granata G, Pazzaglia C, Calandro P, et al. Ultrasound visu-alization of nerve morphological alteration at the site of con-duction block. Muscle Nerve. 2009; 40(6): 1068-1070. doi: 10.1002/mus.21449
Imamura K, Tajiri Y, Kowa H, et al. Peripheral nerve hy-pertrophy in chronic inflammatory demyelinating polyradicu-loneuropathy detected by ultrasonography. Intern Med. 2009; 48(7): 581-582.
Jang JH, Cho CS, Yang KS, Seok HY, Kim BJ. Pattern anal-ysis of nerve enlargement using ultrasonography in chronic in-flammatory demyelinating polyneuropathy. Clin Neurophysiol. 2014. doi: 10.1016/j.clinph.2013.12.115
Padua L, Granata G, Sabatelli M, et al. Heterogeneity of root and nerve ultrasound pattern in CIDP patients. Clin Neurophys-iol. 2014; 125(1): 160-165. doi: 10.1016/j.clinph.2013.07.023
Koller H, Kieseier BC, Jander S, Hartung P. Chronic inflam-matory demyelinating polyneuropathy. N Engl J Med. 2005; 352(13): 1343-1356.
Vallat JM, Sommer C, Magy L. Chronic inflammatory de-myelinating polyradiculoneuropathy: diagnostic and therapeu-tic challenges for a treatable condition. Lancet Neurol. 2010; 9(4): 402-412.
Dalakas MC. Advances in the diagnosis, pathogenesis and treatment of CIDP. Nat Rev Neurol. 2011; 7(9): 507-517. doi: 10.1038/nrneurol.2011.121
Hughes RA, Donofrio P, Bril V, et al. ICE Study Group. In-travenous immune globulin (10% caprylate-chromatography pu-rified) for the treatment of chronic inflammatory demyelinating polyradiculoneuropathy (ICE study): a randomised placebo-con-trolled trial. Lancet Neurol. 2008; 7(2): 136-144. doi: 10.1016/ S1474-4422(07)70329-0
Dionne A, Nicolle MW, Hahn AF. Clinical and electrophysi-ological parameters distinguishing acute-onset chronic inflam-matory demyelinating polyneuropathy from acute inflammatory demyelinating polyneuropathy. Muscle Nerve. 2010; 41(2): 202- 207. doi: 10.1002/mus.21480
Ruts L, Drenthen J, Jacobs BC, Van Doorn PA. Dutch GBS Study Group. Distinguishing acute-onset CIDP from fluctuating Guillain-Barre syndrome: a prospective study. Neurology. 2010; 74(21): 1680-1686. doi: 10.1212/WNL.0b013e3181e07d14
Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS. Nerve ultrasound score in distinguishing chronic from acute in-flammatory demyelinating polyneuropathy. Clin Neurophysiol. 2014; 125(3): 635-641.
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