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Diagnostic value of sonography in treatment-naive chronic inflammatory neuropathies.
- Source :
-
Neurology [Neurology] 2017 Jan 10; Vol. 88 (2), pp. 143-151. Date of Electronic Publication: 2016 Dec 07. - Publication Year :
- 2017
-
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).<br />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.<br />Results: Enlargement of median nerve at forearm >10 mm <superscript>2</superscript> , upper arm >13 mm <superscript>2</superscript> , and any trunk of brachial plexus >8 mm <superscript>2</superscript> 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.<br />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.<br />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.<br /> (© 2016 American Academy of Neurology.)
- Subjects :
- Adult
Aged
Amyotrophic Lateral Sclerosis physiopathology
Brachial Plexus physiopathology
Case-Control Studies
Cohort Studies
Edema etiology
Electromyography
Female
Humans
Logistic Models
Male
Middle Aged
Neural Conduction physiology
Polyradiculoneuropathy, Chronic Inflammatory Demyelinating physiopathology
Amyotrophic Lateral Sclerosis diagnostic imaging
Polyradiculoneuropathy, Chronic Inflammatory Demyelinating diagnostic imaging
Ultrasonography methods
Subjects
Details
- Language :
- English
- ISSN :
- 1526-632X
- Volume :
- 88
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Neurology
- Publication Type :
- Academic Journal
- Accession number :
- 27927940
- Full Text :
- https://doi.org/10.1212/WNL.0000000000003483