Nerve Ultrasound Score in Chronic Inflammatory Demyelinating Polyneuropathy. 2023

Cheng-Yin Tan, and Mohd Azly Yahya, and Khean-Jin Goh, and Nortina Shahrizaila
Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.

Background and Objectives: Studies have suggested that, by applying certain nerve ultrasound scores, demyelinating and axonal polyneuropathies can be differentiated. In the current study, we investigated the utility of ultrasound pattern sub-score A (UPSA) and intra- and internerve cross-sectional area (CSA) variability in the diagnostic evaluation of demyelinating neuropathies. Materials and Methods: Nerve ultrasound was performed in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and acute inflammatory demyelinating polyneuropathy (AIDP) and compared to patients with axonal neuropathies. The UPSA, i.e., the sum of ultrasound scores at eight predefined measurement points in the median (forearm, elbow and mid-arm), ulnar (forearm and mid-arm), tibial (popliteal fossa and ankle) and fibular (lateral popliteal fossa) nerves, was applied. Intra- and internerve CSA variability were defined as maximal CSA/minimal CSA for each nerve and each subject, respectively. Results: A total of 34 CIDP, 15 AIDP and 16 axonal neuropathies (including eight axonal Guillain-Barré syndrome (GBS), four hereditary transthyretin amyloidosis, three diabetic polyneuropathy and one vasculitic neuropathy) were included. A total of 30 age- and sex-matched healthy controls were recruited for comparison. Significantly enlarged nerve CSA was observed in CIDP and AIDP with significantly higher UPSA in CIDP compared to the other groups (9.9 ± 2.9 vs. 5.9 ± 2.0 vs. 4.6 ± 1.9 in AIDP vs. axonal neuropathies, p < 0.001). A total of 89.3% of the patients with CIDP had an UPSA score ≥7 compared to the patients with AIDP (33.3%) and axonal neuropathies (25.0%) (p < 0.001). Using this cut-off, the performance of UPSA in differentiating CIDP from other neuropathies including AIDP was excellent (area under the curve of 0.943) with high sensitivity (89.3%), specificity (85.2%) and positive predictive value (73.5%). There were no significant differences in intra- and internerve CSA variability between the three groups. Conclusion: The UPSA ultrasound score was useful in distinguishing CIDP from other neuropathies compared to nerve CSA alone.

UI MeSH Term Description Entries
D003929 Diabetic Neuropathies Peripheral, autonomic, and cranial nerve disorders that are associated with DIABETES MELLITUS. These conditions usually result from diabetic microvascular injury involving small blood vessels that supply nerves (VASA NERVORUM). Relatively common conditions which may be associated with diabetic neuropathy include third nerve palsy (see OCULOMOTOR NERVE DISEASES); MONONEUROPATHY; mononeuropathy multiplex; diabetic amyotrophy; a painful POLYNEUROPATHY; autonomic neuropathy; and thoracoabdominal neuropathy. (From Adams et al., Principles of Neurology, 6th ed, p1325) Diabetic Amyotrophy,Diabetic Autonomic Neuropathy,Diabetic Neuralgia,Diabetic Polyneuropathy,Neuralgia, Diabetic,Asymmetric Diabetic Proximal Motor Neuropathy,Diabetic Asymmetric Polyneuropathy,Diabetic Mononeuropathy,Diabetic Mononeuropathy Simplex,Diabetic Neuropathy, Painful,Mononeuropathy, Diabetic,Symmetric Diabetic Proximal Motor Neuropathy,Amyotrophies, Diabetic,Amyotrophy, Diabetic,Asymmetric Polyneuropathies, Diabetic,Asymmetric Polyneuropathy, Diabetic,Autonomic Neuropathies, Diabetic,Autonomic Neuropathy, Diabetic,Diabetic Amyotrophies,Diabetic Asymmetric Polyneuropathies,Diabetic Autonomic Neuropathies,Diabetic Mononeuropathies,Diabetic Mononeuropathy Simplices,Diabetic Neuralgias,Diabetic Neuropathies, Painful,Diabetic Neuropathy,Diabetic Polyneuropathies,Mononeuropathies, Diabetic,Mononeuropathy Simplex, Diabetic,Mononeuropathy Simplices, Diabetic,Neuralgias, Diabetic,Neuropathies, Diabetic,Neuropathies, Diabetic Autonomic,Neuropathies, Painful Diabetic,Neuropathy, Diabetic,Neuropathy, Diabetic Autonomic,Neuropathy, Painful Diabetic,Painful Diabetic Neuropathies,Painful Diabetic Neuropathy,Polyneuropathies, Diabetic,Polyneuropathies, Diabetic Asymmetric,Polyneuropathy, Diabetic,Polyneuropathy, Diabetic Asymmetric,Simplex, Diabetic Mononeuropathy,Simplices, Diabetic Mononeuropathy
D005542 Forearm Part of the upper extremity in humans and primates extending from the ELBOW to the WRIST. Antebrachium,Antebrachiums,Forearms
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014463 Ultrasonography The visualization of deep structures of the body by recording the reflections or echoes of ultrasonic pulses directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. Echography,Echotomography,Echotomography, Computer,Sonography, Medical,Tomography, Ultrasonic,Ultrasonic Diagnosis,Ultrasonic Imaging,Ultrasonographic Imaging,Computer Echotomography,Diagnosis, Ultrasonic,Diagnostic Ultrasound,Ultrasonic Tomography,Ultrasound Imaging,Diagnoses, Ultrasonic,Diagnostic Ultrasounds,Imaging, Ultrasonic,Imaging, Ultrasonographic,Imaging, Ultrasound,Imagings, Ultrasonographic,Imagings, Ultrasound,Medical Sonography,Ultrasonic Diagnoses,Ultrasonographic Imagings,Ultrasound, Diagnostic,Ultrasounds, Diagnostic
D020275 Guillain-Barre Syndrome An acute inflammatory autoimmune neuritis caused by T cell- mediated cellular immune response directed towards peripheral myelin. Demyelination occurs in peripheral nerves and nerve roots. The process is often preceded by a viral or bacterial infection, surgery, immunization, lymphoma, or exposure to toxins. Common clinical manifestations include progressive weakness, loss of sensation, and loss of deep tendon reflexes. Weakness of respiratory muscles and autonomic dysfunction may occur. (From Adams et al., Principles of Neurology, 6th ed, pp1312-1314) Acute Autoimmune Neuropathy,Acute Inflammatory Demyelinating Polyradiculoneuropathy,Acute Inflammatory Polyneuropathy,Landry-Guillain-Barre Syndrome,Polyradiculoneuropathy, Acute Inflammatory,Acute Infectious Polyneuritis,Acute Inflammatory Demyelinating Polyneuropathy,Acute Inflammatory Polyradiculoneuropathy,Demyelinating Polyradiculoneuropathy, Acute Inflammatory,Guillain-Barre Syndrome, Familial,Guillain-Barré Syndrome,Guillaine-Barre Syndrome,Inflammatory Demyelinating Polyradiculoneuropathy, Acute,Inflammatory Polyneuropathy Acute,Polyneuropathy, Acute Inflammatory,Polyneuropathy, Inflammatory Demyelinating, Acute,Polyradiculoneuropathy, Acute Inflammatory Demyelinating,Acute Autoimmune Neuropathies,Acute Inflammatory Polyneuropathies,Acute Inflammatory Polyradiculoneuropathies,Autoimmune Neuropathies, Acute,Autoimmune Neuropathy, Acute,Familial Guillain-Barre Syndrome,Familial Guillain-Barre Syndromes,Guillain Barre Syndrome,Guillain Barre Syndrome, Familial,Guillain Barré Syndrome,Guillain-Barre Syndromes, Familial,Guillain-Barré Syndromes,Guillaine Barre Syndrome,Infectious Polyneuritis, Acute,Inflammatory Polyneuropathies, Acute,Inflammatory Polyneuropathy, Acute,Inflammatory Polyradiculoneuropathies, Acute,Landry Guillain Barre Syndrome,Neuropathy, Acute Autoimmune,Polyneuritis, Acute Infectious,Polyneuropathy Acute, Inflammatory,Polyradiculoneuropathies, Acute Inflammatory,Syndrome, Familial Guillain-Barre,Syndrome, Guillain-Barre,Syndrome, Guillain-Barré,Syndrome, Guillaine-Barre,Syndrome, Landry-Guillain-Barre
D020277 Polyradiculoneuropathy, Chronic Inflammatory Demyelinating A slowly progressive autoimmune demyelinating disease of peripheral nerves and nerve roots. Clinical manifestations include weakness and sensory loss in the extremities and enlargement of peripheral nerves. The course may be relapsing-remitting or demonstrate a step-wise progression. Protein is usually elevated in the spinal fluid and cranial nerves are typically spared. GUILLAIN-BARRE SYNDROME features a relatively rapid progression of disease which distinguishes it from this condition. (Adams et al., Principles of Neurology, 6th ed, p1337) CIDP,Chronic Inflammatory Demyelinating Polyradiculoneuropathy,Chronic Inflammatory Polyradiculoneuropathy,Inflammatory Polyradiculopathy, Chronic,Polyneuropathy, Inflammatory Demyelinating, Chronic,Polyradiculoneuropathy, Chronic Inflammatory,Chronic Inflammatory Polyradiculoneuropathies,Chronic Inflammatory Polyradiculopathies,Chronic Inflammatory Polyradiculopathy,Inflammatory Polyradiculoneuropathies, Chronic,Inflammatory Polyradiculoneuropathy, Chronic,Inflammatory Polyradiculopathies, Chronic,Polyradiculoneuropathies, Chronic Inflammatory,Polyradiculopathies, Chronic Inflammatory,Polyradiculopathy, Chronic Inflammatory

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