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Berciano J. Microscopical anatomy of the peripheral nervous system: An essential notion for understanding the pathophysiology of very early classic Guillain-Barré syndrome. Neuropathology 2025; 45:85-99. [PMID: 39350534 DOI: 10.1111/neup.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/26/2024] [Accepted: 09/06/2024] [Indexed: 04/03/2025]
Abstract
The aim of this paper is to analyze the pathophysiological mechanisms acting in very early classic Guillain-Barré syndrome (GBS) (≤4 days of symptomatic onset). In this inaugural period, both in GBS and its animal model, experimental autoimmune neuritis, the outstanding pathological feature is inflammatory edema predominating in proximal nerve trunks, particularly spinal nerves, and possibly in preterminal nerve segments. Nerve trunks external to the subarachnoid angle possess epi- perineurium that is relatively inelastic and of low compliance. Here such edema can increase endoneurial fluid pressure that, when sufficiently critical, may stretch the perineurium and constrict transperineurial microcirculation, compromising blood flow and producing the potential for ischemic nerve injury, whose consequence is rapid partial or complete loss of nerve excitability. These histopathological features correlate well with electrophysiological and imaging findings reported in early GBS stages. Spinal nerve edema and ischemia help to understand the pattern of Wallerian-like degeneration observed in the axonal form of GBS, predominating in motor spinal roots at their exit from the dura matter (spinal nerves) with centrifugal distribution in more distant motor nerve trunks, and centripetal extension to the distal portion of intrathecal roots. The similarity of initial pathogenic mechanisms between demyelinating and axonal forms of GBS explains why an early increase of serum biomarkers of axonal damage is detected in both forms. In conclusion, knowledge of the microscopic anatomy of the peripheral nervous system is an essential step for a reliable understanding of pathophysiological mechanisms operating in the early phase of any classic GBS subtype.
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Affiliation(s)
- José Berciano
- University of Cantabria, Service of Neurology, University Hospital "Marqués de Valdecilla (IDIVAL)", and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
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Mohana-Borges AVR, Silva LTSD, Mohana-Borges RS, Statum S, Jerban S, Wu Y, Barrère V, Souza SAL, Chung CB. Neurovascular crossing patterns between leash of Henry and deep branch of radial nerve: implications for neurointervention and diagnostic imaging. Skeletal Radiol 2025; 54:493-507. [PMID: 39080031 PMCID: PMC11769873 DOI: 10.1007/s00256-024-04740-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 01/28/2025]
Abstract
OBJECTIVE To detail the neurovascular crossing patterns between the leash of Henry (LoH) and the deep branch of the radial nerve (DBRN) in supination and pronation of the forearm, using imaging methods with anatomic correlation. MATERIALS AND METHODS This cross-sectional study was performed ex vivo with HRUS and MRI with anatomic correlation on 6 samples and in vivo with HRUS with Doppler on 55 participants scanned bilaterally. The in vivo participants were enrolled over a 6-month period. The crossing patterns between the LoH and DBRN were assessed ex vivo and in vivo. Additional morphological features of the DBRN, LoH, and fat plane were assessed in vivo only. Biometric features of the participants were recorded. Statistical analyses were performed using Shapiro-Wilk, parametric and non-parametric tests. RESULTS The most common neurovascular crossing pattern was the ascending branch of the radial recurrent artery (RRAab) crossing below (ex vivo: 83.3%, in vivo: 85.3%) and the muscular branch crossing above (ex vivo: 100%, in vivo: 63.2% %) the DBRN. Both the deep and superficial surfaces of the DBRN exhibited an intimate relationship with the vessels of the LoH. A positive correlation between vessel diameter and anthropometric factors was observed. In addition, the muscular branch exhibited a significantly smaller diameter than the RRAab. CONCLUSION Our study detailed the relationship between the LoH and the DBRN and highlighted the high incidence of vessel crossing above the DBRN at the level of the muscular branch. Knowledge of neurovascular crossings is crucial for understanding neurovascular entrapment syndromes and planning interventional procedures to reduce vascular complications.
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Affiliation(s)
- Aurea V R Mohana-Borges
- Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Radiology, University of California, San Diego, USA
- Veterans Affairs Medical Center, San Diego, USA
| | | | - Ronaldo S Mohana-Borges
- Laboratory of Biotechnology and Structural Bioengineering, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sheronda Statum
- Radiology, University of California, San Diego, USA
- Veterans Affairs Medical Center, San Diego, USA
| | - Saeed Jerban
- Radiology, University of California, San Diego, USA
| | - Yuanshan Wu
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA
- Department of Bioengineering, University of California, San Diego, CA, USA
| | - Victor Barrère
- Department of Orthopaedic Surgery, University of California, San Diego, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Sergio A L Souza
- Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Christine B Chung
- Radiology, University of California, San Diego, USA.
- Veterans Affairs Medical Center, San Diego, USA.
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Foesleitner O, Kirchner M, Preisner F, Kronlage M, Godel T, Jende JME, Hilgenfeld T, Heiland S, Wick W, Bendszus M, Schwarz D. High-Resolution US vs MR Neurography for Diagnosis of Upper Extremity Peripheral Nerve Disorders. Radiology 2025; 314:e232063. [PMID: 40035675 DOI: 10.1148/radiol.232063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2025]
Abstract
"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Background High-resolution imaging methods contribute important pathomorphological information in diagnosing peripheral nerve disorders, but their diagnostic roles remain unclear due to limited clinical evidence. Purpose To investigate the diagnostic performance of high-resolution nerve US (HRUS) and MR neurography (MRN). Materials and Methods This prospective observational, single-center cohort study included 800 patients referred for clinically suspected peripheral neuropathy of the upper extremity from November 2015 to February 2022. All patients underwent both HRUS and MRN, performed and interpreted independently by experienced neuroradiologists. Accuracy, sensitivity, and specificity of HRUS and MRN in diagnosing peripheral neuropathy correctly were calculated in reference to the final diagnosis, based on compound results of clinical, electrophysiological, imaging, and surgical/histopathological findings and compared by means of the McNemar's test and X2-Testing. Results In total 800 patients (431 male, 369 female; mean age 47.8 ± 16.5 years) were included. Overall, MRN provided higher accuracy (85.4% [95%CI: 82.7%, 87.8%] vs. 70.6% [95%CI: 67.3%, 73.8%], P<.001) and sensitivity (91.6% [95%CI: 89.1%,93.7%] vs. 68.7% [95%CI: 64.8%,72.3%], P<.001), while HRUS achieved higher specificity (76.0% [95%CI: 69.4%,81.9%] vs. 66.2% [95%CI: 59.1%,72.8%], P<.001) for diagnosing peripheral neuropathy correctly. Conclusion For diagnosing peripheral neuropathies of the upper extremity, MRN achieved higher accuracy and sensitivity while HRUS achieved higher specificity. See also the editorial by Deshmukh in this issue.
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Affiliation(s)
- Olivia Foesleitner
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Marietta Kirchner
- Institute of Medical Biometry, University of Heidelberg, INF 130.3, 69120 Heidelberg, Germany
| | - Fabian Preisner
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Moritz Kronlage
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Tim Godel
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, University Hospital Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
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Kachare MB, Gamanagatti SA, Satish P, Umesh J. Role of Ultrasonography in the Evaluation of Peripheral Nerve Pathologies: A Study of 200 Cases. JOURNAL OF CLINICAL ULTRASOUND : JCU 2025; 53:294-305. [PMID: 39417542 DOI: 10.1002/jcu.23858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/03/2024] [Accepted: 09/16/2024] [Indexed: 10/19/2024]
Abstract
AIM The aim of this study is to ascertain the role of ultrasonography in appraising the structural intricacies of peripheral nerve pathologies. OBJECTIVES (1) To scrutinize the anatomy of both normal and abnormal peripheral nerves. (2) Assess different parameters like continuity of the nerve, echotexture, vascularity, cross-sectional area, and thickness of the nerve in various pathologies. METHODS AND MATERIALS In a prospective observational study conducted at the Department of Radio Diagnosis, Tertiary Care Centre, the study design focused on the examination of 200 cases utilizing a high-resolution 9-14 Mhz and 17 Mhz linear array transducer, integrated into the Aplio 400 Canon Ultrasound System. RESULTS Among the total cases, 62 were identified as traumatic neuropathy cases, 52 as entrapment neuropathy cases, 14 as infective neuropathy cases, 54 as thermal neuropathy cases, 14 as metabolic neuropathy cases, and 4 as nerve-tumor cases. CONCLUSIONS In conclusion, this investigation illuminates the dynamic role of ultrasonography as an invaluable diagnostic instrument in appraising peripheral nerve pathologies. The noninvasive attributes, widespread availability, and economic viability of ultrasonography render it a pragmatic choice for clinicians. This inquiry buttresses the escalating significance of ultrasonography within neurology, emphasizing its potential to revolutionize the terrain of peripheral nerve pathology assessment.
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Affiliation(s)
- Manohar B Kachare
- Department of Radiodiagnosis, Government Medical College, Miraj, India
| | | | - Patil Satish
- Department of Orthopaedics, Patil Institute of Orthopaedic Sciences, Jaisingpur, India
| | - Joshi Umesh
- Department of Orthopaedics, Sakar Nursing Home Sangli, Sangli, India
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Hsieh P, Ro L, Chu C, Liao M, Chang H, Kuo H. Relationship between nerve ultrasonography image and electrophysiology in diabetic polyneuropathy. J Diabetes Investig 2025; 16:257-264. [PMID: 39569559 PMCID: PMC11786178 DOI: 10.1111/jdi.14353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 10/21/2024] [Accepted: 11/04/2024] [Indexed: 11/22/2024] Open
Abstract
AIMS/INTRODUCTION This study aims to investigate the association between cross-sectional area (CSA) imaging findings of nerve ultrasound and conventional nerve conduction studies (NCS) for patients with distal symmetric sensorimotor polyneuropathy (DSPN) due to type 2 diabetes mellitus. MATERIALS AND METHODS We enrolled 103 patients with type 2 diabetes mellitus and collected their demographic data, modified Michigan Neuropathy Screening Instrument (mMNSI) score, NCS, and ultrasonography images of peripheral nerves. The relationship of ultrasound variables for individual nerves and the ultrasound pattern sum score (UPSS) to conventional NCS findings was investigated. RESULTS A higher grade of DSPN was associated with a notably higher CSA. Multivariate step-wise regression analysis revealed that the number of abnormal nerves was a positive independent variable for UPSS (β coefficient = 0.4205; P < 0.0001). Of the five nerves studied, abnormalities of the tibial nerve (P ≤ 0.0100) and ulnar nerve (P = 0.052) were the most significant variables. CONCLUSIONS The tibial nerve exhibited the most substantial association with elevated UPSS. In addition, a strong correlation was observed between abnormal NCS findings and UPSS in patients with DSPN.
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Affiliation(s)
- Pei‐Chen Hsieh
- Department of NeurologyChang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of MedicineTaoyuanTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of NeurologyNew Taipei Municipal TuCheng HospitalNew Taipei CityTaiwan
| | - Long‐Sun Ro
- Department of NeurologyChang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of MedicineTaoyuanTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Chun‐Che Chu
- Department of NeurologyChang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of MedicineTaoyuanTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Ming‐Feng Liao
- Department of NeurologyChang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of MedicineTaoyuanTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Hong‐Shiu Chang
- Department of NeurologyChang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of MedicineTaoyuanTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Hung‐Chou Kuo
- Department of NeurologyChang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of MedicineTaoyuanTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
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Graesser EA, Parsons MS, Olafsen NP, Dy CJ, Brogan DM. Advances in Imaging of Traumatic Nerve Injuries. J Am Acad Orthop Surg 2024:00124635-990000000-01201. [PMID: 39724518 DOI: 10.5435/jaaos-d-24-00889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Accepted: 11/12/2024] [Indexed: 12/28/2024] Open
Abstract
Traumatic peripheral nerve injuries represent a spectrum of conditions and remain challenging to diagnose and prognosticate. High-resolution ultrasonography and magnetic resonance neurography have emerged as useful diagnostic modalities in the evaluation of traumatic peripheral nerve and brachial plexus injuries. Ultrasonography is noninvasive, is able to rapidly interrogate large areas and multiple nerves, allows for a dynamic assessment of nerves and their surrounding anatomy, and is cost-effective. It allows for the prompt differentiation of neurotmetic versus axonotmetic traumatic nerve injuries, which informs surgical decision making. Magnetic resonance neurography yields images of peripheral nerves with high structural resolution down to the level of fascicles, is able to evaluate difficult anatomic areas that may not be reached by ultrasonography, and can detect signs of acute and chronic muscle denervation. Advanced preclinical techniques, such as second-harmonic generation microscopy, use multiphoton microscopy to visualize the internal collagenous structure of peripheral nerves, while third-harmonic generation microscopy can image myelin. One potential future application for multiphoton microscopy is the in vivo real-time assessment of nervous tissue. Near-infrared fluorescence also has the potential to assist with intraoperative peripheral nerve identification and assessment of pathology, but many challenges remain in identifying or designing the ideal contrast agent.
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Affiliation(s)
- Elizabeth A Graesser
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (Graesser), the Washington University School of Medicine in St. Louis, Mallinckrodt Institute of Radiology, St. Louis, MO (Parsons), and the Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO (Olafsen, Dy, and Brogan)
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Kleinveld VEA, Emmelheinz M, Egle D, Ritter M, Löscher WN, Marth C, Horlings CGC, Wanschitz J, Brunner C. A Prospective Comparison of Subjective Symptoms and Neurophysiological Findings in the Assessment of Neuropathy in Cancer Patients. Diagnostics (Basel) 2024; 14:2861. [PMID: 39767220 PMCID: PMC11675596 DOI: 10.3390/diagnostics14242861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 12/09/2024] [Accepted: 12/16/2024] [Indexed: 01/11/2025] Open
Abstract
Objectives: Neurotoxic effects causing peripheral nerve damage have been reported for several chemotherapy agents. There is no established and standardized method to assess the presence of chemotherapy-induced peripheral neuropathy (CIPN). We compared patient-reported CIPN symptoms to neurophysiological findings and neurological assessments in patients receiving taxane-based chemotherapy. Methods: Patients scheduled to receive taxane-based chemotherapy for the treatment of gynecologic cancer were included and prospectively followed for up to 9 months after chemotherapy discontinuation, between May 2020 and January 2023. Patient-reported symptoms, using the EORTC-QLQ-CIPN20 questionnaire, and nerve conduction studies (NCSs) were performed at baseline, halfway through the treatment cycle, at the end of the treatment, 3 months after treatment, and 6-9 months after treatment. Results: A total of 149 patients were included. Overall, 47.0% of patients reported symptoms compatible with CIPN at any of the follow-ups. Subjective symptoms did not correlate with nerve conduction studies. SNAP amplitudes at baseline were lower in patients who developed CIPN compared to the group without CIPN. Conclusions: The overall diagnostic accuracy of electrophysiological parameters as a marker for CIPN was low.
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Affiliation(s)
| | - Miriam Emmelheinz
- Department of Obstetrics and Gynecology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.E.); (D.E.); (M.R.); (C.M.)
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.E.); (D.E.); (M.R.); (C.M.)
| | - Magdalena Ritter
- Department of Obstetrics and Gynecology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.E.); (D.E.); (M.R.); (C.M.)
| | - Wolfgang N. Löscher
- Department of Neurology, Medical University Innsbruck, 6020 Innsbruck, Austria; (V.E.A.K.); (W.N.L.); (C.G.C.H.); (J.W.)
| | - Christian Marth
- Department of Obstetrics and Gynecology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.E.); (D.E.); (M.R.); (C.M.)
| | | | - Julia Wanschitz
- Department of Neurology, Medical University Innsbruck, 6020 Innsbruck, Austria; (V.E.A.K.); (W.N.L.); (C.G.C.H.); (J.W.)
| | - Christine Brunner
- Department of Obstetrics and Gynecology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.E.); (D.E.); (M.R.); (C.M.)
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Gagliardo A, Tripoli M, Corradino B, Gagliardo C, Di Stefano V, Rosatti F, Rimmaudo G, Cordova A, Brighina F, Toia F. Combined ultrasound imaging/neurophysiological evaluation for surgical planning in upper limb traumatic nerve injuries with concomitant vascular damage: Two emblematic cases and a review of litterature. ANN CHIR PLAST ESTH 2024:S0294-1260(24)00176-6. [PMID: 39648055 DOI: 10.1016/j.anplas.2024.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 10/07/2024] [Accepted: 10/17/2024] [Indexed: 12/10/2024]
Abstract
BACKGROUND Traumatic injuries and penetrating traumas of the upper limb are at high risk of combined neurovascular lesion, due to anatomical proximity of main vessels and nerves. Occasionally, post-traumatic pseudoaneurysms or thrombi can develop in the site of trauma or surgery; these vascular complications represent a real urgency and require an accurate and timely diagnosis. The neurophysiological investigation still represents the gold standard for quantification, localization of nerve injuries and outcome prediction. METHODS We reviewed a database of cases of upper limb trauma from the last two years with concomitant vascular and nervous damage evaluated using a combined ultrasound imaging/neurophysiological approach. Furthermore, among these, we have selected two emblematic cases of proximal upper limb injury with late-onset of vascular complications which came to our attention almost a month after trauma. Compound motor action potentials (CMAP) and sensory nerve action potentials (SNAP) were recorded by superficial electrodes and compared with the contralateral electrodes to estimate the percentage of affected fibres and possible recovery. Maximal cross-sectional area (CSA) of each nerve in the traumatic site and in the typical entrapment zones was recorded measuring at the inner hyperechogenic part of each nerve. Finally, a literature review was conducted. RESULTS Our study confirms the importance of the use of electrophysiology in the diagnostic process of post-traumatic nerve injuries, with a diagnostic accuracy that increases significantly if associated with ultrasonography possibly integrated by Doppler. CONCLUSIONS The results reported in this study are very encouraging in the combined use of neurophysiology and ultrasonography in the approach to upper limb trauma with concomitant vascular and nervous damage; larger-scale studies are desirable to strengthen results.
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Affiliation(s)
- A Gagliardo
- Department of Biomedicine, Neuroscience and Advanced Diagnostic - University of Palermo, Palermo, Italy; "Clinical Course" Neurology and Neurophysiology Unit, Palermo, Italy
| | - M Tripoli
- Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care - University of Palermo, Palermo, Italy
| | - B Corradino
- Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care - University of Palermo, Palermo, Italy
| | - C Gagliardo
- Department of Biomedicine, Neuroscience and Advanced Diagnostic - University of Palermo, Palermo, Italy.
| | - V Di Stefano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic - University of Palermo, Palermo, Italy
| | - F Rosatti
- Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care - University of Palermo, Palermo, Italy
| | - G Rimmaudo
- "Clinical Course" Neurology and Neurophysiology Unit, Palermo, Italy
| | - A Cordova
- Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care - University of Palermo, Palermo, Italy
| | - F Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostic - University of Palermo, Palermo, Italy
| | - F Toia
- Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care - University of Palermo, Palermo, Italy
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Xirou S, Anagnostou E. Electrodiagnosis and Ultrasound Imaging for Ulnar Nerve Entrapment at the Elbow: A Review. Neurodiagn J 2024; 64:175-192. [PMID: 39110889 DOI: 10.1080/21646821.2024.2379081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/08/2024] [Indexed: 11/26/2024]
Abstract
Entrapment neuropathy of the ulnar nerve at the elbow, the so-called cubital tunnel syndrome, is the second most frequent focal mononeuropathy after carpal tunnel syndrome in adults. Currently, there is a pressing need to identify cost-effective biomarkers and procedures capable of accurately detecting alterations in ulnar nerve structural and functional integrity. Established electrophysiological techniques, such as motor and sensory nerve conduction studies, along with needle electromyography of specific muscles, represent the gold standard for ulnar nerve electrodiagnosis. Concurrently, the introduction of neuromuscular ultrasound and its integration into electromyographic laboratories has significantly impacted structural diagnosis and the precise localization of ulnar nerve pathology over the past two decades. In this review, our objective is to summarize the current knowledge on both classical and advanced diagnostic methods utilized in clinical neurophysiology laboratories. We aim to provide a synthesis of modern electrodiagnostic and neurosonographic techniques, with a particular emphasis on easily attainable, clinically relevant parameters.
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Affiliation(s)
- Sophia Xirou
- Department of NeurologyNational and Kapodistrian University of Athens Eginition Hospital Athens, Greece
| | - Evangelos Anagnostou
- Department of NeurologyNational and Kapodistrian University of Athens Eginition Hospital Athens, Greece
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Hayashi T, Matsumoto N, Hatake S, Takeshi Y, Suzuki K, Nishiyama Y, Nagayama H, Kimura K. Nerve sonography to detect intraneural microvascularity in patients with peripheral neuropathy. Clin Neurophysiol 2024; 166:244-249. [PMID: 39226617 DOI: 10.1016/j.clinph.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 08/05/2024] [Accepted: 08/13/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVE We assessed microvessel flow within peripheral nerves using nerve sonography in patients with peripheral neuropathy. METHODS This study included consecutive patients with peripheral neuropathy who were admitted to our hospital. The patients were divided into two groups: inflammatory neuropathies for immune-mediated neuropathies, such as Guillain - Barré syndrome and chronic inflammatory demyelinating polyneuropathy, and the rest were defined as non-inflammatory neuropathies. We assessed nerve size and intraneural blood flow at four sites on each median and ulnar nerve. Blood flow was evaluated using color Doppler imaging, advanced dynamic flow (ADF), and superb microvascular imaging (SMI) techniques. RESULTS Thirty-nine patients (median age, 60.0 years; 20 male) were enrolled in this study. An increase in intraneural blood flow was observed in five patients when evaluated by color Doppler, five patients by ADF, and 13 patients by SMI. An overall analysis of the three methods showed that intraneural blood flow was significantly higher in patients with inflammatory neuropathy than in those with non-inflammatory neuropathy (54.2% vs. 0%, p = 0.0005). CONCLUSIONS Intraneural hypervascularization is more frequent in patients with inflammatory neuropathy than in those with non-inflammatory neuropathy. SIGNIFICANCE Evaluation of microvessel flow within peripheral nerves may contribute to the diagnosis of peripheral neuropathy.
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Affiliation(s)
| | | | - Seira Hatake
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Yuho Takeshi
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Kentaro Suzuki
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | | | | | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Tokyo, Japan
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Sowah MN, Klein BR, Attiah M, Pereda NIP, Murray RA, John DL, Panday A, Levi AD. The use of ultrasound-guided imaging to localize peripheral nerve injury in pediatric patients: A case report. Surg Neurol Int 2024; 15:347. [PMID: 39372995 PMCID: PMC11450850 DOI: 10.25259/sni_580_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 08/30/2024] [Indexed: 10/08/2024] Open
Abstract
Background The use of ultrasonography to diagnose and manage peripheral nerve injury is not routinely performed, but is an advantageous alternative to magnetic resonance imaging (MRI) in the pediatric population. Case Description The authors report a case of a toddler-aged female who sustained a supracondylar fracture and subsequent median and ulnar nerve injuries. All preoperative and postoperative imaging was performed through high-resolution ultrasound as opposed to MRI. Starting at 6 months post-nerve repair and with 18 months of follow-up, the patient exhibited substantial improvement in motor strength and sensory function. This case demonstrated a successful outcome while providing an imaging alternative that is portable, relatively low-cost, lacks ionizing radiation, provides additional information on vascular integrity, and obviates the need for general anesthetic such as MRI. Conclusion The authors conclude that the use of ultrasonography to diagnose and manage traumatic peripheral nerve injury is advantageous, particularly in the pediatric population.
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Affiliation(s)
- Mareshah N. Sowah
- Department of Neurosurgery, University of South Carolina School of Medicine Greenville, Greenville, United States
| | - Benjamin R. Klein
- Department of Surgery, College of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, United States
| | - Mark Attiah
- Department of Neurological Surgery, University of North Carolina, Chapel Hill, United States
| | | | - Roseanna A. Murray
- School of Medicine, University of Miami Miller School of Medicine, Miami, United States
| | - Danny Lincoln John
- School of Medicine, University of Miami Miller School of Medicine, Miami, United States
| | - Avidesh Panday
- Department of Clinical Medical Sciences, The University of the West Indies, Trinidad and Tobago
| | - Allan D. Levi
- Department of Neurological Surgery, Miami, United States
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Rocks MC, Comunale V, Sanchez-Navarro GE, Nicholas RS, Hacquebord JH, Adler RS. Diagnostic Capability of Ultrasonography in Evaluating Peripheral Nerve Injuries of the Brachial Plexus. Hand (N Y) 2024:15589447241277844. [PMID: 39289880 PMCID: PMC11559805 DOI: 10.1177/15589447241277844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
BACKGROUND The purpose of this study is to determine the diagnostic capability of ultrasonography (US) in patients with suspected brachial plexus injury (BPI) to the terminal nerves by comparing physical examination (PE) findings with US, electromyography (EMG), and magnetic resonance imaging (MRI) reports. METHODS All patients at a single institution who underwent US for peripheral nerve injury of the brachial plexus and terminal nerves resulting in sensory-motor deficits from October 1, 2017 to October 31, 2023 were identified. A retrospective chart review was performed. Each PE, US, EMG, and MRI reports were given an overall rating: "normal" or "abnormal." Terminal nerves (musculocutaneous, axillary, radial, ulnar, medial) were individually assessed as "normal" or "abnormal." The interobserver agreement between reports was calculated using Cohen kappa. Specificity and sensitivity analyses were performed to determine diagnostic accuracy and were reported with 95% confidence intervals (CI). RESULTS A total of 120 patients were included. Most injuries were traumatic in nature (78.8%) and were low-energy (53.8%). When each imaging modality was compared with the PE findings, EMG had the highest interobserver agreement (Cohen kappa = 0.18), followed by US (Cohen kappa = 0.10), and last MRI (Cohen kappa = 0.07). The US had the highest sensitivity (0.92, CI = 0.85, 0.96) among the 3 imaging modalities (Table 2). On US, the ulnar nerve was most commonly abnormal (n = 84, 70.0%). DISCUSSION Ultrasonography serves as a useful adjunct in the workup of patients with suspected peripheral BPI and is reliable in localizing the pathology of injured terminal nerves in the brachial plexus.
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Graesser EA, Parsons MS, Dy CJ, Brogan DM. Advances in Imaging of Compressive Neuropathies. Hand Clin 2024; 40:325-336. [PMID: 38972677 DOI: 10.1016/j.hcl.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Ultrasound and magnetic resonance neurography are useful modalities to aid in the assessment of compressive neuropathies, although they are still limited in their resolution of nerve microstructure and their capacity to monitor postoperative nerve recovery. Optical coherence tomography, a preclinical imaging modality, is promising in its ability to better identify structural and potential physiologic changes to peripheral nerves, but requires additional testing and research prior to widespread clinical implementation. Further advances in nerve imaging may elucidate the ability to visualize the zone of nerve injury intraoperatively, monitor the progression of nerve regeneration, and localize problems during nerve recovery.
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Affiliation(s)
- Elizabeth A Graesser
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Matthew S Parsons
- Division of Diagnostic Radiology, Section of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
| | - Christopher J Dy
- Division of Hand and Microsurgery, Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - David M Brogan
- Division of Hand and Microsurgery, Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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Radunovic G, Velickovic Z, Pavlov-Dolijanovic S, Janjic S, Stojic B, Jeftovic Velkova I, Suljagic N, Soldatovic I. Wearable Movement Exploration Device with Machine Learning Algorithm for Screening and Tracking Diabetic Neuropathy-A Cross-Sectional, Diagnostic, Comparative Study. BIOSENSORS 2024; 14:166. [PMID: 38667158 PMCID: PMC11047826 DOI: 10.3390/bios14040166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/23/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Diabetic neuropathy is one of the most common complications of diabetes mellitus. The aim of this study is to evaluate the Moveo device, a novel device that uses a machine learning (ML) algorithm to detect and track diabetic neuropathy. The Moveo device comprises 4 sensors positioned on the back of the hands and feet accompanied by a mobile application that gathers data and ML algorithms that are hosted on a cloud platform. The sensors measure movement signals, which are then transferred to the cloud through the mobile application. The cloud triggers a pipeline for feature extraction and subsequently feeds the ML model with these extracted features. METHODS The pilot study included 23 participants. Eleven patients with diabetes and suspected diabetic neuropathy were included in the experimental group. In the control group, 8 patients had suspected radiculopathy, and 4 participants were healthy. All participants underwent an electrodiagnostic examination (EDx) and a Moveo examination, which consists of sensors placed on the feet and back of the participant's hands and use of the mobile application. The participant performs six tests that are part of a standard neurological examination, and a ML algorithm calculates the probability of diabetic neuropathy. A user experience questionnaire was used to compare participant experiences with regard to both methods. RESULTS The total accuracy of the algorithm is 82.1%, with 78% sensitivity and 87% specificity. A high linear correlation up to 0.722 was observed between Moveo and EDx features, which underpins the model's adequacy. The user experience questionnaire revealed that the majority of patients preferred the less painful method. CONCLUSIONS Moveo represents an accurate, easy-to-use device suitable for home environments, showing promising results and potential for future usage.
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Affiliation(s)
- Goran Radunovic
- Institute of Rheumatology, 11000 Belgrade, Serbia; (Z.V.); (S.P.-D.); (S.J.); (B.S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Zoran Velickovic
- Institute of Rheumatology, 11000 Belgrade, Serbia; (Z.V.); (S.P.-D.); (S.J.); (B.S.)
| | - Slavica Pavlov-Dolijanovic
- Institute of Rheumatology, 11000 Belgrade, Serbia; (Z.V.); (S.P.-D.); (S.J.); (B.S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Sasa Janjic
- Institute of Rheumatology, 11000 Belgrade, Serbia; (Z.V.); (S.P.-D.); (S.J.); (B.S.)
| | - Biljana Stojic
- Institute of Rheumatology, 11000 Belgrade, Serbia; (Z.V.); (S.P.-D.); (S.J.); (B.S.)
| | - Irena Jeftovic Velkova
- DIVS Neuroinformatics DOO, 11000 Belgrade, Serbia; (I.J.V.); (N.S.)
- General Hospital Loznica, 15300 Loznica, Serbia
| | - Nikola Suljagic
- DIVS Neuroinformatics DOO, 11000 Belgrade, Serbia; (I.J.V.); (N.S.)
- Faculty of Electrical Engineering, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivan Soldatovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- DIVS Neuroinformatics DOO, 11000 Belgrade, Serbia; (I.J.V.); (N.S.)
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Kim DS, Jo NG, Lee DW, Ko MH, Seo JH, Kim GW. Ultrasonographic Contrast and Therapeutic Effects of Hydrogen Peroxide-Responsive Nanoparticles in a Rat Model with Sciatic Neuritis. Int J Nanomedicine 2024; 19:3031-3044. [PMID: 38562612 PMCID: PMC10982809 DOI: 10.2147/ijn.s447691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/19/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Peripheral nerve damage lacks an appropriate diagnosis consistent with the patient's symptoms, despite expensive magnetic resonance imaging or electrodiagnostic assessments, which cause discomfort. Ultrasonography is valuable for diagnosing and treating nerve lesions; however, it is unsuitable for detecting small lesions. Poly(vanillin-oxalate) (PVO) nanoparticles are prepared from vanillin, a phytochemical with antioxidant and anti-inflammatory properties. Previously, PVO nanoparticles were cleaved by H2O2 to release vanillin, exert therapeutic efficacy, and generate CO2 to increase ultrasound contrast. However, the role of PVO nanoparticles in peripheral nerve lesion models is still unknown. Herein, we aimed to determine whether PVO nanoparticles can function as contrast and therapeutic agents for nerve lesions. Methods To induce sciatic neuritis, rats were administered a perineural injection of carrageenan using a nerve stimulator under ultrasonographic guidance, and PVO nanoparticles were injected perineurally to evaluate ultrasonographic contrast and therapeutic effects. Reverse transcription-quantitative PCR was performed to detect mRNA levels of pro-inflammatory cytokines, ie, tumor necrosis factor-α, interleukin-6, and cyclooxygenase-2. Results In the rat model of sciatic neuritis, PVO nanoparticles generated CO2 bubbles to increase ultrasonographic contrast, and a single perineural injection of PVO nanoparticles suppressed the expression of tumor necrosis factor-α, interleukin-6, and cyclooxygenase-2, reduced the expression of F4/80, and increased the expression of GAP43. Conclusion The results of the current study suggest that PVO nanoparticles could be developed as ultrasonographic contrast agents and therapeutic agents for nerve lesions.
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Affiliation(s)
- Da-Sol Kim
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Nam-Gyu Jo
- Department of Physical Medicine and Rehabilitation, Hansol Convalescence Rehabilitation Hospital, Jeonju, Republic of Korea
| | - Dong-Won Lee
- Department of Bionanotechnology and Bioconvergence Engineering, Jeonbuk National University, Jeonju, Republic of Korea
- Department of Polymer Nano Science and Technology, Jeonbuk National University, Jeonju, Republic of Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jeong-Hwan Seo
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Gi-Wook Kim
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Bionanotechnology and Bioconvergence Engineering, Jeonbuk National University, Jeonju, Republic of Korea
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Berciano J. The pathophysiological role of endoneurial inflammatory edema in early classical Guillain-Barré syndrome. Clin Neurol Neurosurg 2024; 237:108131. [PMID: 38308937 DOI: 10.1016/j.clineuro.2024.108131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/22/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024]
Abstract
The objective of this review was to analyze the pathophysiological role of endoneurial inflammatory edema in initial stages of classic Guillain-Barré syndrome (GBS), arbitrarily divided into very early GBS (≤ 4 days after symptom onset) and early GBS (≤ 10 days). Classic GBS, with variable degree of flaccid and areflexic tetraparesis, encompasses demyelinating and axonal forms. Initial autopsy studies in early GBS have demonstrated that endoneurial inflammatory edema of proximal nerve trunks, particularly spinal nerves, is the outstanding lesion. Variable permeability of the blood-nerve barrier dictates such lesion topography. In proximal nerve trunks possessing epi-perineurium, edema may increase the endoneurial fluid pressure causing ischemic changes. Critical analysis the first pathological description of the axonal form GBS shows a combination of axonal degeneration and demyelination in spinal roots, and pure Wallerian-like degeneration in peripheral nerve trunks. This case might be reclassified as demyelinating GBS with secondary axonal degeneration. Both in acute motor axonal neuropathy and acute motor-sensory axonal neuropathy, Wallerian-like degeneration of motor fibers predominates in the distal part of ventral spinal roots abutting the dura mater, another feature re-emphasizing the pathogenic relevance of this area. Electrophysiological and imaging studies also point to a predominant alteration at the spinal nerve level, which is a hotspot in any early GBS subtype. Serum biomarkers of axonal damage, including neurofilament light chain and peripherin, are increased in the great majority of patients with any early GBS subtype; endoneurial ischemia of proximal nerve trunks could contribute to such axonal damage. It is concluded that inflammatory edema of proximal nerve trunks is an essential pathogenic event in early GBS, which has a tangible impact for accurate approach to the disease.
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Affiliation(s)
- José Berciano
- University of Cantabria, University Hospital "Marqués de Valdecilla (IDIVAL)", and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain.
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Bürkle E, Ruff C, Lindig T, Nägele T, Hauser TK, Grimm A, Winter N. [Choosing the right imaging for the diagnostics and assessment of the course of peripheral nerve injuries]. DER NERVENARZT 2023; 94:1087-1096. [PMID: 37848647 DOI: 10.1007/s00115-023-01550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Nerve injuries are a frequent problem in routine clinical practice and require intensive interdisciplinary care. OBJECTIVE The current status of imaging to confirm the diagnosis of nerve injuries is described. The role of high-resolution ultrasound and magnetic resonance imaging (MRI) in the diagnostics and follow-up of peripheral nerve injuries is elaborated. MATERIAL AND METHODS Review of the current state of imaging to confirm the diagnosis of nerve injuries. RESULTS Depending on the suspected site of damage, the primary domain of magnetic resonance (MR) imaging (MR neurography) is injuries in the region of the spine, nerve roots, brachial plexus and lumbar plexus, pelvis and proximal thigh. In contrast, in other peripheral nerve lesions of the extremities the advantages of high-resolution nerve ultrasound in a dynamic setting predominate. The MR neurography is indicated here, especially in the frequent bottleneck syndromes and only in very isolated and selected cases. CONCLUSION In addition to a correct anatomical assignment, the timely decision for a possible intervention and the appropriate concomitant treatment are an important basis for a favorable prognosis of nerve injuries. Imaging techniques should therefore be used early in the diagnostics and follow-up controls of peripheral nerve injuries.
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Affiliation(s)
- Eva Bürkle
- Abteilung für diagnostische und interventionelle Neuroradiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - Christer Ruff
- Abteilung für diagnostische und interventionelle Neuroradiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
| | - Tobias Lindig
- Abteilung für diagnostische und interventionelle Neuroradiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - Thomas Nägele
- Abteilung für diagnostische und interventionelle Neuroradiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
- Radiologie Sport Stuttgart, Stuttgart-Bad Cannstatt, Deutschland
| | - Till-Karsten Hauser
- Abteilung für diagnostische und interventionelle Neuroradiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - Alexander Grimm
- Abteilung für Neurologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Natalie Winter
- Abteilung für Neurologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
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Wu WT, Lin CY, Shu YC, Shen PC, Lin TY, Chang KV, Özçakar L. The Potential of Ultrasound Radiomics in Carpal Tunnel Syndrome Diagnosis: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:3280. [PMID: 37892101 PMCID: PMC10606315 DOI: 10.3390/diagnostics13203280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy for which ultrasound imaging has recently emerged as a valuable diagnostic tool. This meta-analysis aims to investigate the role of ultrasound radiomics in the diagnosis of CTS and compare it with other diagnostic approaches. Methods: We conducted a comprehensive search of electronic databases from inception to September 2023. The included studies were assessed for quality using the Quality Assessment Tool for Diagnostic Accuracy Studies. The primary outcome was the diagnostic performance of ultrasound radiomics compared to radiologist evaluation for diagnosing CTS. Results: Our meta-analysis included five observational studies comprising 840 participants. In the context of radiologist evaluation, the combined statistics for sensitivity, specificity, and diagnostic odds ratio were 0.78 (95% confidence interval (CI), 0.71 to 0.83), 0.72 (95% CI, 0.59 to 0.81), and 9 (95% CI, 5 to 15), respectively. In contrast, the ultrasound radiomics training mode yielded a combined sensitivity of 0.88 (95% CI, 0.85 to 0.91), a specificity of 0.88 (95% CI, 0.84 to 0.92), and a diagnostic odds ratio of 58 (95% CI, 38 to 87). Similarly, the ultrasound radiomics testing mode demonstrated an aggregated sensitivity of 0.85 (95% CI, 0.78 to 0.89), a specificity of 0.80 (95% CI, 0.73 to 0.85), and a diagnostic odds ratio of 22 (95% CI, 12 to 41). Conclusions: In contrast to assessments by radiologists, ultrasound radiomics exhibited superior diagnostic performance in detecting CTS. Furthermore, there was minimal variability in the diagnostic accuracy between the training and testing sets of ultrasound radiomics, highlighting its potential as a robust diagnostic tool in CTS.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10048, Taiwan;
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan
| | - Che-Yu Lin
- Institute of Applied Mechanics, College of Engineering, National Taiwan University, Taipei 10617, Taiwan; (C.-Y.L.); (Y.-C.S.)
| | - Yi-Chung Shu
- Institute of Applied Mechanics, College of Engineering, National Taiwan University, Taipei 10617, Taiwan; (C.-Y.L.); (Y.-C.S.)
| | - Peng-Chieh Shen
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan 26546, Taiwan; (P.-C.S.); (T.-Y.L.)
| | - Ting-Yu Lin
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan 26546, Taiwan; (P.-C.S.); (T.-Y.L.)
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10048, Taiwan;
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey;
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Kelley N, Hubbard J, Belton M. Cubital tunnel compression neuropathy in the presence of an anomalous venous complex: a case study. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:427-430. [PMID: 37588498 PMCID: PMC10426564 DOI: 10.1016/j.xrrt.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Naomi Kelley
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - James Hubbard
- Department of Orthopedic Surgery, Mercy Hospital St. Louis, St. Louis, MO, USA
| | - Matthew Belton
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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Breville G, Sukockiene E, Vargas MI, Lascano AM. Emerging biomarkers to predict clinical outcomes in Guillain-Barré syndrome. Expert Rev Neurother 2023; 23:1201-1215. [PMID: 37902064 DOI: 10.1080/14737175.2023.2273386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/17/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is an immune-mediated poly(radiculo)neuropathy with a variable clinical outcome. Identifying patients who are at risk of suffering from long-term disabilities is a great challenge. Biomarkers are useful to confirm diagnosis, monitor disease progression, and predict outcome. AREAS COVERED The authors provide an overview of the diagnostic and prognostic biomarkers for GBS, which are useful for establishing early treatment strategies and follow-up care plans. EXPERT OPINION Detecting patients at risk of developing a severe outcome may improve management of disease progression and limit potential complications. Several clinical factors are associated with poor prognosis: higher age, presence of diarrhea within 4 weeks of symptom onset, rapid and severe weakness progression, dysautonomia, decreased vital capacity and facial, bulbar, and neck weakness. Biological, neurophysiological and imaging measures of unfavorable outcome include multiple anti-ganglioside antibodies elevation, increased serum and CSF neurofilaments light (NfL) and heavy chain, decreased NfL CSF/serum ratio, hypoalbuminemia, nerve conduction study with early signs of demyelination or axonal loss and enlargement of nerve cross-sectional area on ultrasound. Depicting prognostic biomarkers aims at predicting short-term mortality and need for cardio-pulmonary support, long-term patient functional outcome, guiding treatment decisions and monitoring therapeutic responses in future clinical trials.
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Affiliation(s)
- Gautier Breville
- Neurology Division, Neuroscience Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Egle Sukockiene
- Neurology Division, Neuroscience Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Maria Isabel Vargas
- Neuroradiology Division, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Agustina M Lascano
- Neurology Division, Neuroscience Department, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Xu XD, Lin L, Qiu YB, Zeng BW, Chen Y, Liu JL, Ye CH, Wang JL, Liu PC, Zhang LC. Ultrasonic visualization technique for anatomical and functional analyses of the sciatic nerve in rats. Front Neurosci 2023; 17:1187669. [PMID: 37456994 PMCID: PMC10339105 DOI: 10.3389/fnins.2023.1187669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/01/2023] [Indexed: 07/18/2023] Open
Abstract
Background and objective Ultrasound has been widely used in the diagnosis and minimally invasive treatment of peripheral nerve diseases in the clinic, but there is still a lack of feasibility analysis in rodent models of neurological disease. The purpose of this study was to investigate the changes in the cross-sectional area of the sciatic nerve of different genders and body weights and to explore the effectiveness and reliability of an ultrasound-guided block around the sciatic nerve in living rats. Methods Using ultrasound imaging anatomy of the sciatic nerve of rats, the cross-sectional area of the sciatic nerve in rats of different genders from 6 to 10 weeks old was calculated, and then analyzed its correlation with body weight. Further analyses were conducted through behavioral and cadaveric studies to evaluate the feasibility of ultrasound-guided perineural injection of the sciatic nerve in rats. Results We first reported that the sciatic nerve cross-sectional area of rats was increased with age (F = 89.169, P < 0.001), males had a higher sciatic nerve cross-sectional area than females (F = 60.770, P < 0.001), and there was a positive correlation with body weight (rMale = 0.8976, P < 0.001; rFemale = 0.7733, P < 0.001). Behavioral observation of rats showed that the lower extremity complete block rate was 80% following the administration of drugs around the sciatic nerve under ultrasound guidance and staining with methylene blue occurred in all sciatic nerves and surrounding muscles and fascia using 20 ultrasound-guided injections. Conclusions Ultrasound visualization technology can be used as a new auxiliary evaluation and intervention therapy for animal models of peripheral nerve injury, and will provide overwhelming new references for the basic research of neurological diseases.
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Affiliation(s)
- Xiao-Dong Xu
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
- The Graduate School of Fujian Medical University, Fuzhou, China
| | - Lei Lin
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yu-Bei Qiu
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Bang-Wei Zeng
- Administration Department of Nosocomial Infection, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ye Chen
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
- The Graduate School of Fujian Medical University, Fuzhou, China
| | - Jun-Le Liu
- Department of Anesthesiology, Xiamen Third Hospital, Xiamen, China
| | - Cai-Hong Ye
- The Graduate School of Fujian Medical University, Fuzhou, China
| | - Jia-Li Wang
- The Graduate School of Fujian Medical University, Fuzhou, China
| | - Pei-Chang Liu
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liang-Cheng Zhang
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
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Hildebrand A, Schreiber F, Weber L, Arndt P, Garz C, Petri S, Prudlo J, Meuth SG, Waerzeggers Y, Henneicke S, Vielhaber S, Schreiber S. Peripheral Nerve Ultrasound for the Differentiation between ALS, Inflammatory, and Hereditary Polyneuropathies. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1192. [PMID: 37512004 PMCID: PMC10383275 DOI: 10.3390/medicina59071192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/10/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Ultrasound (US) is a non-invasive tool for the in vivo detection of peripheral nerve alterations. Materials and Methods: In this study, we applied nerve US to assist the discrimination between the spectrum of amyotrophic lateral sclerosis (ALS, n = 11), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP, n = 5), and genetically confirmed Charcot-Marie-Tooth disease (CMT, n = 5). All participants and n = 15 controls without neurological diseases underwent high-resolution US of the bilateral tibial nerve. The nerve cross-sectional area (CSA) and nerve microvascular blood flow were compared between the groups and related to cerebrospinal fluid (CSF) measures, clinical symptoms, and nerve conduction studies. The analyses are part of a larger multimodal study on the comparison between US and 7 Tesla (7T) magnetic resonance neurography (MRN). Results: The patients and controls were matched with respect to their demographical data. CMT had the longest disease duration, followed by CIDP and ALS. CSA was related to age, weight, and disease duration. CSA was larger in CMT and CIDP compared to ALS and controls. The blood flow was greatest in CIDP, and higher than in CMT, ALS, and controls. In ALS, greater CSA was correlated with greater CSF total protein and higher albumin quotient. The US measures did not correlate with clinical scores or nerve conduction studies in any of the subgroups. Conclusion: Our results point towards the feasibility of CSA and blood flow to discriminate between ALS, CIDP, and CMT, even in groups of small sample size. In ALS, larger CSA could indicate an inflammatory disease subtype characterized by reduced blood-nerve barrier integrity. Our upcoming analysis will focus on the additive value of 7T MRN in combination with US to disentangle the spectrum between more inflammatory or more degenerative disease variants among the disease groups.
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Affiliation(s)
- Annkatrin Hildebrand
- Department of Neurology, Otto von Guericke University Magdeburg (OVGU), 39120 Magdeburg, Germany
| | - Frank Schreiber
- Department of Neurology, Otto von Guericke University Magdeburg (OVGU), 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany
| | - Luisa Weber
- Department of Neurology, Otto von Guericke University Magdeburg (OVGU), 39120 Magdeburg, Germany
- Department of Neurology, Saarland University Medical Center, 66421 Homburg, Germany
| | - Philipp Arndt
- Department of Neurology, Otto von Guericke University Magdeburg (OVGU), 39120 Magdeburg, Germany
| | - Cornelia Garz
- Leibniz Institute for Neurobiology (LIN), 39120 Magdeburg, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Johannes Prudlo
- Department of Neurology, Rostock University Medical Center, 18147 Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE), 18147 Rostock, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Yannic Waerzeggers
- Department of Neurology, Otto von Guericke University Magdeburg (OVGU), 39120 Magdeburg, Germany
| | - Solveig Henneicke
- Department of Neurology, Otto von Guericke University Magdeburg (OVGU), 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto von Guericke University Magdeburg (OVGU), 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39120 Magdeburg, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto von Guericke University Magdeburg (OVGU), 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39120 Magdeburg, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Germany
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23
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Lu Y, Xing H, Liu C, Huang D, Sun C, Yu M, Meng L, Lv H, Zhang W, Wang Z, Yuan Y, Xie Z. Pathogenic PSAT1 Variants and Autosomal Recessive Axonal Charcot-Marie-Tooth Disease With Ichthyosis. Pediatr Neurol 2023; 140:25-34. [PMID: 36599231 DOI: 10.1016/j.pediatrneurol.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/26/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Biallelic pathogenic phosphoserine aminotransferase 1 (PSAT1) variants generally cause a severe phenotype predominantly involving the central nervous system. Here, for the first time, we report two patients harboring pathogenic PSAT1 variants only manifested as polyneuropathy and ichthyosis. METHODS Two patients from unrelated families presenting with polyneuropathy and ichthyosis were enrolled. Whole exome sequencing was performed to identify possible disease-causing variants. Their clinical, electrophysiological, imaging, biochemical, and pathologic changes were in detail assessed and investigated. RESULTS Homozygous variant c.43G>C and compound heterozygous variants c.112A>C and c.43G>C in PSAT1 were identified in patients 1 and 2, respectively. Nerve conduction studies revealed preserved or mild slowing motor nerve conduction velocities of the median nerves in the two patients, whereas the compound motor action potential in patient 1 was severely decreased. Brain magnetic resonance imaging of the two patients found no abnormalities. Median nerve enlargement was observed on ultrasound in patient 1. Both patients had normal level of serine and glycine in plasma and cerebrospinal fluid. Sural nerve biopsy found severe loss of myelinated fibers. Electron microscopy revealed neurofilament accumulation and mitochondrial aggregation in axons. Both variants in PSAT1 were classified as likely pathogenic or pathogenic variants according to the standard guidelines. CONCLUSIONS Our study confirms that pathogenic PSAT1 variants can cause a mild phenotype, predominantly as autosomal recessive axonal Charcot-Marie-Tooth disease.
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Affiliation(s)
- Yanyu Lu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Haiying Xing
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Chang Liu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Diandian Huang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Chengyue Sun
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Meng Yu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Lingchao Meng
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - He Lv
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing, China.
| | - Zhiying Xie
- Department of Neurology, Peking University First Hospital, Beijing, China.
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24
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Lee J, Lee D, Suh GH, Choi J. Contrast-enhanced ultrasonography for evaluation of the blood perfusion of sciatic nerves in healthy dogs. Vet Radiol Ultrasound 2023; 64:322-329. [PMID: 36264587 DOI: 10.1111/vru.13180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 08/27/2022] [Accepted: 08/27/2022] [Indexed: 11/30/2022] Open
Abstract
Blood supply to the peripheral nerves is essential for fulfilling their structural and functional requirements. This prospective, experimental, exploratory study aimed to assess the feasibility of contrast-enhanced ultrasonography (CEUS) for evaluating blood perfusion of the sciatic nerve in normal dogs. Contrast-enhanced ultrasonography examinations were performed on the bilateral sciatic nerves after bolus injection of Sonazoid™ (0.015 mL/kg) in 12 healthy Beagles for 150 s. Then, qualitative assessment of the wash-in timing, degree and enhancement patterns, and quantitative measurement of the peak intensity and time to peak intensity were performed from the sciatic nerve. The results were compared to those obtained from the adductor muscle around the nerve and caudal gluteal artery. After contrast agent injection, the sciatic nerve was enhanced at approximately 13-14 s, immediately after wash-in of the caudal gluteal artery. The peak intensity of the sciatic nerve was significantly lower than that of the caudal gluteal artery and higher than that of the adductor muscle. The time to peak intensity was significantly slower than that of the caudal gluteal artery; but was not significantly different from that of the adductor muscle. There were no significant differences in the peak intensity and time to peak intensity between the left and right sciatic nerves. These results demonstrate the feasibility of CEUS to assess blood perfusion of the sciatic nerve in healthy dogs qualitatively and quantitatively. This result from healthy dogs could serve as a reference for further studies that evaluate the sciatic nerve under pathological conditions.
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Affiliation(s)
- Juryeong Lee
- Department of veterinary Medical Imaging, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| | - Dongjae Lee
- Department of Veterinary Medical Imaging, College of Veterinary medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Guk-Hyun Suh
- Department of veterinary Medical Imaging, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| | - Jihye Choi
- Department of Veterinary Medical Imaging, College of Veterinary medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, South Korea
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25
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Wu Y, Barrere V, Han A, Chang EY, Andre MP, Shah SB. Repeatability, Reproducibility and Sources of Variability in the Assessment of Backscatter Coefficient and Texture Parameters from High-Frequency Ultrasound Acquisitions in Human Median Nerve. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:122-135. [PMID: 36283940 DOI: 10.1016/j.ultrasmedbio.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/01/2022] [Accepted: 08/07/2022] [Indexed: 06/16/2023]
Abstract
Ultrasound (US) is an increasingly prevalent and effective diagnostic modality for neuromuscular imaging. Gray-scale B-mode imaging has been the dominant US approach to evaluating nerves qualitatively or making morphometric measurements of nerves, providing important insights into pathological changes for conditions such as carpal tunnel syndrome. Among more recent ultrasound strategies, high-frequency ultrasound (often defined as >15 MHz for clinical applications), quantitative ultrasound and image textural analysis offer promising enhancements for improved and more objective approaches to nerve imaging. In this study, we evaluated the repeatability and reproducibility of backscatter coefficient (BSC) and imaging texture features extracted by gray-level co-occurrence matrices (GLCMs) in homogeneous tissue-mimicking reference phantoms and in median nerves in the wrists of healthy participants. We also investigated several practical sources of variability in the assessment of quantitative parameters, including influences of operators, and participant-to-participant variability. Overall, BSC- and GLCM-based outcomes are highly repeatable and reproducible after operator training, based on measurement of descriptive statistics, repeatability coefficient (RC) and reproducibility coefficient recommended by Quantitative Imaging Biomarker Alliance (QIBA RDC). GLCM parameters appear more reproducible and repeatable than BSC-based parameters in healthy participants in vivo. However, such variability noted here must be compared with the value ranges and variability of the results in pathological nerves, including median nerves afflicted by trauma, overuse syndromes such as carpal tunnel syndrome and after surgical repair.
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Affiliation(s)
- Yuanshan Wu
- Department of Bioengineering, University of California, San Diego, California, USA; Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Victor Barrere
- Research Service, VA San Diego Healthcare System, San Diego, California, USA; Department of Orthopaedic Surgery, University of California, San Diego, California, USA
| | - Aiguo Han
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Eric Y Chang
- Research Service, VA San Diego Healthcare System, San Diego, California, USA; Department of Radiology, University of California, San Diego, California, USA
| | - Michael P Andre
- Research Service, VA San Diego Healthcare System, San Diego, California, USA; Department of Radiology, University of California, San Diego, California, USA
| | - Sameer B Shah
- Department of Bioengineering, University of California, San Diego, California, USA; Research Service, VA San Diego Healthcare System, San Diego, California, USA; Department of Orthopaedic Surgery, University of California, San Diego, California, USA.
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26
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Zaottini F, Picasso R, Pistoia F, Sanguinetti S, Pansecchi M, Tovt L, Viglino U, Cabona C, Garnero M, Benedetti L, Martinoli C. High-resolution ultrasound of peripheral neuropathies in rheumatological patients: An overview of clinical applications and imaging findings. Front Med (Lausanne) 2022; 9:984379. [PMID: 36388946 PMCID: PMC9661426 DOI: 10.3389/fmed.2022.984379] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Peripheral neuropathies are surprisingly common and can be associated with a number of conditions, including rheumatological diseases. Whether the co-existence of peripheral neuropathies with rheumatological disorders is coincidental or related to a common pathogenic mechanism, these disabling conditions can affect the outcome of rheumatological patients and should be targeted with specific treatment. The clinical presentation of peripheral neuropathy can be multifaceted and difficult to recognize in polysymptomatic patients. However, physicians adopting state-of-art diagnostic strategies, including nerve imaging, may improve the detection rate and management of neuropathies. In particular, a diagnostic approach relying exclusively on clinical history and nerve conduction studies may not be sufficient to disclose the etiology of the nerve damage and its anatomical location and thus requires integration with morphological studies. High-Resolution Ultrasound (HRUS) is increasingly adopted to support the diagnosis and follow-up of both joint disorders in rheumatology and peripheral neuropathies of different etiologies. In this review, the different types of nerve disorders associated with the most common syndromes of rheumatological interest are discussed, focusing on the distinctive sonographic features.
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Affiliation(s)
- Federico Zaottini
- San Martino Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Riccardo Picasso
- San Martino Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
- *Correspondence: Riccardo Picasso,
| | - Federico Pistoia
- Dipartimento di Medicina Sperimentale, Scuola di Scienze Mediche e Farmaceutiche, Università di Genova, Genoa, Italy
| | - Sara Sanguinetti
- Dipartimento di Medicina Sperimentale, Scuola di Scienze Mediche e Farmaceutiche, Università di Genova, Genoa, Italy
| | - Michelle Pansecchi
- Dipartimento di Scienze della Salute, Scuola di Scienze Mediche e Farmaceutiche, Università di Genova, Genoa, Italy
| | - Luca Tovt
- Dipartimento di Scienze della Salute, Scuola di Scienze Mediche e Farmaceutiche, Università di Genova, Genoa, Italy
| | - Umberto Viglino
- Dipartimento di Scienze della Salute, Scuola di Scienze Mediche e Farmaceutiche, Università di Genova, Genoa, Italy
| | - Corrado Cabona
- San Martino Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Science, School of Medical and Pharmaceutical Sciences, University of Genoa, Genoa, Italy
| | - Martina Garnero
- San Martino Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Science, School of Medical and Pharmaceutical Sciences, University of Genoa, Genoa, Italy
| | - Luana Benedetti
- San Martino Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Science, School of Medical and Pharmaceutical Sciences, University of Genoa, Genoa, Italy
| | - Carlo Martinoli
- San Martino Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
- Dipartimento di Scienze della Salute, Scuola di Scienze Mediche e Farmaceutiche, Università di Genova, Genoa, Italy
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27
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Berciano J. Axonal pathology in early stages of Guillain-Barré syndrome. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:466-479. [PMID: 35779867 DOI: 10.1016/j.nrleng.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/12/2018] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is an acute-onset, immune-mediated disease of the peripheral nervous system. It may be classified into 2 main subtypes: demyelinating (AIDP) and axonal (AMAN). This study aims to analyse the mechanisms of axonal damage in the early stages of GBS (within 10 days of onset). DEVELOPMENT We analysed histological, electrophysiological, and imaging findings from patients with AIDP and AMAN, and compared them to those of an animal model of myelin P2 protein-induced experimental allergic neuritis. Inflammatory oedema of the spinal nerve roots and spinal nerves is the initial lesion in GBS. The spinal nerves of patients with fatal AIDP may show ischaemic lesions in the endoneurium, which suggests that endoneurial inflammation may increase endoneurial fluid pressure, reducing transperineurial blood flow, potentially leading to conduction failure and eventually to axonal degeneration. In patients with AMAN associated with anti-ganglioside antibodies, nerve conduction block secondary to nodal sodium channel dysfunction may affect the proximal, intermediate, and distal nerve trunks. In addition to the mechanisms involved in AIDP, active axonal degeneration in AMAN may be associated with nodal axolemma disruption caused by anti-ganglioside antibodies. CONCLUSION Inflammatory oedema of the proximal nerve trunks can be observed in early stages of GBS, and it may cause nerve conduction failure and active axonal degeneration.
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Affiliation(s)
- J Berciano
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain.
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28
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Berciano J. Axonal pathology in early stages of Guillain-Barré syndrome. Neurologia 2022; 37:466-479. [PMID: 30057217 DOI: 10.1016/j.nrl.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/05/2018] [Accepted: 06/12/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is an acute-onset, immune-mediated disease of the peripheral nervous system. It may be classified into 2 main subtypes: demyelinating (AIDP) and axonal (AMAN). This study aims to analyse the mechanisms of axonal damage in the early stages of GBS (within 10days of onset). DEVELOPMENT We analysed histological, electrophysiological, and imaging findings from patients with AIDP and AMAN, and compared them to those of an animal model of myelin P2 protein-induced experimental allergic neuritis. Inflammatory oedema of the spinal nerve roots and spinal nerves is the initial lesion in GBS. The spinal nerves of patients with fatal AIDP may show ischaemic lesions in the endoneurium, which suggests that endoneurial inflammation may increase endoneurial fluid pressure, reducing transperineurial blood flow, potentially leading to conduction failure and eventually to axonal degeneration. In patients with AMAN associated with anti-ganglioside antibodies, nerve conduction block secondary to nodal sodium channel dysfunction may affect the proximal, intermediate, and distal nerve trunks. In addition to the mechanisms involved in AIDP, active axonal degeneration in AMAN may be associated with nodal axolemma disruption caused by anti-ganglioside antibodies. CONCLUSION Inflammatory oedema of the proximal nerve trunks can be observed in early stages of GBS, and it may cause nerve conduction failure and active axonal degeneration.
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Affiliation(s)
- J Berciano
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, España.
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29
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Oka Y, Tsukita K, Tsuzaki K, Takamatsu N, Uchibori A, Chiba A, Hamano T. Nerve ultrasound characteristics of immunoglobulin M neuropathy associated with anti-myelin-associated glycoprotein antibodies. Muscle Nerve 2022; 65:667-675. [PMID: 35353922 DOI: 10.1002/mus.27542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION/AIMS Immunoglobulin M neuropathy associated with anti-myelin-associated glycoprotein antibody (IgM/anti-MAG) neuropathy typically presents with chronic, distal-dominant symmetrical sensory or sensorimotor deficits. Ultrasonographic studies of IgM/anti-MAG neuropathy are limited, and were all performed on Western populations. We aimed to characterize the nerve ultrasonographic features of IgM/anti-MAG neuropathy in the Japanese population and evaluate whether they differ from the findings of the common subtypes of chronic inflammatory demyelinating polyneuropathy (CIDP). METHODS In this cross-sectional study, we retrospectively reviewed medical records and extracted the cross-sectional areas (CSAs) of C5-C7 cervical nerve roots and median and ulnar nerves of 6 IgM/anti-MAG neuropathy patients, 10 typical CIDP (t-CIDP) patients, 5 multifocal CIDP (m-CIDP) patients, and 17 healthy controls (HCs). RESULTS Cervical nerve root CSAs were significantly larger at every examined site on both sides in IgM/anti-MAG neuropathy than in m-CIDP and HCs but were comparable to those in t-CIDP. Peripheral nerve enlargements were greatest at common entrapment sites (ie, wrist and elbow) in IgM/anti-MAG neuropathy, a pattern shared with t-CIDP but not with m-CIDP. The degree of nerve enlargement at entrapment sites compared to non-entrapment sites was significantly higher in IgM/anti-MAG neuropathy than in t-CIDP. DISCUSSION Our study delineated the ultrasonographic features of IgM/anti-MAG neuropathy in the Japanese population and observed similar characteristics to those of t-CIDP, with subtle differences. Further studies comparing results from various populations are required to optimize the use of nerve ultrasound worldwide.
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Affiliation(s)
- Yuwa Oka
- Department of Neurology, Kansai Electric Power Hospital, Osaka, Japan.,Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Osaka, Japan.,Department of Neurology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Kazuto Tsukita
- Center for Sleep-Related Disorders and Department of Neurology, Kansai Electric Power Hospital, Osaka, Japan.,Division of Sleep Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan.,Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Advanced Comprehensive Research Organization, Teikyo University, Itabashi, Japan
| | - Koji Tsuzaki
- Department of Neurology, Kansai Electric Power Hospital, Osaka, Japan.,Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Osaka, Japan
| | - Naoko Takamatsu
- Department of Neurology, Kansai Electric Power Hospital, Osaka, Japan.,Department of Neurology, Tokushima University Hospital, Tokushima, Japan
| | - Ayumi Uchibori
- Department of Neurology, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Atsuro Chiba
- Department of Neurology, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Toshiaki Hamano
- Department of Neurology, Kansai Electric Power Hospital, Osaka, Japan.,Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Osaka, Japan
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30
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Greenfield AL, Parrikh M, Kanesa-Thasan R. Ultrasonographic Evaluation of Peripheral Nerves: Technical Considerations. Semin Musculoskelet Radiol 2022; 26:105-113. [PMID: 35609572 DOI: 10.1055/s-0042-1742606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Advances in ultrasonographic (US) technology featuring high-resolution transducers have revolutionized US over recent years as a modality increasingly used in the evaluation of musculoskeletal structures and peripheral nerves. A wide variety of nerve pathologies can be detected, such as neoplastic and tumorlike lesions, entrapment syndromes, posttraumatic injuries, and inflammatory conditions. US can serve as an imaging tool for guiding percutaneous treatments, such as injection therapies or hydrodissection, and assist with perioperative nerve marking and visualization of peripheral nerves in the operating room. This article describes the normal US appearance of peripheral nerves, US imaging techniques, common peripheral nerve pathologies, and interventional applications.
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Affiliation(s)
- Antje L Greenfield
- Section of Musculoskeletal Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mannan Parrikh
- Section of Musculoskeletal Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Riti Kanesa-Thasan
- Section of Musculoskeletal Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
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31
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Crump NH, Cartwright MS. A Retrospective Study of Ultrasound Accuracy for the Diagnosis of Chronic Inflammatory Demyelinating Polyneuropathy. J Clin Neurophysiol 2022; 39:312-316. [PMID: 33009042 DOI: 10.1097/wnp.0000000000000782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Ultrasound is emerging as a useful tool for the evaluation of immune-mediated neuropathies because it can provide high-resolution anatomic information to complement electrodiagnostic data. Nerve enlargements are commonly found in chronic inflammatory demyelinating polyneuropathy (CIDP), and their presence likely useful in diagnosis, particularly if multifocal. METHODS In this study, the authors undertook a retrospective chart review to identify ultrasound findings in patients with CIDP previously studied in a single busy neurodiagnostic laboratory. RESULTS Of the 50 cases identified from 2000 to 2017, individuals with a confirmed diagnosis of CIDP (21 cases) were more likely to have multiple sites of enlargement, as well as more pronounced nerve enlargement, than patients who were subsequently found to have an alternate cause of neuropathy (22 cases). The presence of any moderately enlarged nerve segment predicted definite CIDP with sensitivity of 81% and specificity 77%. CONCLUSION This study demonstrates that ultrasound can be of diagnostic utility in patients with suspected CIDP, even when conducted in a nonstandardized real-world setting.
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Affiliation(s)
- Nicholas H Crump
- Departments of Neurology and Medicine, Austin Health and University of Melbourne, Victoria, Australia ; and
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
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32
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Spitz CN, Mogami R, Pitta IJR, Hacker MAVB, Sales AM, Sarno EN, Jardim MR. Ultrasonography as a diagnostic tool for Neural Pain in Leprosy. PLoS Negl Trop Dis 2022; 16:e0010393. [PMID: 35486667 PMCID: PMC9094535 DOI: 10.1371/journal.pntd.0010393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/11/2022] [Accepted: 04/05/2022] [Indexed: 11/19/2022] Open
Abstract
Leprosy is still a prevalent disease in Brazil, representing 93% of all occurrences in the Americas. Leprosy neuropathy is one of the most worrying manifestations of the disease. Acute neuropathy usually occurs during reaction episodes and is called neuritis. Twenty-two leprosy patients were included in this study. These patients had neural pain associated with ulnar sensory neuropathy, with or without adjunct motor involvement. The neurological picture began within thirty days of the clinical evaluation. The patients underwent a nerve conduction study and the demyelinating findings confirmed the diagnosis of neuritis. Ultrasonographic study (US) of the ulnar nerve was performed in all patients by a radiologist who was blinded to the clinical or neurophysiological results. Morphological characteristics of the ulnar nerve were analyzed, such as echogenicity, fascicular pattern, transverse cross-sectional area (CSA), aspect of the epineurium, as well as their anatomical relationships. The volume of selected muscles referring to the ulnar nerve, as well as their echogenicity, was also examined. Based on this analysis, patients with increased ulnar nerve CSA associated with loss of fascicular pattern, epineurium hyperechogenicity and presence of power Doppler flow were classified as neuritis. Therefore, patients initially classified by the clinical-electrophysiological criteria were reclassified by the imaging criteria pre-established in this study as with and without neuritis. Loss of fascicular pattern and flow detection on power Doppler showed to be significant morphological features in the detection of neuritis. In 38.5% of patients without clinical or neurophysiological findings of neuritis, US identified power Doppler flow and loss of fascicular pattern. The US is a method of high resolution and portability, and its low cost means that it could be used as an auxiliary tool in the diagnosis of neuritis and its treatment, especially in basic health units. Leprosy remains a public health problem, despite being an ancient disease. In most cases, it is associated with neuropathy that can be acute or chronic and this neural involvement can occur before, during, or after multidrug therapy (MDT). Acute neuropathy usually occurs during reaction episodes and is called neuritis. It causes compromised nerve function associated with nociceptive pain [1]. The inflammatory process can also develop neuroplasticity of the peripheral and central nervous systems, which perpetuates this sensation; this phenomenon is known as neuropathic pain, a chronic sensation in leprosy. Differential diagnosis between nociceptive and neuropathic pain is not always easy and in some patients there may be an overlap between nociceptive and neuropathic pain. Currently, clinical and electrophysiological criteria are used for the differential diagnosis of neural pain [2], but especially in the case of recurrent neuritis, these criteria are insufficient. Recent knowledge about pain mechanisms does not define the limit as to where nociceptive ends and neuropathic begins, suggesting that this process is continuous, in addition to being associated. Ultrasonography (US) has been used as an auxiliary tool in the early diagnosis of peripheral nervous system diseases. The method can be implemented in addition to clinical and neurophysiological studies for the diagnosis of neuritis, which allows for the early identification and treatment of the disease [3,4].
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Affiliation(s)
- Clarissa Neves Spitz
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
- * E-mail:
| | - Roberto Mogami
- Pedro Ernesto University Hospital/Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Izabela Jardim Rodrigues Pitta
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | | | - Anna Maria Sales
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | | | - Marcia Rodrigues Jardim
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
- Pedro Ernesto University Hospital/Rio de Janeiro State University, Rio de Janeiro, Brazil
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Strakowski JA. Ultrasound Evaluation of Peripheral Nerve Trauma. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Issar T, Walker S, Arnold R, Poynten AM, Endre ZH, Krishnan AV. Peripheral nerve morphology and intraneural blood flow in chronic kidney disease with and without diabetes. Muscle Nerve 2022; 65:603-607. [PMID: 35119701 PMCID: PMC9305967 DOI: 10.1002/mus.27513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 11/22/2022]
Abstract
Introduction/Aims Sonographic alterations of peripheral nerves in pre‐dialytic kidney disease are yet to be determined. We aimed to assess peripheral nerve cross‐sectional area (CSA) and intraneural blood flow in patients with pre‐dialytic chronic kidney disease (CKD) and diabetic kidney disease (DKD). Methods Subjects with CKD (n = 20) or DKD (n = 20) underwent ultrasound to assess CSA of the median and tibial nerves as well as intraneural blood flow of the median nerve. Blood flow was quantified using maximum perfusion intensity. Neuropathy was assessed using the Total Neuropathy Score. A 6‐m timed walk test was also performed. Healthy controls (n = 28) were recruited for comparison. Results The DKD group had more severe neuropathy (p = .024), larger tibial nerve CSA (p = .002) and greater median nerve blood flow than the CKD group (p = .023). Blood flow correlated with serum potassium in disease groups (r = 0.652, p = .022). Disease groups had larger tibial nerve CSA than controls (p < .05). No blood flow was detected in controls. Tibial nerve enlargement was associated with slower maximal walking speeds in disease groups (r = −0.389, p = .021). Discussion Subjects with DKD demonstrated enlarged tibial nerve CSA and increased median nerve blood flow compared to those with CKD. Elevations in serum potassium were associated with increased blood flow. Sonographic alterations were detectable in pre‐dialytic kidney disease compared to controls, highlighting the utility of ultrasound in the assessment of nerve pathology in these patient groups.
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Affiliation(s)
- Tushar Issar
- Prince of Wales Clinical School, UNSW Sydney, NSW, Australia
| | - Susan Walker
- Prince of Wales Clinical School, UNSW Sydney, NSW, Australia
| | - Ria Arnold
- School of Medical Sciences, UNSW Sydney, NSW, Australia
| | - Ann M Poynten
- Department of Endocrinology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Zoltan H Endre
- Department of Nephrology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, UNSW Sydney, NSW, Australia
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Jatoi M. Role of sonography in assessment of upper extremity nerve pathologies. J Med Imaging Radiat Sci 2022; 53:305-313. [DOI: 10.1016/j.jmir.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 01/04/2023]
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Chen W, Wu X, Li S, Zhang Y, Huang Y, Zhuang Y, Bai X, Chen X, Lin X. Optical coherence tomography of the retina combined with color Doppler ultrasound of the tibial nerve in the diagnosis of diabetic peripheral neuropathy. Front Endocrinol (Lausanne) 2022; 13:938659. [PMID: 36339439 PMCID: PMC9634106 DOI: 10.3389/fendo.2022.938659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 10/03/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate the value of the retinal nerve fiber layer (RNFL) thickness in the optic disc and the cross-sectional area (CSA) of lower limb nerves in the diagnosis of diabetic peripheral neuropathy (DPN) separately and in combination. METHODS A total of 140 patients with type 2 diabetes were enrolled, including 51 patients with DPN (DPN group) and 89 patients without DPN (NDPN group). Clinical data and biochemical parameters were collected. Electromyography/evoked potential instrument was performed for nerve conduction study. Optical coherence tomography was performed to measure the RNFL thickness of the optic disc. Color Doppler ultrasound was performed to measure CSA of lower limb nerves. RESULTS The RNFL thickness was lower and the CSA of the tibial nerve (TN) in the DPN group was larger than that in the NDPN group. The album/urine creatinine ratio, diabetic retinopathy, and CSA of TN at 3 cm were positively correlated with DPN. The RNFL thickness in the superior quadrant of the optic disc was negatively correlated with DPN. For RNFL thickness to diagnose DPN, the area under the curve (AUC) of the superior quadrant was the largest, which was 0.723 (95% confidence interval [CI]: 0.645-0.805), and the best cutoff value was 127.5 μm (70.5% sensitivity, 72.1% specificity). For CSA of TN to diagnose DPN, the AUC of the distance of 5 cm was the largest, which was 0.660 (95% CI: 0.575-0.739), and the best cutoff value was 13.50 mm2 (82.0% sensitivity, 41.6% specificity). For the combined index, the AUC was greater than that of the above two indicators, which was 0.755 (95% CI: 0.664-0.846), and the best cutoff value was 0.376 (64.3% sensitivity, 83.0% specificity). CONCLUSIONS Patients with DPN have a reduction of the RNFL thickness and an increase in the CSA of TN, and these two changes are related to DPN. The RNFL thickness of the optic disc and the CSA of TN can be used as diagnostic indicators of DPN, and the combination of the two indicators has a higher diagnostic value.
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Affiliation(s)
- Weimiao Chen
- Department of Clinical Nutrition, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- *Correspondence: Xiahong Lin, ; ; Weimiao Chen,
| | - Xiaohong Wu
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Shilin Li
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yan Zhang
- Department of Ophthalmology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yinqiong Huang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yong Zhuang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xuefeng Bai
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xiaoyu Chen
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xiahong Lin
- Department of Endocrinology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
- Department of Geriatric Medicine, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
- *Correspondence: Xiahong Lin, ; ; Weimiao Chen,
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Hannaford A, Vucic S, Kiernan MC, Simon NG. Review Article "Spotlight on Ultrasonography in the Diagnosis of Peripheral Nerve Disease: The Evidence to Date". Int J Gen Med 2021; 14:4579-4604. [PMID: 34429642 PMCID: PMC8378935 DOI: 10.2147/ijgm.s295851] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Neuromuscular ultrasound is rapidly becoming incorporated into clinical practice as a standard tool in the assessment of peripheral nerve diseases. Ultrasound complements clinical phenotyping and electrodiagnostic evaluation, providing critical structural anatomical information to enhance diagnosis and identify structural pathology. This review article examines the evidence supporting neuromuscular ultrasound in the diagnosis of compressive mononeuropathies, traumatic nerve injury, generalised peripheral neuropathy and motor neuron disease. Extending the sonographic evaluation of nerves beyond simple morphological measurements has the potential to improve diagnostics in peripheral neuropathy, as well as advancing the understanding of pathological mechanisms, which in turn will promote precise therapies and improve therapeutic outcomes.
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Affiliation(s)
- Andrew Hannaford
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Steve Vucic
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Neil G Simon
- Northern Beaches Clinical School, Macquarie University, Sydney, Australia
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Mahran SA, Galluccio F, Khedr TM, Elsonbaty A, Allam AES, Garcia Martos A, Osman DMM, Matucci-Cerinic M, Guiducci S, Galal MAA. Peripheral neuropathy in systemic lupus erythematosus: what can neuromuscular ultrasonography (NMUS) tell us? A cross-sectional study. Lupus Sci Med 2021; 8:e000521. [PMID: 34312211 PMCID: PMC8314698 DOI: 10.1136/lupus-2021-000521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate peripheral nerve involvement in patients with SLE with neuromuscular ultrasonography (NMUS) and understand its role in investigating SLE-related peripheral neuropathy. METHODS This is an observational cross-sectional study on patients with SLE and healthy controls. Five nerves in each patient were examined bilaterally with NMUS, and the cross-sectional area (CSA) of each nerve at certain sites was estimated. The mean CSA at each site, for each nerve, in each group was statistically analysed and compared between groups. RESULTS 370 nerves were evaluated in 37 patients. By nerve conduction study (NCS), 36 patients had polyneuropathy (80.6% mixed type, 19.4% sensory). Significant mean CSA enlargement was present among the ulnar nerve at the Guyon's canal and mid-humerus (both p=0.001); tibial nerve at the distal leg and proximal to the tarsal tunnel (p=0.003 and p=0.001, respectively); and peroneal nerve at the popliteal fossa (p=0.042). The mean CSA showed high specificity compared with NCS. CONCLUSION Our study shows that CSA could be a complementary tool to NCS for studying peripheral neuropathy in SLE. Furthermore, NMUS provides data on the different pathophysiological aspects of nerve involvement in SLE. Future studies using more than one sonographic parameter in combination with NCS and nerve histopathology are recommended to further investigate SLE-related neuropathy.Trial registration number NCT04527172.
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Affiliation(s)
- Safaa A Mahran
- Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University, Assiut, Egypt
| | - Felice Galluccio
- Medical-Geriatric Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
- MoMaRC Morphological Madrid Research Center, Ultradissection group, Madrid, Spain
| | - Tayseer Mohamed Khedr
- Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University, Assiut, Egypt
| | - Amira Elsonbaty
- Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University, Assiut, Egypt
| | - Abdallah El-Sayed Allam
- MoMaRC Morphological Madrid Research Center, Ultradissection group, Madrid, Spain
- Department of Physical Medicine, Rheumatology and Rehabilitation, Tanta University Faculty of Medicine, Tanta, Egypt
| | | | - Doaa M M Osman
- Department of Public Health and Community, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Serena Guiducci
- Medical-Geriatric Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Marwa A A Galal
- Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University, Assiut, Egypt
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Abstract
We herein report a 73-year-old woman case with sarcoid neuropathy showing nerve enlargement assessed by nerve ultrasound both before and after treatment. The site of conduction block in the left tibial nerve corresponded to the site of nerve enlargement with a hypo-echoic pattern. After treatment with prednisolone, nerve ultrasound detected the remission of the nerve enlargement, and the conduction block and clinical symptoms also improved. Nerve enlargement may reflect inflammation of the peripheral nerve. A follow-up study of sonographic nerve enlargement may be of clinical significance for assessing the effectiveness of treatment for sarcoid neuropathy.
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Affiliation(s)
- Takamasa Kitaoji
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yukiko Tsuji
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Shinji Ashida
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Akihiro Tanaka
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Toshiki Mizuno
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
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Applicability of High-Frequency Ultrasound to the Early Diagnosis of Diabetic Peripheral Neuropathy. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5529063. [PMID: 33829060 PMCID: PMC8004362 DOI: 10.1155/2021/5529063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022]
Abstract
This study investigated the applicability of high-frequency ultrasound (HFU) to the early diagnosis of diabetic peripheral neuropathy (DPN). Patients with type 2 diabetes (N = 60) were divided into diabetic nonperipheral neuropathy and DPN groups (group A and group B, respectively; n = 30 each) based on electroneurophysiologic findings. Additionally, 30 nondiabetic patients were included as the healthy control group (group C). We calculated the cross-sectional area (CSA) of the median nerve (MN) of the right upper limb at 7 different sites (MN1–7) based on measured width (W) and thickness (T). Ultrasound imaging characteristics of the MN including internal echo, internal structure, boundary, epineurium, and blood flow were recorded. The 90 subjects (51 male and 39 female) had an average age of 56.09 ± 12.66 years. W, T, and CSA of the MN were increased in group A compared to group C (with significant differences at MN1, MN4, and MN7 (P < 0.05)) and in group B compared to group C (with significant differences at all 7 levels, especially MN6 and MN7 (P < 0.05)). Receiver operating characteristic curve analysis showed that CSA at the MN7 level had the highest diagnostic accuracy for DPN in group B, with a threshold value of 12.42 mm2. Ultrasound examination revealed that the MN had lost the internal sieve mesh structure and showed reduced echo, a partial blood flow signal, and thickened epineurium in patients with DPN; these findings were particularly obvious at MN6 and MN7, corresponding to the carpal tunnel. CSA was positively correlated with motor latency and F wave average latency and negatively correlated with motor conduction velocity, motor amplitude, and sensory conduction velocity in group B. Thus, HFU may be useful for the early diagnosis of DPN, which can improve clinical outcomes.
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Advances in imaging technologies for the assessment of peripheral neuropathies in rheumatoid arthritis. Rheumatol Int 2021; 41:519-528. [PMID: 33427917 DOI: 10.1007/s00296-020-04780-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/26/2020] [Indexed: 12/22/2022]
Abstract
Peripheral neuropathy in patients with rheumatoid arthritis is associated with a maladaptive autoimmune response that may cause chronic pain and disability. Nerve conduction studies are the routine method performed when rheumatologists presume its presence. However, this approach is invasive, may not reveal subtle malfunctions in the early stages of the disease, and does not expose abnormalities in structures surrounding the nerves and muscles, limiting the possibility of a timely diagnosis. This work aims to present a narrative review of new technologies for the clinical assessment of peripheral neuropathy in Rheumatoid Arthritis. Through a bibliographic search carried out in five repositories, from 1990 to 2020, we identified three technologies that could detect peripheral nerve lesions and perform quantitative evaluations: (1) magnetic resonance neurography, (2) functional magnetic resonance imaging, and (3) high-resolution ultrasonography of peripheral nerves. We found these tools can overcome the main constraints imposed by the previous electrophysiologic methods, enabling early diagnosis.
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Ultrasound-guided platelet-rich plasma injection and multimodality ultrasound examination of peripheral nerve crush injury. NPJ Regen Med 2020; 5:21. [PMID: 33298932 PMCID: PMC7680141 DOI: 10.1038/s41536-020-00101-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/28/2020] [Indexed: 02/06/2023] Open
Abstract
Ultrasound-guided platelet-rich plasma (PRP) injection is able to make up for the limitations of applying a single growth factor. The goal of this study was to investigate the effects of serial ultrasound-guided PRP injections of the appropriate concentration on the treatment of sciatic nerve crush injury, and explore the value of multimodality ultrasound techniques in evaluating the prognosis of crushed peripheral nerve. In vitro, optimal concentration of PRP (from 150%, 250%, 450%, and 650%) was screened due for its maximal effect on proliferation and neurotrophic function of Schwann cells (SCs). In vivo, ninety rabbits were equally and randomly divided into normal control, model, PRP-2.5×, PRP-4.5×, and PRP-6.5× groups. The neurological function and electrophysiological recovery evaluation, and the comparison of the multimodality ultrasound evaluation with the histological results of sciatic nerve crush injury were performed to investigate the regenerative effects of PRP at different concentrations on the sciatic nerve crush injury. Our results showed that the PRP with a 4.5-fold concentration of whole blood platelets could significantly stimulate the proliferation and secretion of SCs and nerve repair. The changes in stiffness and blood perfusion were positively correlated with the collagen area percentage and VEGF expression in the injured nerve, respectively. Thus, serial ultrasound-guided PRP injections at an appropriate concentration accelerates the recovery of axonal function. Multimodality ultrasound techniques provide a clinical reference for prognosis by allowing the stiffness and microcirculation perfusion of crush-injured peripheral nerves to be quantitatively evaluated.
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Kojima Y, Noto YI, Tsuji Y, Kitani-Morii F, Shiga K, Mizuno T, Nakagawa M. Charcot-Marie-Tooth disease type 1A: Longitudinal change in nerve ultrasound parameters. Muscle Nerve 2020; 62:722-727. [PMID: 32959396 DOI: 10.1002/mus.27068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to elucidate the longitudinal changes in nerve ultrasound parameters of adult Charcot-Marie-Tooth disease type 1A (CMT1A) patients. METHODS Fifteen adult patients with CMT1A prospectively underwent nerve ultrasound and clinical assessment (CMT neuropathy score [CMTNS]) at baseline and 5 y later. Nerve cross-sectional area (CSA) and echogenicity were measured in the median and sural nerves. Changes in ultrasound parameters and CMTNS and correlation between changes of ultrasound parameters and CMTNS were analyzed. RESULTS Median and sural nerve CSAs did not change over 5 y, although CMTNS increased (P < .01). Nerve echogenicity in the sural nerve decreased over 5 y (P = .045). No correlations between changes in nerve ultrasound parameters and CMTNS were identified. CONCLUSIONS No longitudinal changes in nerve size was detected in adult CMT1A. Exploring the factors that determine nerve size in childhood CMT1A may lead to the development of treatments.
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Affiliation(s)
- Yuta Kojima
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yukiko Tsuji
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fukiko Kitani-Morii
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kensuke Shiga
- Department of Neurology, Matsushita Memorial Hospital, Osaka, Japan
| | - Toshiki Mizuno
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masanori Nakagawa
- North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Gupta S, Ghatak S, Hery T, Khanna S, El Masry M, Sundaresan VB, Sen CK. Ad hoc hybrid synaptic junctions to detect nerve stimulation and its application to detect onset of diabetic polyneuropathy. Biosens Bioelectron 2020; 169:112618. [PMID: 33007616 DOI: 10.1016/j.bios.2020.112618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/21/2020] [Accepted: 09/14/2020] [Indexed: 01/05/2023]
Abstract
We report a minimally invasive, synaptic transistor-based construct to monitor in vivo neuronal activity via a longitudinal study in mice and use depolarization time from measured data to predict the onset of polyneuropathy. The synaptic transistor is a three-terminal device in which ionic coupling between pre- and post-synaptic electrodes provides a framework for sensing low-power (sub μW) and high-bandwidth (0.1-0.5 kHz) ionic currents. A validated first principles-based approach is discussed to demonstrate the significance of this sensing framework and we introduce a metric, referred to as synaptic efficiency to quantify structural and functional properties of the electrodes in sensing. The application of this framework for in vivo neuronal sensing requires a post-synaptic electrode and its reference electrode and the tissue becomes the pre-synaptic signal. The ionic coupling resembles axo-axonic junction and hence we refer to this framework as an ad hoc synaptic junction. We demonstrate that this arrangement can be applied to measure excitability of sciatic nerves due to a stimulation of the footpad in cohorts of m+/db and db/db mice for detecting loss in sensitivity and onset of polyneuropathy. The signal attributes were subsequently integrated with machine learning-based framework to identify the probability of polyneuropathy and to detect the onset of diabetic polyneuropathy.
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Affiliation(s)
- Sujasha Gupta
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, 43220, USA
| | - Subhadip Ghatak
- Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Travis Hery
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, 43220, USA
| | - Savita Khanna
- Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Mohamed El Masry
- Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, 46202, USA; Plastic and Reconstructive Surgery Department, Zagazig University, 44519, Egypt
| | - Vishnu Baba Sundaresan
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, 43220, USA.
| | - Chandan K Sen
- Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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Strakowski JA, Chiou-Tan FY. Musculoskeletal ultrasound for traumatic and torsional alterations. Muscle Nerve 2020; 62:654-663. [PMID: 32696511 DOI: 10.1002/mus.27025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/10/2020] [Accepted: 07/19/2020] [Indexed: 12/20/2022]
Abstract
The sonographic appearance of soft tissue can be altered by trauma and positional change with torsional stress. This creates challenges for ultrasonographic interpretation, because most descriptive literature and standard instructional references are displayed in anatomically neutral or other conventional positions. Knowledge of anatomic alteration and changes in sonographic appearance with torsional stress is essential for accurately assessing soft tissue abnormalities in conditions of spasticity, traumatic and post-surgical changes, and other conditions that distort musculoskeletal relationships. A systematic scanning approach to these alterations is needed for accurate diagnostic interpretation, optimizing electrode placement for electrodiagnostic techniques, effective needle placement for therapeutic ultrasound-guided procedures, and even planning for restorative surgery. This review describes expected positional changes of normal structures with torsional alteration, as well as sonographic recognition of scars, burns, hematomas, fat layer fracture, Morel-Lavallee lesions, abscesses, foreign bodies, myotendinous lesions, muscle injury and denervation, and traumatic peripheral nerve injury.
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Affiliation(s)
- Jeffry A Strakowski
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Faye Y Chiou-Tan
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
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46
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Berciano J. Axonal degeneration in Guillain-Barré syndrome: a reappraisal. J Neurol 2020; 268:3728-3743. [PMID: 32607643 DOI: 10.1007/s00415-020-10034-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/28/2022]
Abstract
The aim of this review was to analyse the pathophysiology of axonal degeneration in Guillain-Barré syndrome (GBS) with emphasis on early stages (≤ 10 days after onset). An overview of experimental autoimmune neuritis (EAN) models is provided. Originally GBS and acute inflammatory demyelinating polyneuropathy were equated, presence of axonal degeneration being attributed to a "bystander" effect. Afterwards, primary axonal GBS forms were reported, designated as acute motor axonal neuropathy/acute motor-sensory axonal neuropathy. Revision of the first pathological description of axonal GBS indicates the coexistence of active axonal degeneration and demyelination in spinal roots, and pure Wallerian-like degeneration in peripheral nerve trunks. Nerve conduction studies are essential for syndrome subtyping, though their sensitivity is scanty in early GBS. Serum markers of axonal degeneration include increased levels of neurofilament light chain and presence of anti-ganglioside reactivity. According to nerve ultrasonographic features and autopsy studies, ventral rami of spinal nerves are a hotspot in early GBS. In P2-induced EAN models, the initial pathogenic change is inflammatory oedema of spinal roots and sciatic nerve, which is followed by demyelination, and Wallerian-like degeneration in nerve trunks possessing epi-perineurium; a critical elevation of endoneurial fluid pressure is a pre-requisite for inducing ischemic axonal degeneration. Similar lesion topography may occur in GBS. The repairing role of adaxonal Schwann cytoplasm in axonal degeneration is analysed. A novel pathophysiological mechanism for nerve trunk pain in GBS, including pure motor forms, is provided. The potential therapeutic role of intravenous boluses of methylprednisolone for early severe GBS and intractable pain is argued.
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Affiliation(s)
- José Berciano
- Professor Emeritus of Neurology, Service of Neurology, University Hospital "Marqués de Valdecilla (IDIVAL)", "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", University of Cantabria, Santander, Spain.
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Carroll AS, Simon NG. Current and future applications of ultrasound imaging in peripheral nerve disorders. World J Radiol 2020; 12:101-129. [PMID: 32742576 PMCID: PMC7364285 DOI: 10.4329/wjr.v12.i6.101] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/10/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
Neuromuscular ultrasound (NMUS) is a rapidly evolving technique used in neuromuscular medicine to provide complimentary information to standard electrodiagnostic studies. NMUS provides a dynamic, real time assessment of anatomy which can alter both diagnostic and management pathways in peripheral nerve disorders. This review describes the current and future techniques used in NMUS and details the applications and developments in the diagnosis and monitoring of compressive, hereditary, immune-mediated and axonal peripheral nerve disorders, and motor neuron diseases. Technological advances have allowed the increased utilisation of ultrasound for management of peripheral nerve disorders; however, several practical considerations need to be taken into account to facilitate the widespread uptake of this technique.
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Affiliation(s)
- Antonia S Carroll
- Brain and Mind Research Centre, University of Sydney, Camperdown 2050, NSW, Australia
- Department of Neurology, Westmead Hospital, University of Sydney, Westmead 2145, NSW, Australia
- Department of Neurology, St Vincent’s Hospital, Sydney, Darlinghurst 2010, NSW, Australia
| | - Neil G Simon
- Northern Clinical School, University of Sydney, Frenchs Forest 2086, NSW, Australia
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Niu J, Zhang L, Ding Q, Liu J, Zhang Z, Cui L, Liu M. Vagus Nerve Ultrasound in Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Charcot-Marie-Tooth Disease Type 1A. J Neuroimaging 2020; 30:910-916. [PMID: 32592620 DOI: 10.1111/jon.12747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Both clinical autonomic dysfunction and involvement of autonomic nerves have been reported in a range of peripheral nerve disorders. We employed nerve ultrasound to assess the size of the vagus nerve in a serial study of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and Charcot-Marie-Tooth type 1B (CMT1B) as compared to healthy controls (HCs). We correlated these findings with involvement of the median and ulnar nerves. METHODS Forty-three patients with CIDP, 8 with CMT1A, and 105 HC were prospectively recruited. The cross-sectional areas (CSAs) of the vagus, median, and ulnar nerves were measured bilaterally. The alteration of CSA of those nerves was followed longitudinally in CIDP. RESULTS The median (range) CSA of the vagus nerve was 2 (1-28) mm2 in CIDP, 3 (2-6) mm2 in CMT1A, and 1 (1-2) mm2 in HC. The vagus nerve CSA was positively correlated with the maximum CSA of median/ulnar nerve in CIDP and CMT1A. The alteration in vagus nerve CSA was positively correlated with the alteration in mean median/ulnar nerve CSA in CIDP during follow-up. CONCLUSIONS The vagus nerve was involved to a similar extent as the median and ulnar nerves in CIDP and CMT1A, although no symptoms or signs of vagus nerve involvement were found. Further study should be performed to explore the clinical relevance of vagus nerve enlargement in these disorders.
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Affiliation(s)
- Jingwen Niu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingyun Ding
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingwen Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhe Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Liu X, Zhou H, Wang Z, Liu X, Li X, Nie C, Li Y. WITHDRAWN: Efficacy of High-frequency Ultrasound Image Information Diagnosis on Neurological-abnormality in Patients with Type-2-diabetes Combined with Peripheral- neuropathy. Neurosci Lett 2020:135205. [PMID: 32590043 DOI: 10.1016/j.neulet.2020.135205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022]
Abstract
This article has been withdrawn at the request of the Editor-in-Chief. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Xiaoqiang Liu
- Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian City, 116027, Liaoning Province, China
| | - Hongyan Zhou
- Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian City, 116027, Liaoning Province, China
| | - Zhaoyun Wang
- Department of Wound repair, The Second Hospital of Dalian Medical University, Dalian City, 116027, Liaoning Province, China
| | - Xiaoli Liu
- Department of Respiratory, The Second Hospital of Dalian Medical University, Dalian City, 116027, Liaoning Province, China
| | - Xin Li
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian City, 116027, Liaoning Province, China
| | - Chen Nie
- Department of Neurology, The Second Hospital of Dalian Medical University, Dalian City, 116027, Liaoning Province, China
| | - Yang Li
- Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian City, 116027, Liaoning Province, China.
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Heinen C, Dömer P, Schmidt T, Kewitz B, Janssen-Bienhold U, Kretschmer T. Fascicular Ratio Pilot Study: High-Resolution Neurosonography-A Possible Tool for Quantitative Assessment of Traumatic Peripheral Nerve Lesions Before and After Nerve Surgery. Neurosurgery 2020; 85:415-422. [PMID: 30107513 DOI: 10.1093/neuros/nyy355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 07/11/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clinical and electrophysiological assessments prevail in evaluation of traumatic nerve lesions and their regeneration following nerve surgery in humans. Recently, high-resolution neurosonography (HRNS) and magnetic resonance neurography have gained significant importance in peripheral nerve imaging. The use of the grey-scale-based "fascicular ratio" (FR) was established using both modalities allowing for quantitative assessment. OBJECTIVE To find out whether FR using HRNS can assess nerve trauma and structural reorganization in correlation to postoperative clinical development. METHODS Retrospectively, 16 patients with operated traumatic peripheral nerve lesions were included. The control group consisted of 6 healthy volunteers. All imaging was performed with a 15 to 6 MHz ultrasound probe (SonoSite X-Porte; Fujifilm, Tokyo, Japan). FR was calculated using Fiji () on 8-bit-images ("MaxEntropy" using "Auto-Threshold" plug-in). RESULTS Thirteen of 16 patients required autologous nerve grafting and 3 of 16 extra-intraneural neurolysis. There was no statistical difference between the FR of nonaffected patients' nerve portion with 43.48% and controls with FR 48.12%. The neuromatous nerve portion in grafted patients differed significantly with 85.05%. Postoperatively, FR values returned to normal with a mean of 39.33%. In the neurolyzed patients, FR in the affected portion was 78.54%. After neurolysis, FR returned to healthy values (50.79%). Ten of 16 patients showed clinical reinnervation. CONCLUSION To our best knowledge, this is the first description of FR using HRNS for quantitative assessment of nerve damage and postoperative structural reorganization. Our results show a significant difference in healthy vs lesioned nerves and a change in recovering nerve portions towards a more "physiological" ratio. Further evaluation in larger patient groups is required.
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Affiliation(s)
- Christian Heinen
- Department of Neurosurgery, Evangelisches Krankenhaus, Campus Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Patrick Dömer
- Department of Neurosciences, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Thomas Schmidt
- Department of Neurosurgery, Evangelisches Krankenhaus, Campus Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Bettina Kewitz
- Department of Neurosciences, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Ulrike Janssen-Bienhold
- Department of Neurosciences, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Thomas Kretschmer
- Department of Neurosurgery, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
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