A comparative study of brachial plexus sonography and magnetic resonance imaging in chronic inflammatory demyelinating neuropathy and multifocal motor neuropathy

Goedee, H. Stephan; Jongbloed, Bas A.; Asseldonk, J.T.H. van; Hendrikse, Jeroen; Vrancken, Alexander F.J.E.; Franssen, Hessel; Nikolakopoulos, Stavros; Visser, Leo H.; Pol, W. Ludo van der; Berg, Leonard H van den

doi:10.1111/ene.13380

Cited by 55 publications

(52 citation statements)

References 40 publications

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“…Brachial plexus MRIs were abnormal in 35–63% of MMN patients in previous studies, and in 69% of patients in our study. This difference may be explained by an improvement in MRI technique, by the fact that the MRI examinations were read by an experienced and unblinded radiologist, and because nearly half of our patients fulfilled the diagnostic criteria for definite MMN.…”

Section: Discussionsupporting

confidence: 64%

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Comparison of MRI and motor evoked potential with triple stimulation technique for the detection of brachial plexus abnormalities in multifocal motor neuropathy

et al. 2019

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Background Conduction blocks (CB) are the diagnostic hallmark of multifocal motor neuropathy (MMN). Conventional nerve conduction studies cannot detect CB above Erb's point. Our purpose was to compare the performance of the motor evoked potential with triple stimulation technique (MEP‐TST) and MRI in the detection of abnormalities of the brachial plexus. Methods Examinations were performed on 26 patients with MMN (11 definite, 6 probable, 9 possible), of whom 7 had no CB. Results MEP‐TST detected proximal CB in 19/26 patients. Plexus MRI showed T2 hyperintensity in 18/26 patients, with nerve enlargement in 14/18. A combination of both techniques increased the detection rate of brachial plexus abnormalities to 96% of patients (25/26). Conclusions MEP‐TST and MRI have high sensitivities for detecting brachial plexus abnormalities. A combination of the two techniques increases the detection rate of supportive criteria for the diagnosis of MMN.

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Section: Discussionsupporting

confidence: 64%

“…Brachial plexus MRI scans may show nerve enlargement or an increased signal intensity on T2‐weighted imaging. Few studies have focused on the importance of brachial plexus MRI in the diagnosis of MMN, and brachial plexus MRI scans have not been compared with MEP‐TST results in the context of MMN diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Comparison of MRI and motor evoked potential with triple stimulation technique for the detection of brachial plexus abnormalities in multifocal motor neuropathy

et al. 2019

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“…Neuroimaging is included in the supportive criteria for the diagnosis of CIDP, and is gaining increasing role in the diagnostic workup of neuropathies . Ultrasound, being easily accessible, non‐invasive and reproducible, is often used in CIDP, also in light of its diagnostic power in inflammatory neuropathies also when compared with MRI . Peculiar US patterns in some demyelinating hereditary neuropathies (diffuse homogeneous increase of CSA in the entire length of the nerves), clearly different from those found in typical CIDP, proved to be useful in our cohort (patients #4, 5) suggesting the correct diagnosis.…”

Section: Discussionmentioning

confidence: 90%

“…Overlap syndromes should be considered especially in those CMT patients with acute/subacute deterioration or proximal involvement. Exposition of unusual epitopes or the co‐activation of inflammatory pathways might play a role when hereditary neuropathies and inflammatory processes concur …”

Section: Discussionmentioning

confidence: 99%

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Sporadic hereditary neuropathies misdiagnosed as chronic inflammatory demyelinating polyradiculoneuropathy: Pitfalls and red flags

Campagnolo

Taioli

Cacciavillani³

et al. 2020

J Peripheral Nervous Sys

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Hereditary neuropathies may be misdiagnosed with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). A correct diagnosis is crucial for avoiding unnecessary therapies and access genetic counseling. We report on nine patients (seven men, mean age 49.2 ± 16.1) diagnosed with and treated as CIDP, in whom mutations or variants of unknown significance (VUS) in genes associated with hereditary neuropathies were reported. All underwent neurological and neurophysiological examination, eight also cerebrospinal fluid (CSF) analysis. In 4/9, nerve ultrasound and/or MR‐neurography were performed. All the patients complained of progressive upper or lower limbs sensory‐motor symptoms, with heterogeneous disease duration (1‐34 years, mean 8.6 ± 10.8). Neurophysiology showed demyelinating signs in seven patients, mixed findings with predominant axonal damage in two patients. Neuroimaging disclosed diffuse abnormalities at proximal and distal segments. Molecular screening showed PMP22 duplication in two patients, mutations in the MPZ, EGR2, and GJB1 genes were reported in each of the remaining patients. The two patients with mixed neurophysiological findings had p.Val30Met mutation in the transthyretin gene. Two patients had VUS in the MARS and HSPB1 genes. Four patients had partial response to immunomodulant therapies, and CSF and neurophysiological features suggesting an inflammatory condition concomitant with the hereditary neuropathy. Hereditary neuropathy may be misdiagnosed with CIDP. The most common pitfalls are CSF (high protein levels and oligoclonal bands), incorrect interpretation of neurophysiology, and transient benefit from therapies. Neuroimaging may be helpful in cases with atypical presentations or when severe axonal damage complicate the neurophysiological interpretation.

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Quantitative magnetic resonance neurography in chronic inflammatory demyelinating polyradiculoneuropathy: A longitudinal study over 6 years

Preisner,

Pitarokoili,

Lueling

et al. 2023

Ann Clin Transl Neurol

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ObjectiveTo evaluate magnetic resonance neurography (MRN) for the longitudinal assessment of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).MethodsProspective examination of twelve CIDP patients by neurological assessment, MRN, and nerve conduction studies in 2016 and 6 years later in 2022. Imaging parameters were compared with matched healthy controls and correlated with clinical and electrophysiological markers. The MRN protocol included T2‐weighted imaging, diffusion tensor imaging (DTI), T2 relaxometry, and magnetization transfer imaging (MTI).ResultsNerve cross‐sectional area (CSA) was increased in CIDP patients compared to controls (plexus: p = 0.003; sciatic nerve: p < 0.001). Over 6 years, nerve CSA decreased in CIDP patients, most pronounced at the lumbosacral plexus (p = 0.015). Longitudinally, changes in CSA correlated with changes in the inflammatory neuropathy cause and treatment validated overall disability sum score (INCAT/ODSS) (p = 0.006). High initial nerve CSA was inversely correlated with changes in the INCAT/ODSS over 6 years (p < 0.05). The DTI parameter fractional anisotropy (FA) showed robust correlations with electrodiagnostic testing both cross‐sectionally and longitudinally (p < 0.05). MTI as a newly added imaging technique revealed a significantly reduced magnetization transfer ratio (MTR) in CIDP patients (p < 0.01), suggesting underlying changes in macromolecular tissue composition, and correlated significantly with electrophysiological parameters of demyelination (p < 0.05).InterpretationThis study provides evidence that changes in nerve CSA and FA reflect the clinical and electrophysiological course of CIDP patients. Initial nerve hypertrophy might predict a rather benign course or better therapy response.

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A comparative study of brachial plexus sonography and magnetic resonance imaging in chronic inflammatory demyelinating neuropathy and multifocal motor neuropathy

Abstract: Brachial plexus sonography could complement MRI in the diagnostic work-up of patients with suspected CIDP and MMN. Our results indicate that combined imaging studies may add value to the current diagnostic consensus criteria for chronic inflammatory neuropathies.

Cited by 55 publications

References 40 publications

Comparison of MRI and motor evoked potential with triple stimulation technique for the detection of brachial plexus abnormalities in multifocal motor neuropathy

Comparison of MRI and motor evoked potential with triple stimulation technique for the detection of brachial plexus abnormalities in multifocal motor neuropathy

Sporadic hereditary neuropathies misdiagnosed as chronic inflammatory demyelinating polyradiculoneuropathy: Pitfalls and red flags

Quantitative magnetic resonance neurography in chronic inflammatory demyelinating polyradiculoneuropathy: A longitudinal study over 6 years

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