Contribution of ultrasound in the assessment of nerve diseases

Padua, Luca; Liotta, Giovanna; Pasquale, Antonella Di; Granata, Giuseppe; Pazzaglia, Costanza; Caliandro, Pietro; Martinoli, Carlo

doi:10.1111/j.1468-1331.2011.03421.x

Cited by 90 publications

(101 citation statements)

References 25 publications

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“…For entrapment syndromes-which are often bilateral-CSA was expressed in square millimeters (mm 2 ) and compared with reference values form the literature. 25 For tumors, CSA was also expressed in square millimeters. Color Doppler ultrasound scans were performed for suspected tumors.…”

Section: Ultrasonographymentioning

confidence: 99%

Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound?

Toia

Gagliardo

D’Arpa

et al. 2016

JNS

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Since its first description for the assessment of recurrent laryngeal nerve palsy, 30 ultrasound nerve imaging has become an established technique for the study of peripheral neuropathies. Several clinical studies have recently demonstrated its high sensitivity and specificity and validated its usefulness in the diagnostic and therapeutic process for focal and generalized peripheral neuropathies. 1,4,7,15,19,29 High-resolution ultrasound is a reliable tool for examining both the extraneural and the intraneural morphology of peripheral nerves. It allows evaluation of nerve continuity and shape and detection of nerve enlargements, comabbreviatioNs CMAP = compound muscle action potential; CSA = cross-sectional area; EMG = electromyography; LSD = least significant difference; MUAP = motor unit action potential; SNAP = sensory nerve action potential. obJeCtive The purpose of this study was to evaluate the usefulness of ultrasound in the preoperative workup of peripheral nerve lesions and illustrate how nerve ultrasonography can be integrated in routine clinical and neurophysiological evaluation and in the management of focal peripheral nerve injuries. The diagnostic role and therapeutic implications of ultrasonography for different neuropathies are described. methods The authors analyzed the use of ultrasound in 119 entrapment, tumoral, posttraumatic, or postsurgical nerve injuries of limbs evaluated in 108 patients during 2013 and 2014. All patients were candidates for surgery, and in all cases the evaluation included clinical examination, electrodiagnostic studies (nerve conduction study and electromyography), and ultrasound nerve study. Ultrasound was used to explore the nerve fascicular echo-texture, continuity, and surrounding tissues. The maximum cross-sectional area (CSA) and the presence of epineurial hyperechogenicity or intraneural hyper- or hypoechogenicity, of anatomical anomalies, dynamic nerve dislocations, or compressions were recorded. The concordance rate of neurophysiological and ultrasonographic data was analyzed, classifying ultrasound findings as confirming, contributive, or nonconfirming with respect to electrodiagnostic data. The correlation between maximum nerve CSA and neurophysiological severity degree in entrapment syndromes was statistically analyzed. results Ultrasonography confirmed electrodiagnostic findings in 36.1% of cases and showed a contributive role in the diagnosis and surgical planning in 53.8% of all cases; the findings were negative ("nonconfirming") in only 10.1% of the patients. In 16% of cases, ultrasound was not only contributive, but had a key diagnostic role in the presence of doubtful electrodiagnostic findings. The contributive role differed according to etiology, being higher for tumors (100%) and for posttraumatic or postsurgical neuropathies (72.2%) than for entrapment neuropathies (43.8%). CoNClusioNs Ultrasound is a powerful, noninvasive tool for the examination of peripheral nerve injuries, and can guide diagnosis of and surgical strategy for focal peripheral ne...

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Section: Ultrasonographymentioning

confidence: 99%

Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound?

Toia

Gagliardo

D’Arpa

et al. 2016

JNS

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“…[4][5][6][7][8][9][10][11][12][13][14][15] Ultrasound and MRI are the most commonly used methods for visualizing peripheral nerves. Ultrasonography of nerve lesions impacts management beyond the electrodiagnostic findings in as many as 43% of patients 16 and, by identifying nerve continuity, can change surgical decisions after traumatic neuropathies.17 MRI visualizes nerves, characterizes soft tissue structures when evaluating atypical sites of compression, identifies features of malignancy in peripheral nerve tumors, and provides information on the presence of muscle denervation and atrophy. 11,12,18 MRI can describe nerve lesions in areas that are difficult to localize using electrodiagnostic studies 8,19,20 or visualize using ultrasound.…”

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confidence: 99%

“…Depending on the specific clinical question, MRI or ultrasound can be a peripheral nerve imaging modality of choice. 4,6,16,21 In this retrospective study of 53 patients with clinical/pathologic diagnoses of From the …”

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confidence: 99%

Detection of peripheral nerve pathology

et al. 2013

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Objective: To compare accuracy of ultrasound and MRI for detecting focal peripheral nerve pathology, excluding idiopathic carpal or cubital tunnel syndromes.Methods: We performed a retrospective review of patients referred for neuromuscular ultrasound to identify patients who had ultrasound and MRI of the same limb for suspected brachial plexopathy or mononeuropathies, excluding carpal/cubital tunnel syndromes. Ultrasound and MRI results were compared to diagnoses determined by surgical or, if not performed, clinical/electrodiagnostic evaluation. Results:We identified 53 patients who had both ultrasound and MRI of whom 46 (87%) had nerve pathology diagnosed by surgical (n 5 39) or clinical/electrodiagnostic (n 5 14) evaluation. Ultrasound detected the diagnosed nerve pathology (true positive) more often than MRI (43/46 vs 31/46, p , 0.001). Nerve pathology was correctly excluded (true negative) with equal frequency by MRI and ultrasound (both 6/7). In 25% (13/53), ultrasound was accurate (true positive or true negative) when MRI was not. These pathologies were typically (10/13) long (.2 cm) and only occasionally (2/13) outside the MRI field of view. MRI missed multifocal pathology identified with ultrasound in 6 of 7 patients, often (5/7) because pathology was outside the MRI field of view.Conclusions: Imaging frequently detects peripheral nerve pathology and contributes to the differential diagnosis in patients with mononeuropathies and brachial plexopathies. Ultrasound is more sensitive than MRI (93% vs 67%), has equivalent specificity (86%), and better identifies multifocal lesions than MRI. In sonographically accessible regions ultrasound is the preferred initial imaging modality for anatomic evaluation of suspected peripheral nervous system lesions. Neurology â 2013;80: [1634][1635][1636][1637][1638][1639][1640] Nerve imaging augments patient management by providing information regarding lesion morphology, anatomic location, relationship of lesions to surrounding soft tissue, and evaluation of areas difficult to evaluate by electrodiagnostic testing. Imaging can also identify peripheral nerve lesions that are not apparent on electrodiagnostic testing. Types of peripheral nerve abnormalities suited to visualization by imaging include changes in nerve caliber, continuity, and echogenicity or magnetic resonance signal characteristics.1-3 Imaging can identify peripheral nerve tumors, traumatic neuromas, lacerations, entrapments with nerve damage, inflammation, demyelinating features, and infections. [4][5][6][7][8][9][10][11][12][13][14][15] Ultrasound and MRI are the most commonly used methods for visualizing peripheral nerves. Ultrasonography of nerve lesions impacts management beyond the electrodiagnostic findings in as many as 43% of patients 16 and, by identifying nerve continuity, can change surgical decisions after traumatic neuropathies.17 MRI visualizes nerves, characterizes soft tissue structures when evaluating atypical sites of compression, identifies features of malignancy in peripheral ner...

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“…Ölçüm yöntemlerinden olan SKA ise periferik sinirlerin görüntülenmesinde literatürde en sık karşılaşılan yöntem olarak göze çarpmak-tadır. 10 Tanı amacıyla USG kullanımının artması, normal sinir ölçüm değerlerinin saptanması ihtiyacını da doğurmuştur. Bu amaçla yapılan çalışmalar literatürde mevcuttur ve birçok faktörün sinir ölçüm sonuçlarıyla ilişkili olduğu saptanmıştır.…”

Section: Sonuçunclassified

“…[6][7][8][9] Sinir boyutu ölçümü için en sık tercih edilen metot sinir kesit alanı (SKA) nın ölçümüdür. 10 Üst ekstremite SKA ölçümlerinin normal değerleri ve yaş, cinsiyet, ırk, kilo, boy, beden kitle indeksi (BKİ) korelasyonu ile yapılmış pek çok çalışma mevcuttur.…”

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Ultrasonographic Evaluation of Dominant and Non-dominant Upper Extremity Nerve Cross Sectional Areas in Healthy Volunteers

Ökmen¹,

Ökmen²,

Altan³

2018

J PMR Sci

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Ö ÖZ ZE ET T A Am ma aç ç: : Yüksek çözünürlüklü ultrasonografi (USG) ile üst ekstremite periferik sinirlerin kesit alanlarının (SKA) dominant ekstremite ile ilişkisini saptamaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Doksan sekiz katılımcının bilateral medyan ve ulnar sinir SKA'ları ön kolda belirlenen ikişer noktadan ve üst kolda radyal SKA'ı belirlenen tek noktadan ölçüldü. Aynı zamanda SKA'ların hastanın yaşı, cinsiyeti, boy, kilosu ve beden kitle indeksi ile korelasyonlarına hem dominant hem de non-dominant ekstremiteden bakıldı. B Bu ul lg gu ul la ar r: : Bütün katılımcılar değerlendirildiğinde ölçüm noktalarında medyan, ulnar ve radyal SKA değerlerinde dominant ve non-dominant üst extremite arasında istatistiksel olarak anlamlı fark bulunmadı (p>0,05). Katılımcıların dominant taraf tüm ölçüm noktalarında SKA değerleri cinsiyet ve boy ile korele bulunur iken (p<0,05), non-dominant tarafta anlamlı bir korelasyon saptanmadı (p>0,05). Erkek katılımcılarda ise dominant ve non-dominant taraf arasında medyan ve ulnar SKA'nın her iki ölçüm noktasında da istatistiksel olarak anlamlı fark tespit edildi. S So on nu uç ç: : Ölçüm noktalarının ve tekniklerin standardize olmaması, var olabilecek asemptomatik hastalıkların varlığı, demografik verilere göre sinir çaplarındaki farklılıklar USG ile periferik sinir ölçümlerinde sınırlamalara yol açmaktadır. Ancak, sinir çapı ile hastalıkların tanısı konulmaya çalışılırken, erkeklerde fiziki kuvvet ile ça-lışmaya bağlı dominant ve non-dominant taraf arasında fark olabileceği mutlaka göz önünde bulundurulmalıdır.A An na ah ht ta ar r K Ke el li im me el le er r: : Yüksek çözünürlüklü ultrasonografi; sinir kesit alanı; periferik sinir; dominant A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The aim of this study was to determine the relationship between the cross-sectional areas (CSA) of the upper extremity peripheral nerves and the dominant extremity with high resolution ultrasonography (USG). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : In 98 participants, the bilateral median and ulnar nerve CSA were measured from the two points on the forearm and the radial CSA on the upper arm from a single point. At the same time, correlations of CSA with age, gender, height, weight and body mass index of the patients were evaluated both dominantly and non-dominantly. R Re es su ul lt ts s: : There was no statistically significant difference between dominant and non-dominant upper extremities in median, ulnar and radial CSA values at the measurement points when all participants were evaluated (p>0.05). CSA values were correlated with gender and height (p<0.05) at all dominant sides of the participants, but there was no significant correlation at the non-dominant side (p>0.05). In male participants, a statistically significant difference was found between both dominant and non-dominant sides of both median and ulnar CSA. C Co on nc cl lu us si io on n: : The lack of standardization of measurement points and techniques, the presence of possible as...

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Contribution of ultrasound in the assessment of nerve diseases

Abstract: US complements neurophysiological assessment even in routine practice, and this confirms the increasing interest in US for a multidimensional evaluation of peripheral nerve system diseases.

Cited by 90 publications

References 25 publications

Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound?

Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound?

Detection of peripheral nerve pathology

Ultrasonographic Evaluation of Dominant and Non-dominant Upper Extremity Nerve Cross Sectional Areas in Healthy Volunteers

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