Diffusion Tensor Imaging in Chronic Inflammatory Demyelinating Polyneuropathy

Kronlage, Moritz; Pitarokoili, Kalliopi; Schwarz, Dániel; Godel, Tim; Heiland, Sabine; Yoon, Min‐Suk; Bendszus, Martin; Bäumer, Philipp

doi:10.1097/rli.0000000000000394

Cited by 78 publications

(99 citation statements)

References 41 publications

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“…Inflammation and edema can lead to an increased ADC value. As expected, the TN and CPN of GBS patients showed a significant decrease in FA and an increase in ADC values, which were consistent with the results of Breckwoldt et al, Wu et al, and Kronlage et al The AD value provides information about the integrity of axons. Haakma et al concluded that the decreases in AD values were associated with axonal degeneration.…”

Section: Discussionsupporting

confidence: 91%

“…The axial diffusion coefficient (AD) and radial diffusion coefficient (RD) values mean the eigenvalues when water diffuses along and perpendicular to the long axis of the fiber bundle, respectively. These two parameters were also used in recent studies to detect the functional changes in peripheral nerves …”

mentioning

confidence: 99%

“…These two parameters were also used in recent studies to detect the functional changes in peripheral nerves. 8,10,11 There has been recent interest in using DTI to evaluate peripheral nerves. [12][13][14][15][16][17] Skorpil et al demonstrated the feasibility of DTI in MRN imaging.…”

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confidence: 99%

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Diffusion Tensor Imaging of Tibial and Common Peroneal Nerves in Patients With Guillain–Barre Syndrome: A Feasibility Study

Cao

Wang

et al. 2018

Magnetic Resonance Imaging

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Background The development of a noninvasive, objective, and accurate method to assess peripheral nerve disorders in Guillain–Barre syndrome (GBS) is of clinical significance. Diffusion tensor imaging (DTI) has been used to evaluate some peripheral nerve disorders. Purpose To investigate the feasibility of DTI in evaluating the peripheral nerve disorders in patients with GBS. Study Type Case control. Subjects Twenty GBS patients and 16 healthy volunteers. Field Strength/Sequence 3.0T, T1WI‐SE, T2WI‐SPAIR, DTI; electrophysiology. Assessment MRI data were analyzed by two radiologists blindly and independently. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusion coefficient (AD), and radial diffusion coefficient (RD) values of tibial nerve (TN) and common peroneal nerve (CPN) were recorded. Motor nerve conduction velocity (MCV) and motor nerve conduction amplitude of TN and CPN were recorded. Statistical Tests Intraclass correlation coefficient (ICC), t‐test, receiver‐operating characteristic (ROC), and area under the curve (AUC) analysis, Pearson correlation coefficient. Results The FA and AD values of TN and CPN in the GBS group were significantly lower and the ADC and RD values were higher than those in the controls (P <0.05). The AUC of the FA values (0.970 for TN and 0.927 for CPN) were higher than that of the ADC, AD, and RD values. FA and AD values were positively correlated and ADC, RD values were negatively correlated with MCV and motor nerve conduction amplitude, respectively (P <0.05). The correlations between FA value and electrophysiology parameters were the highest. Data Conclusion DTI quantitative parameters could evaluate the disorders of peripheral nerves in patients with GBS. A moderate correlation was observed between DTI and electrophysiology parameters. Level of Evidence: 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:1356–1364.

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

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Diffusion Tensor Imaging of Tibial and Common Peroneal Nerves in Patients With Guillain–Barre Syndrome: A Feasibility Study

Cao

Wang

et al. 2018

Magnetic Resonance Imaging

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“…Still, electrophysiological data are a prerequisite to diagnose CIDP and diagnosis cannot be based on HRUS data. However, different opinions about the suitability of NCS for patient follow‐up were described previously . Progression of disease can be approached by NCS by showing deterioration of myelination or secondary axonal loss.…”

Section: Discussionmentioning

confidence: 99%

“…However, different opinions about the suitability of NCS for patient follow-up were described previously. [27][28][29] Progression of disease can be approached by NCS by showing deterioration of myelination or secondary axonal loss. In our study, we found significant changes of NCS parameters in progressive CIDP only for a decrease of the CMAP amplitudes of the tibial and median nerve at a few time points.…”

Section: Discussionmentioning

confidence: 99%

Clinical, Sonographic, and Electrophysiologic Longitudinal Features of Chronic Inflammatory Demyelinating Polyneuropathy

Fisse

Pitarokoili

Trampe

et al. 2018

Journal of Neuroimaging

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BACKGROUND AND PURPOSE Several studies have aimed to find potential biomarkers to simplify the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) and to monitor and predict the disease course. However, reliable markers are still lacking. We aimed to investigate whether high‐resolution nerve ultrasound (HRUS) is suitable for monitoring the long‐term clinical course of CIDP. METHODS Twenty patients fulfilling the definite diagnostic criteria of CIDP received clinical examination, evaluation of the INCAT (inflammatory neuropathy cause and treatment) overall disability sum score (ODSS) as well as nerve conduction studies, and HRUS every 6 months over a median follow‐up time of 34 months. Patients were divided into clinically stable/regressive disease course or progressive disease course according to the development of the ODSS. RESULTS The intranerve cross‐sectional‐area (CSA) variability of the nerves of the lower extremity increased with disease progression, whereas it remained unchanged in patients with a stable or remitting disease course. CONCLUSION Nerve ultrasound can be used as a method to objectify the long‐term disease course in CIDP patients. The intranerve CSA variability is suitable for monitoring the clinical course of patients with CIDP.

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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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Diffusion Tensor Imaging in Chronic Inflammatory Demyelinating Polyneuropathy

Abstract: Diffusion tensor imaging yields valid quantitative biomarkers in CIDP and might aid in diagnosis with high diagnostic accuracy. Fractional anisotropy and RD may serve as parameters of myelin sheath integrity, but AD is unable to reflect axonal damage in CIDP.

Cited by 78 publications

References 41 publications

Diffusion Tensor Imaging of Tibial and Common Peroneal Nerves in Patients With Guillain–Barre Syndrome: A Feasibility Study

Diffusion Tensor Imaging of Tibial and Common Peroneal Nerves in Patients With Guillain–Barre Syndrome: A Feasibility Study

Clinical, Sonographic, and Electrophysiologic Longitudinal Features of Chronic Inflammatory Demyelinating Polyneuropathy

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

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