Guidelines for neuromuscular ultrasound training

Tawfik, Eman A.; Cartwright, Michael S.; Grimm, Alexander; Boon, Andrea J.; Kerasnoudis, Antonios; Preston, David C.; Wilder-Smith, Einar; Axer, Hubertus; Hobson‐Webb, Lisa D.; Alfen, Nens van; Crump, Nicholas; Shahrizaila, Nortina; Inkpen, Peter; Mandeville, Ross; Sakamuri, Sarada; Shook, Steven J.; Shin, Susan; Walker, Francis O.

doi:10.1002/mus.26642

Cited by 25 publications

(39 citation statements)

References 22 publications

(47 reference statements)

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“…By providing an estimation of the benefit of US in everyday practice, we hope this study will encourage more neuromuscular physicians to integrate US into routine clinical care. It could also contribute information that may help to finalize formal recommendations and guidelines for US use and training 11,12 . Future studies may wish to investigate the relative influence of neuromuscular US in a broader spectrum of disesases, to help formulate new protocols and practice guidelines, and to improve diagnostic yield.…”

Section: Discussionmentioning

confidence: 99%

Utility of neuromuscular ultrasound in the investigation of common mononeuropathies in everyday neurophysiology practice

2020

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Introduction In everyday clinical neurophysiology practice, mononeuropathies are evaluated primarily by traditional electrodiagnostic testing. We sought to assess the additional benefit of neuromuscular ultrasound (US) in this scenario. Methods All consecutive mononeuropathies undergoing combined US and electrodiagnostic evaluation over a 23‐mo period at a single neurophysiology practice were reviewed. Three independent examiners assessed how often US was: (a) “contributory” ‐ enabling a definite diagnosis not made by electrophysiology alone and/or impacting on the therapeutic decision, (b) “confirmatory” of the electrodiagnostic findings, but not adding further diagnostic or therapeutic information, or (c) “negative” ‐ missed the diagnosis. Results There were 385 studies included. US was “contributory” in 36%, “confirmatory” in 61% and “negative” in 3%. Discussion In this study of everyday neurophysiology practice, neuromuscular US contributed significant diagnostic or therapeutic information in over 1/3 of the investigations for common mononeuropathies. False negative US studies were uncommon in this setting.

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Section: Discussionmentioning

confidence: 99%

Utility of neuromuscular ultrasound in the investigation of common mononeuropathies in everyday neurophysiology practice

2020

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“…Specific hands‐on training in muscle ultrasound is not yet a part of standard clinical neurophysiology training programs. An international consensus‐based guideline statement for neuromuscular ultrasound training was recently published 72 to help establish a core curriculum, in which visual muscle ultrasound recognition and grading is considered one of the basic techniques. For those seeking to learn, the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) and International Society of Peripheral Neurophysiologic Imaging (ISPNI) organize yearly courses and conference meetings on nerve and muscle ultrasound, and some specialized centers offer training possibilities for visiting clinicians.…”

Section: Setting‐related Challengesmentioning

confidence: 99%

Muscle ultrasound: Present state and future opportunities

2020

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Muscle ultrasound is a valuable addition to the neuromuscular toolkit in both the clinic and research settings, with proven value and reliability. However, it is currently not fulfilling its full potential in the diagnostic care of patients with neuromuscular disease. This review highlights the possibilities and pitfalls of muscle ultrasound as a diagnostic tool and biomarker, and discusses challenges to its widespread implementation. We expect that limitations in visual image interpretation, posed by user inexperience, could be overcome with simpler scoring systems and the help of deep‐learning algorithms. In addition, more information should be collected on the relation between specific neuromuscular disorders, disease stages, and expected ultrasound abnormalities, as this will enhance specificity of the technique and enable the use of muscle ultrasound as a biomarker. Quantified muscle ultrasound gives the most sensitive results but is hampered by the need for device‐specific reference values. Efforts in creating dedicated muscle ultrasound systems and artificial intelligence to help with image interpretation are expected to improve usability. Finally, the standard inclusion of muscle and nerve ultrasound in neuromuscular teaching curricula and guidelines will facilitate further implementation in practice. Our hope is that this review will help in unleashing muscle ultrasound's full potential.

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Section: Introductionunclassified

“…Standards für die klinisch-ärztliche Ausbildung zur Erlernung der Technik der Nervensonografie sowie für einheitliche Untersuchungsprotokolle werden aktuell sowohl national als auch international von führenden Experten im Feld erarbeitet [4,5]. Es besteht internationale Einigkeit über die Notwendigkeit der kombinierten (Grund-)Kenntnisse aus nervaler Anatomie, elektrophysiologischer Diagnostik und Nervensonografie [4]. Die Fähigkeit des trainierten Untersuchers sowohl sonografisch verschiedene Nervenabschnitte aufzufinden als auch deren Pathologie zu erkennen soll dabei in Form verschiedener Expertenlevels ("basic", "intermediate", "advanced") widergespiegelt werden [4].…”

Section: Introductionunclassified

“…Es besteht internationale Einigkeit über die Notwendigkeit der kombinierten (Grund-)Kenntnisse aus nervaler Anatomie, elektrophysiologischer Diagnostik und Nervensonografie [4]. Die Fähigkeit des trainierten Untersuchers sowohl sonografisch verschiedene Nervenabschnitte aufzufinden als auch deren Pathologie zu erkennen soll dabei in Form verschiedener Expertenlevels ("basic", "intermediate", "advanced") widergespiegelt werden [4]. Entsprechende Zertifizierungen erfolgen bereits in Deutschland, Österreich und der Schweiz über die jeweiligen Ultraschallgesellschaften der Medizin (DEGUM, ÖGUM, SGUM); in Nordamerika finden vergleichbare Entwicklungen statt.…”

Section: Introductionunclassified

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Nervensonografie – eine neurologische Perspektive auf chirurgisch relevante Krankheitsbilder der peripheren Nerven

2020

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ZusammenfassungDie Nervensonografie ist ein relativ neues und patientennahes Verfahren zur Visualisierung der peripheren Nerven von ihren distalen bis zu den proximalen Segmenten. Mithilfe dieser Methode gelingt die Auffindung und anatomisch genaue Lokalisation von peripher-nervalen Läsionen sowie deren ätiologische Zuordnung. Die Nervensonografie kann dabei nervale Engpasssyndrome und deren sekundäre Ursachen relativ sicher diagnostizieren. Auch operativ zu versorgende Faszikeltorsionen lassen sich mithilfe von Ultraschall nachweisen. Weitere Anwendungsgebiete eröffnen sich durch sonografisch geführte Interventionen am peripheren Nerven sowie im Rahmen der intraoperativen Anwendung als Navigationsverfahren. In der interdisziplinären Zusammenarbeit mit den chirurgischen Fachrichtungen liegt der Wert des Nervenultraschalls vor allem in der frühzeitigen Detektion von irreversiblen traumatischen Nervenschädigungen i. S. kompletter Nervendurchtrennungen, die eine frühzeitige operative Versorgung erforderlich machen. Für die neurologische Diagnostik relevant ist die Differenzierung zwischen verschiedenen Polyneuropathieformen. Der vorgelegte Übersichtsartikel soll eine Einführung in das Feld der Nervensonografie geben und die für die chirurgisch relevanten Krankheitsbilder des peripheren Nervensystems wesentlichen Ultraschallbefunde darstellen. Dieses neue bildgebende Verfahren wird zukünftig einer der Schlüssel für den Aufbau von interdisziplinären Kompetenzzentren zur Versorgung von Krankheitsbildern der peripheren Nerven sein.

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Guidelines for neuromuscular ultrasound training

Cited by 25 publications

References 22 publications

Utility of neuromuscular ultrasound in the investigation of common mononeuropathies in everyday neurophysiology practice

Utility of neuromuscular ultrasound in the investigation of common mononeuropathies in everyday neurophysiology practice

Muscle ultrasound: Present state and future opportunities

Nervensonografie – eine neurologische Perspektive auf chirurgisch relevante Krankheitsbilder der peripheren Nerven

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