High-resolution ultrasound of peripheral nerves in systemic sclerosis: a pilot study of computer-aided quantitative assessment of nerve density

Bignotti, Bianca; Ghio, Massimo; Panico, Nicoletta; Tagliafico, Giulio; Martinoli, Carlo; Tagliafico, Alberto

doi:10.1007/s00256-015-2230-5

Cited by 22 publications

(13 citation statements)

References 29 publications

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“…The evidence from these studies suggests that CTS occurring concomitantly to SSc is also associated with ultra sonographically-detectable morphological alterations of the median nerve. Specifically, patients with SSc presented with larger CSA, higher transverse diameters, and higher flattening ratios of the median nerve than healthy controls [46] and had lower ratio of fascicular to non-fascicular structures within the nerve [47]. These findings are consistent with the ultrasonographic observations of patients with CTS of other aetiology, suggesting that peripheral neuropathy in SSc might develop in a compression mechanism.…”

Section: Peripheral Neuropathy In Systemic Sclerosissupporting

confidence: 71%

Ultrasound elastography in the evaluation of peripheral neuropathies: a systematic review of the literature

Zakrzewski¹,

Zakrzewska

Pluta³

et al. 2020

Pol J Radiol

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Peripheral neuropathy is associated with an increase in intraneural pressure, and hence ultrasound elastography seems to be an ideal method to detect early stages of this condition based on changes in the affected nerve stiffness. The aim of this systematic review was to analyse the applicability of strain elastography (SE) and shear wave elastography (SWE) in the evaluation of peripheral nerves in patients with neuropathy of various aetiologies. Published evidence shows clearly that ultrasound elastography can accurately diagnose many types of peripheral neuropathies (carpal tunnel syndrome and other entrapment neuropathies, diabetic peripheral neuropathy and peripheral neuropathy associated with other systemic diseases), sometimes at the stages at which the condition is still asymptomatic. However, it is still unclear whether elastographic changes within the nerves precede functional anomalies detectable on nerve conduction studies. Also, relatively little is known about the relationship between the stiffness of peripheral nerves and the severity of peripheral neuropathy and its underlying condition. Based on the reproducibility data, SWE seems to be superior to SE. Nevertheless, the sources of heterogeneity in the peripheral nerve stiffness in healthy persons need to be identified, and the sets of reference values for specific peripheral nerves need to be determined. Finally, the potential confounding effect of hardening artefacts, such as bones, on the stiffness of peripheral nerves needs to be verified. After addressing all these issues, elastographic evaluation of peripheral nerve stiffness might become a reliable, easily accessible, and convenient diagnostic test performed routinely in patients with various peripheral neuropathies.

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Section: Peripheral Neuropathy In Systemic Sclerosissupporting

confidence: 71%

Ultrasound elastography in the evaluation of peripheral neuropathies: a systematic review of the literature

Zakrzewski¹,

Zakrzewska

Pluta³

et al. 2020

Pol J Radiol

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“…In this study, we reported that the inside-epineurium method was more reliable than the outside-epineurium method in measuring the nerve CSA due to its higher intra- and inter-rater reliability. In recent years, with advancements in US technology, most high resolution US machines are able to delineate the ultrastructure of the peripheral nerves ( 24 ). The echotexture of nerve fascicles are hypoechoic, whereas the surrounding connective tissues like epineurium and perineurium appear hyperechoic ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

Basis of Shoulder Nerve Entrapment Syndrome: An Ultrasonographic Study Exploring Factors Influencing Cross-Sectional Area of the Suprascapular Nerve

Chang

Mezian

et al. 2018

Front. Neurol.

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As changes in nerves' shape and size are common ultrasonographic findings of entrapment neuropathy, measurement of the nerve cross-sectional area (CSA) becomes the mostly used indicator to differentiate normality from pathology. Recently, more US research has been conducted to measure the shape of the suprascapular notch and the diameter of the suprascapular nerve. Because the suprascapular nerve is paramount for various shoulder disorders, the present study aims to establish normal values of suprascapular nerve sizes at different levels as well as to investigate potential influence of participants' characteristics on the CSA measurements. The present study used a cross-sectional design investigating the CSA values of the suprascapular nerve from the supraclavicular region to spinoglenoid notch. We employed the inside-epineurium and outside-epineurium methods to quantify CSA of cervical roots (C5 and C6) and the suprascapular nerve on US imaging. Univariate comparisons of nerve sizes among different age and gender groups were carried out. Multivariate analysis was performed to analyze the impact of participants' characteristics on nerve CSA. Repeated measurement analysis of variance was conducted to examine segmental variations of CSA of the suprascapular nerve from its origin to infraspinatus fossa. Our study included 60 healthy adults with 120 shoulders and had three major findings: (1) the inside-epineurium method was more reliable than the outside-epineurium approach for CSA measurements due to higher intra- and inter-rater reliability, (2) women had smaller sizes for cervical nerve roots and for the most proximal segment of the suprascapular nerves, and (3) using the outside-epineurium method, the suprascapular nerve CSA was larger in its distal division than the portion proximal to the mid-clavicular line. In conclusion, the inside-epineurium method has better reliability for nerve CSA assessment but the outside-epineurium method is needed for quantifying the size of distal suprascapular nerve. Gender difference in CSA values should be considered during evaluation of the most proximal nerve segment. Using the outside-epineurium method, the distal suprascapular nerve would be estimated larger than its proximal portion and the segmental discrepancy should be not misinterpreted as pathology.

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“…Previous studies that visualized the median nerve in SSC were not about the elasticity of the nerve. The median nerve area, diameter and flattening ratio were significantly affected in patients with SSC [ 8 ] and the ratio between the fascicular and non-fascicular structure of the median nerve was decreased [ 17 ]. This is the first study to actually document an increase in the stiffness of the median nerve in patients with SSC.…”

Section: Discussionmentioning

confidence: 99%

Increased stiffness of median nerve in systemic sclerosis

Yağcı

Keniş-Coşkun

Özen

et al. 2017

BMC Musculoskelet Disord

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BackgroundSystemic sclerosis can affect peripheral nerves, but the extent and the nature of this involvement are not well defined. The aim of this study is to compare the sonoelastrographic measurements of median nerves in systemic sclerosis (SSC), idiopathic carpal tunnel syndrome (CTS) and healthy individuals.MethodsThe clinical, electrophysiological and ultrasonographic assessments were done. Patients with SSC and CTS were assessed with nerve conduction studies. The measurements of cross sectional areas (CSA) were performed at psiform and forearm level from axial US images. The elastic ratio is the ratio of strain distribution in two selected region of interests (ROI) done via comparing the median nerve to flexor digitorum superfcialis tendon. The ROIs were fixed to 2 mm.ResultsThe study was completed with 47 hands of 24 patients with SSC, 53 hands of 27 patients with CTS and 38 hands of health controls. The CSA of CTS group was significantly higher than systemic sclerosis and control groups. The elastic ratio at psiform level and forearm levels of systemic sclerosis group were significantly higher than the CTS and control groups.ConclusionMedian nerves lose the elasticity while the CSA’s are in the normal range in patients with SSC. These results suggested that the increased peripheral nerve involvement in SSC is about the increased stiffness of the nerves.

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High-resolution ultrasound of peripheral nerves in systemic sclerosis: a pilot study of computer-aided quantitative assessment of nerve density

Abstract: In lcSSc patients, nerve density was reduced, especially in the symptomatic group, compared to control subjects.

Cited by 22 publications

References 29 publications

Ultrasound elastography in the evaluation of peripheral neuropathies: a systematic review of the literature

Ultrasound elastography in the evaluation of peripheral neuropathies: a systematic review of the literature

Basis of Shoulder Nerve Entrapment Syndrome: An Ultrasonographic Study Exploring Factors Influencing Cross-Sectional Area of the Suprascapular Nerve

Increased stiffness of median nerve in systemic sclerosis

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