Indications for neuromuscular ultrasound: Expert opinion and review of the literature

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Background We present one patient with an initial diagnosis of Guillain‐Barré syndrome (GBS) and one with Charcot–Marie–Tooth disease (CMT) type 1A. Methods Both patients underwent ankle tibial nerve fusion‐imaging of high‐resolution ultrasound (HRUS) with 7T MR neurography (MRN). Results In GBS, the nerve was enlarged, T2‐hyperintense, and showed increased vascularization 21 months after symptom onset. In CMT1A, the enlarged nerve was T2‐isointense with normal endoneurial blood flow. Conclusions We demonstrate the utility of 7T‐MRN‐HRUS‐fusion‐imaging. In GBS, there was evidence of ongoing inflammation resulting in a changed diagnosis to acute‐onset chronic demyelinating polyradiculoneuropathy and maintenance of immunotherapy. By MRN‐HRUS‐fusion, patients with presumed peripheral axonal degeneration could be shown to display imaging markers associated with peripheral nervous system inflammation. Thus, more accurate identification of a treatable inflammatory component may become possible.

Section: Introductionmentioning

confidence: 99%

7T MR neurography‐ultrasound fusion for peripheral nerve imaging

Schreiber

Peter

et al. 2020

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“…Over the years, it has evolved into a distinct ultrasound subspecialty. A vast amount of literature provides evidence regarding the value of neuromuscular ultrasound in the diagnostic evaluation of neuromuscular disorders (more key references are provided in Data S1 online) . As a result, neuromuscular ultrasound has become a fundamental diagnostic tool in many electrodiagnostic labs, clinics, and radiology centers.…”

Section: Introductionmentioning

confidence: 99%

“…vided in Data S1 online). [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] As a result, neuromuscular ultrasound has become a fundamental diagnostic tool in many electrodiagnostic labs, clinics, and radiology centers. This has driven a growing interest among physicians to learn and master the skill.…”

mentioning

confidence: 99%

Guidelines for neuromuscular ultrasound training

Tawfik

Cartwright

Grimm³

et al. 2019

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Neuromuscular ultrasound has become an essential tool in the diagnostic evaluation of various neuromuscular disorders, and, as such, there is growing interest in neuromuscular ultrasound training. Effective training is critical in mastering this modality. Our aim was to develop consensus‐based guidelines for neuromuscular ultrasound training courses. A total of 18 experts participated. Expert opinion was sought through the Delphi method using 4 consecutive electronic surveys. A high degree of consensus was achieved with regard to the general structure of neuromuscular ultrasound training; the categorization of training into basic, intermediate, and advanced levels; the learning objectives; and the curriculum for each level. In this study, a group of neuromuscular ultrasound experts established consensus‐based guidelines for neuromuscular ultrasound training. These guidelines can be used in the development of the specialty and the standardization of neuromuscular ultrasound training courses and workshops.

“…Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy worldwide. Its diagnosis is based on a suggestive history and clinical findings with support from ancillary tests including traditional electrodiagnostic studies and nerve imaging …”

mentioning

confidence: 99%

“…Its diagnosis is based on a suggestive history and clinical findings with support from ancillary tests including traditional electrodiagnostic studies and nerve imaging. [1][2][3][4] Nerve ultrasound is increasingly being adopted into clinical neurophysiology practice for evaluation of CTS. Since the first description by Buchberger et al, 5,6 a number of sonographic abnormalities have been reported in individuals with clinical CTS, including: increase in median nerve cross-sectional area (CSA) at the level of the pisiform bone (carpal tunnel inlet) and hamate; increase in nerve CSA at the level of the pisiform bone compared with the area at the distal radius (swelling ratio) or forearm (wrist-to-forearm ratio); increase in the flattening ratio at the hook of the hamate; palmar bowing of the flexor retinaculum; isolated enlargement of the median nerve in the distal carpal tunnel; and, more recently, changes in nerve echogenicity and vascularity.…”

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confidence: 99%

Carpal tunnel syndrome in advanced age: A sonographic and electrodiagnostic study

Mulroy

Pelosi

2019

Introduction: After noting inconsistent sonographic median nerve cross‐sectional area (CSA) enlargement at the wrist in very elderly patients with carpal tunnel syndrome (CTS), we systematically reviewed ultrasound, electrodiagnostic, and clinical data collected over a 12‐month period in patients from 2 age groups: 80–95 years and 40–65 years old. Methods: Clinical and electrodiagnostic CTS severity, sensitivity of ultrasound CSA (against both electrodiagnostic and clinical reference standards), and correlations between ultrasound CSA and clinical and electrodiagnostic severity were compared in both groups. Results: In very elderly patients, despite a higher prevalence of severe CTS, nerve ultrasound was less sensitive than in the younger group (54% vs. 87%, using clinical reference standard), and did not correlate with clinical (r = 0.28, P = 0.10) or electrodiagnostic (r = 0.09, P = 0.60) severity. Discussion: Median nerve ultrasound CSA at the wrist is not a sensitive marker of CTS in very elderly populations. In this work we detail and discuss potential pathophysiological underpinnings of this unexpected finding. Muscle Nerve, 2019