Large coverage MR neurography in CIDP: diagnostic accuracy and electrophysiological correlation

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

doi:10.1007/s00415-017-8543-7

Cited by 56 publications

(59 citation statements)

References 24 publications

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“…The most frequent abnormalities in this group were increased signal intensity on STIR images and nerve root enlargement (in 100% and 91% of abnormal MRIs, respectively), which is consistent with typical CIDP [12,19]. Abnormalities were chiefly multifocal and asymmetrical in these patients (in 59% and 73% of abnormal MRIs, respectively), and this is noteworthy since it varies from the diffuse symmetrical pattern generally observed in cohorts of typical CIDP and also in our CIDP-D group [12][13][14]. The restricted asymmetrical nature of the abnormalities was mainly demonstrated in patients with atypical clinical profiles, such as those with Lewis-Sumner syndrome [15].…”

Section: Discussionsupporting

confidence: 66%

Diagnostic usefulness of plexus magnetic resonance imaging in chronic inflammatory demyelinating polyradiculopathy without electrodiagnostic criteria of demyelination

Fargeot

Théaudin

Labeyrie

et al. 2018

Euro J of Neurology

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Background and purpose The usefulness of plexus magnetic resonance imaging (MRI) in the diagnosis of chronic inflammatory demyelinating polyradiculopathy (CIDP) without definite European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) electrodiagnostic criteria is currently unclear. Methods Data from consecutive patients with clinical manifestations suggesting CIDP, with or without (CIDP‐D and CIDP‐ND, respectively) definite EFNS/PNS electrodiagnostic criteria, and referred for plexus MRI in our imaging centre were retrospectively analysed. An expert committee of neurologists compared the level of suspicion of CIDP in CIDP‐ND patients to the blinded/unblinded MRI findings. Plexus MRI was reviewed by a neuroradiologist blinded to the final diagnosis. Results In all, 38 patients were assessed with suspected CIDP‐ND [7/38 (18%) probable; 13/38 (34%) possible; 18/38 (47%), no EFNS/PNS electrodiagnostic criteria], plus 10 with CIDP‐D. Thirty‐six of the 38 (95%) fulfilled clinical criteria of CIDP variants, including pure sensory neuropathy in 22/36 (61%). Plexus MRI showed abnormalities in 22/38 (58%) patients including increased nerve signal intensity on T2‐weighted images in 22/22 (100%), nerve enlargement in 20/22 (91%) and contrast enhancement in 8/22 (36%). Plexus MRI enabled the expert committee's final diagnosis to be adjusted in 7/38 (18%) patients, and in conjunction with nerve conduction studies was a supportive criterion to classify 7/24 (29%) patients as definite CIDP. MRI abnormalities were more asymmetrical (P = 0.03) and less diffuse (P = 0.1) in CIDP‐ND than in CIDP‐D. Conclusions Our observations suggest that plexus MRI makes a valuable contribution to the diagnosis of CIDP‐ND patients. Further studies are needed to investigate inter‐rater reliability of clinical and imaging criteria of CIDP in these patients, and the impact on outcomes.

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Section: Discussionsupporting

confidence: 66%

Diagnostic usefulness of plexus magnetic resonance imaging in chronic inflammatory demyelinating polyradiculopathy without electrodiagnostic criteria of demyelination

Fargeot

Théaudin

Labeyrie

et al. 2018

Euro J of Neurology

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“…MR neurography (MRN) can overcome some of the aforementioned diagnostic limitations by directly visualizing peripheral nerve lesions 11–21 . The quantitative MRN parameters, proton spin density ( ρ ) and apparent T2 relaxation time ( T2 app ), have previously proven their feasibility to detect subclinical and early nerve lesions as well as to differentiate between neuropathic patients and controls or even between different disease severities in several neuropathies 14–18 .…”

Section: Introductionmentioning

confidence: 99%

Magnetization transfer ratio quantifies polyneuropathy in hereditary transthyretin amyloidosis

Kollmer

Hegenbart

Kimmich

et al. 2020

Ann Clin Transl Neurol

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Objective: To quantify peripheral nerve lesions in symptomatic and asymptomatic hereditary transthyretin amyloidosis with polyneuropathy (ATTRv-PNP) by analyzing the magnetization transfer ratio (MTR) of the sciatic nerve, and to test its potential as a novel biomarker for macromolecular changes. Methods: Twenty-five patients with symptomatic ATTRv-PNP, 30 asymptomatic carriers of the mutant transthyretin gene (mutTTR), and 20 age-/sexmatched healthy controls prospectively underwent magnetization transfer contrast imaging at 3 Tesla. Two axial three-dimensional gradient echo sequences with and without an off-resonance saturation rapid frequency pulse were conducted at the right distal thigh. Sciatic nerve regions of interest were manually drawn on 10 consecutive axial slices in the images without off-resonance saturation, and then transferred to the corresponding slices that were generated by the sequence with the off-resonance saturation pulse. Subsequently, the MTR and cross-sectional area (CSA) of the sciatic nerve were evaluated. Detailed neurologic and electrophysiologic examinations were conducted in all ATTRv-PNP patients and mutTTR-carriers. Results: Sciatic nerve MTR and CSA reliably differentiated between ATTRv-PNP, mutTTR-carriers, and controls. MTR was lower in ATTRv-PNP (26.4 AE 0.7; P < 0.0001) and in mutTTR-carriers (32.6 AE 0.8; P = 0.0005) versus controls (39.4 AE 2.1), and was also lower in ATTRv-PNP versus mutTTR-carriers (P = 0.0009). MTR correlated negatively with the NIS-LL and positively with CMAPs and SNAPs. CSA was higher in ATTRv-PNP (34.3 AE 1.7 mm 3 ) versus mutTTR-carriers (26.0 AE 1.1 mm 3 ; P = 0.0005) and versus controls (20.4 AE 1.2 mm 3 ; P < 0.0001). CSA was also higher in mutTTR-carriers versus controls. Interpretation: MTR is a novel imaging marker that can quantify macromolecular changes in ATTRv-PNP and differentiate between symptomatic ATTRv-PNP and asymptomatic mutTTRcarriers and correlates with electrophysiology.

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“…Further investigations, including cerebrospinal fluid protein levels, somatosensory evoked potentials, distal nerve biopsy, magnetic resonance imaging (MRI) of nerve roots or plexus or of the cauda equina and response to immunotherapy can all be used as supportive criteria for the diagnosis of CIDP [1,4]. Increased signal intensity and/or hypertrophy on T2weighted images of plexus structures, with or without gadolinium enhancement, have been described in small series of typical CIDP [5][6][7][8][9][10]; these findings are consistent with the predominantly proximal distribution [11,12] and enlarged peripheral nerves [13] in CIDP. Data assessing the contribution of plexus MRI in the diagnosis of CIDP are scarce [14].…”

Section: Introductionmentioning

confidence: 99%

Prospective study of the additional benefit of plexus magnetic resonance imaging in the diagnosis of chronic inflammatory demyelinating polyneuropathy

Jomier

Bousson

Péreón

et al. 2019

Euro J of Neurology

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Background and purpose Hypertrophy/signal hyperintensity and/or gadolinium enhancement of plexus structures on magnetic resonance imaging (MRI) are observed in two‐thirds of cases of typical chronic inflammatory demyelinating polyneuropathy (CIDP). The objective of our study was to determine the additional benefit of plexus MRI in patients referred to tertiary centers with baseline clinical and electrophysiological characteristics suggestive of typical or atypical CIDP. Methods A total of 28 consecutive patients with initial suspicion of CIDP were recruited in nine centers and followed for 2 years. Plexus MRI data from the initial assessment were reviewed centrally. Physicians blinded to the plexus MRI findings established the final diagnosis (CIDP or neuropathy of another cause). The proportion of patients with abnormal MRI was analyzed in each group. Results Chronic inflammatory demyelinating polyneuropathy was confirmed in 14 patients (50%), as were sensorimotor CIDP (n = 6), chronic immune sensory polyradiculoneuropathy (n = 2), motor CIDP (n = 1) and multifocal acquired demyelinating sensory and motor neuropathy (n = 5). A total of 37 plexus MRIs were performed (17 brachial, 19 lumbosacral and 8 in both localizations). MRI was abnormal in 5/37 patients (14%), all of whom were subsequently diagnosed with CIDP [5/14(36%)], after an atypical baseline presentation. With plexus MRI results masked, non‐invasive procedures confirmed the diagnosis of CIDP in all but one patient [1/14 (7%)]. Knowledge of the abnormal MRI findings in the latter could have prevented nerve biopsy being performed. Conclusion Systematic plexus MRI in patients with initially suspected CIDP provides little additional benefit in confirming the diagnosis of CIDP.

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Large coverage MR neurography in CIDP: diagnostic accuracy and electrophysiological correlation

Cited by 56 publications

References 24 publications

Diagnostic usefulness of plexus magnetic resonance imaging in chronic inflammatory demyelinating polyradiculopathy without electrodiagnostic criteria of demyelination

Diagnostic usefulness of plexus magnetic resonance imaging in chronic inflammatory demyelinating polyradiculopathy without electrodiagnostic criteria of demyelination

Magnetization transfer ratio quantifies polyneuropathy in hereditary transthyretin amyloidosis

Prospective study of the additional benefit of plexus magnetic resonance imaging in the diagnosis of chronic inflammatory demyelinating polyneuropathy

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