MR neurography for the evaluation of CIDP

Ishikawa, Tomomasa; Asakura, Koichi; Mizutani, Yasuaki; Ueda, Akihiro; Murate, Ken Ichiro; Hikichi, Chika; Shima, Sayuri; Kizawa, Madoka; Komori, Masako; Murayama, Kazuhiro; Toyama, Hiroshi; Ito, Shinji; Mutoh, Tatsuro

doi:10.1002/mus.25368

Cited by 41 publications

(24 citation statements)

References 21 publications

(35 reference statements)

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“…Application of ultrasound scores can increase diagnostic sensitivity for CIDP compared with other chronic immune-mediated, 39 hereditary 40 or diabetic neuropathies. 41 MRI techniques that have been evaluated in CIDP include magnetic resonance neurography [42][43][44] and diffusion tensor imaging (DTI). [45][46][47] DTI-based fractional anisotropy (FA) values are significantly lower in the nerves of the upper and lower extremities in CIDP, with the largest differences in ulnar and sciatic nerves compared with those of controls.…”

Section: Neuroimagingmentioning

confidence: 99%

Chronic inflammatory demyelinating polyneuropathy: update on diagnosis, immunopathogenesis and treatment

Lehmann

Burke

Kuwabara

2019

J Neurol Neurosurg Psychiatry

169

110

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Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated neuropathy typically characterised by symmetrical involvement, and proximal as well as distal muscle weakness (typical CIDP). However, there are several ‘atypical’ subtypes, such as multifocal acquired demyelinating sensory and motor neuropathy (Lewis-Sumner syndrome) and ‘distal acquired demyelinating symmetric neuropathy’, possibly having different immunopathogenesis and treatment responses. In the absence of diagnostic and pathogenetic biomarkers, diagnosis and treatment may be difficult, but recent progress has been made in the application of neuroimaging tools demonstrating nerve hypertrophy and in identifying subgroups of patients who harbour antibodies against nodal proteins such as neurofascin and contactin-1. Despite its relative rarity, CIDP represents a significant economic burden, mostly due to costly treatment with immunoglobulin. Recent studies have demonstrated the efficacy of subcutaneous as well as intravenous immunoglobulin as maintenance therapy, and newer immunomodulating drugs can be used in refractory cases. This review provides an overview focusing on advances over the past several years.

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Section: Neuroimagingmentioning

confidence: 99%

Chronic inflammatory demyelinating polyneuropathy: update on diagnosis, immunopathogenesis and treatment

Lehmann

Burke

Kuwabara

2019

J Neurol Neurosurg Psychiatry

169

110

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“…We excluded reviews, spinal cord studies and animal or in vivo studies. Our review identified a total of 35 articles: 24 DTI studies and 11 diffusionweighted MR neurography studies [31][32][33][34][35][36][37][38][39][40][41] . The number of lumbar nerve DTI studies has sharply increased in recent years ( Fig.…”

Section: Trends In Clinical Mr Neuroimaging Of Lumbar Nervesmentioning

confidence: 99%

Recent advances in magnetic resonance neuroimaging of lumbar nerve to clinical applications: A review of clinical studies utilizing Dffusion Tensor Imaging and Diffusion-weighted magnetic resonance neurography

Eguchi

Kanamoto

Oikawa³

et al. 2017

Spine Surg Relat Res

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Abstract:Much progress has been made in neuroimaging with Magnetic Resonance neurography and Diffusion Tensor Imaging (DTI) owing to higher magnetic fields and improvements in pulse sequence technology. Reports on lumbar nerve DTI have also increased considerably.Many studies have shown that the use of DTI in lumbar nerve lesions, such as lumbar foraminal stenosis and lumbar disc herniation, makes it possible to capture images of interruptions of tractography at stenotic sties, enabling the diagnosis of stenosis. DTI can also reveal significant decreases in fractional anisotropy (FA) with significant increases in apparent diffusion coefficient (ADC) values in compression lesions.FA values have higher accuracy than ADC values. Furthermore, strong correlations exist between FA values and indications of neurological severity, including the Japanese Orthopedic Association (JOA) score, the Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire (RDQ) in patients with lumbar disc herniation-induced radiculopathy.Most lumbar DTI has become 3T; 3T MRI has made it possible to take high-resolution DTI measurements in a short period of time. However, increased motion artifacts in the magnetic susceptibility effect lead to signal irregularities and image distortion. In the future, high-resolution DTI with reduced field-of-view may become useful in clinical applications, since visualization of nerve lesions and quantification of DTI parameters could allow more accurate diagnoses of lumbar nerve dysfunctions. Future translational studies will be necessary to successfully bring MR neuroimaging of lumbar nerve into clinical use.

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“…7 Quantitative sensory testing is useful in documenting sensory dysfunction in patients with polyneuropathy. 8 Magnetic resonance imaging (MRI) 9 and neuromuscular ultrasound 10 have also been shown to be helpful in the evaluation of patients with peripheral neuropathy. With the current advances in neurophysiologic, immunologic, and genetic testing in peripheral neuropathy, the use of nerve biopsy is now primarily limited to patients with possible vasculitic neuropathy, select patients with possible amyloid neuropathy, and atypical forms of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).…”

mentioning

confidence: 99%

A Clinician's Approach to Peripheral Neuropathy

Siao

Kaku

2019

Semin Neurol

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Peripheral neuropathies are a group of disorders that affect the peripheral nervous system, for which hundreds of etiologies have been identified. This article presents a stepwise approach to the evaluation and workup of peripheral neuropathy, which starts with a detailed history of symptoms, family and occupational history, and a neurological as well as general physical exam. Pattern recognition of various neuropathies can help to build a differential diagnosis based on the presentation. Such patterns include acute versus chronic, primary demyelinating versus axonal, hereditary versus acquired, asymmetric versus symmetric, presence of facial palsies, sensory or motor predominant, and presence of prominent autonomic symptoms. Early categorization of the type of neuropathy can help focus the workup for peripheral neuropathy. Nerve conduction studies and electromyography (NCS/EMG) is the primary diagnostic tool in the evaluation of patients with large-fiber polyneuropathy. One of the most important roles of NCS/EMG is to help categorize polyneuropathy as primary axonal versus primary demyelinating. The finding of a primary demyelinating polyneuropathy narrows the differential diagnosis of polyneuropathy dramatically and increases the chances of finding a treatable etiology. Laboratory workup includes serum studies and potentially cerebrospinal fluid, genetic studies, immunological markers, and fat pad biopsy for select patients. Skin biopsy may be used to assess intraepidermal nerve fiber density if small-fiber neuropathy is suspected, and nerve biopsy may be useful in select cases. In recent years, magnetic resonance imaging and neuromuscular ultrasound have also shown promise in the evaluation of peripheral neuropathy. Identification of the etiology of neuropathy is crucial and often time-sensitive, as an increasing number of causes are now reversible or treatable.

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MR neurography for the evaluation of CIDP

Abstract: MR neurography and the measurement of peripheral nerve volume are useful for diagnosing and assessing CIDP. Muscle Nerve 55: 483-489, 2017.

Cited by 41 publications

References 21 publications

Chronic inflammatory demyelinating polyneuropathy: update on diagnosis, immunopathogenesis and treatment

Chronic inflammatory demyelinating polyneuropathy: update on diagnosis, immunopathogenesis and treatment

Recent advances in magnetic resonance neuroimaging of lumbar nerve to clinical applications: A review of clinical studies utilizing Dffusion Tensor Imaging and Diffusion-weighted magnetic resonance neurography

A Clinician's Approach to Peripheral Neuropathy

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