MRI detects peripheral nerve and adjacent muscle pathology in non-systemic vasculitic neuropathy (NSVN)

Schneider, Christian A.; Sprenger, Alina; Weiss, Kilian; Slebocki, Karin; Maintz, David; Fink, Gereon R.; Henning, Tobias D.; Lehmann, Helmar C.; Lichtenstein, Thorsten

doi:10.1007/s00415-019-09224-0

Cited by 12 publications

(9 citation statements)

References 19 publications

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“…Axonal PNPs, as mentioned above, are characterized by axonal injury mainly in distal nerve segments. Correspondingly, previous studies have demonstrated a decreased FA value and increased ADC value in lower extremity nerves (30)(31)(32). The proximal lumbosacral nerve roots, however, have never been covered.…”

Section: Discussionmentioning

confidence: 90%

MR neurography of lumbosacral nerve roots for differentiating chronic inflammatory demyelinating polyneuropathy from acquired axonal polyneuropathies: a cross-sectional study

Wu¹,

Wang²,

Yang³

et al. 2022

Quant Imaging Med Surg

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Background: Magnetic resonance (MR) neurography is an imaging technique focused on the peripheral nerves. Its role in the diagnosis and differential diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) has yet to be investigated. This study explored the value of MR neurography in identifying CIDP and differentiating it from acquired axonal polyneuropathies. Methods:In this study, 20 patients with CIDP, 10 patients with acquired axonal polyneuropathies, and 20 healthy controls were prospectively enrolled. Three-dimensional T2-weighted image fat-suppressed and diffusion tensor imaging sequences of the lumbosacral plexus were completed in all participants. The cross-sectional area (CSA) and diffusion parameters, including the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the L3 to S1 nerve roots, were measured and compared across the 3 groups using Kruskal-Wallis 1-way analysis of variance. Receiver operating characteristic (ROC) curves were plotted to determine the value of CSA and diffusion parameters in the diagnosis and differential diagnosis of CIDP.Results: CSA and ADC increased in CIDP patients but didn't differ between patients with axonal polyneuropathies and healthy controls (CAS: 45.35±23.889, 22.25±3.878, 22.81±4.079 mm 2 , ADC:(1.64±0.269)×10 -3 mm 2 /s, (1.37±0.204)×10 -3 mm 2 /s and (1.39±0.156)×10 -3 mm 2 /s, in CIDP, axonal polyneuropathies and healthy controls, respectively, both P<0.001). Compared with healthy controls, FA reduced in patients with CIDP and axonal polyneuropathies but no difference was observed in the two groups (FA: 0.24±0.053, 0.27±0.014 and 0.32±0.045, in CIDP, axonal polyneuropathies and healthy controls, respectively, P<0.001). To identify CIDP, ROC analysis showed that FA had better efficiency with cut-off value of 0.278 and sensitivity and specificity of 85% and 90% respectively. To differentiate CIDP from axonal polyneuropathies, CSA had better diagnostic accuracy with cut-off value of 29.46 mm 2 and sensitivity and specificity of 75% and 100% respectively. Conclusion:CSA and ADC values of lumbosacral nerve roots can help to identify patients with CIDP and further distinguish them from patients with axonal polyneuropathies. FA decreased in both types of polyneuropathies and may thus have limited value in the discrimination of the 2 types of neuropathies.

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Section: Discussionmentioning

confidence: 90%

MR neurography of lumbosacral nerve roots for differentiating chronic inflammatory demyelinating polyneuropathy from acquired axonal polyneuropathies: a cross-sectional study

Wu¹,

Wang²,

Yang³

et al. 2022

Quant Imaging Med Surg

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“…Advanced MRI imaging techniques such as diffusion tensor imaging may be more informative. 14,15 The clinical audit provided valuable insights into our peripheral nerve biopsy patient population and instigated quality improvement measures to improve patient management (refer to Fig. 2).…”

Section: Discussionmentioning

confidence: 99%

Utilising clinical parameters to improve the selection of nerve biopsy candidates

Kopanidis

Baskozos

Byrne

et al. 2023

Internal Medicine Journal

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BackgroundPeripheral nerve biopsy is a valuable final diagnostic tool; however, histopathological results can be non‐diagnostic.AimsWe aim to identify quality improvement measures by evaluating the pre‐biopsy assessment and diagnostic yield of specific histopathological diagnosis.MethodsThis was a retrospective study based on 10 years of experience with peripheral nerve biopsies at a single centre. Clinical data were obtained regarding pre‐biopsy history, examination, serum and cerebrospinal fluid (CSF) investigations, neurophysiology and peripheral nerve imaging. Based upon a histopathological outcome, patients were grouped into vasculitis, granulomatous and infiltrative (diagnostic) group, or a comparison group of non‐specific axonal neuropathy and normal (non‐specific/normal) group.ResultsFrom a cohort of 64 patients, 21 (32.8%) were included in the diagnostic group and 30 (46.9%) in the non‐specific/normal group. Clinical parameters associated with the diagnostic group were shorter history (mean 10.2 months vs 38.1), stepwise progression (81% vs 20%), neuropathic pain (85.7% vs 56.7%), vasculitic rash (23.8% vs 0%), mononeuritis multiplex (57.1% vs 10%), asymmetry (90.5% vs 60%), raised white cell count (47.6% vs 16.7%), myeloperoxidase antibody (19.1% vs 0%) and abnormal peripheral nerve imaging (33.3% vs 10%).ConclusionSelection of patients undergoing nerve biopsy requires careful consideration of clinical parameters, including peripheral nerve imaging. Several quality improvement measures are proposed to improve yield of clinically actionable information from nerve biopsy.

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“…At some centers, MRI is performed to guide targeted fascicular biopsies of proximal nerves but the comparison of its diagnostic accuracy in VN has not been reported. However, MR diffusion tensor imaging (DTI) in patients with NSVN shows that mean fractional anisotropy, a measure of nerve integrity, was decreased in the tibial nerves of 10 patients with NSVN compared with 10 normal controls, representing a suitable candidate biomarker for NSVN-related disease activity [ 44 ]. The use of high-resolution peripheral nerve ultrasonography has been more frequently studied in VN.…”

Section: Diagnostic Pathwaymentioning

confidence: 99%

Central and Peripheral Nervous System Complications of Vasculitis Syndromes from Pathology to Bedside: Part 2—Peripheral Nervous System

Mansueto

Lanza

Falleti

et al. 2023

Curr Neurol Neurosci Rep

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Purpose of Review Peripheral nervous system vasculitides (PNSV) are a heterogeneous group of disorders with a clinical subset that may differ in prognosis and therapy. We provide a comprehensive update on the clinical assessment, diagnosis, complications, treatment, and follow-up of PNSV. Recent Findings Progress in neuroimaging, molecular testing, and peripheral nerve biopsy has improved clinical assessment and decision-making of PNSV, also providing novel insights on how to prevent misdiagnosis and increase diagnostic certainty. Advances in imaging techniques, allowing to clearly display the vessel walls, have also enhanced the possibility to differentiate inflammatory from non-inflammatory vascular lesions, while recent histopathology data have identified the main morphological criteria for more accurate diagnosis and differential diagnoses. Overall, the identification of peculiar morphological findings tends to improve diagnostic accuracy by defining a clearer boundary between systemic and non-systemic neuropathies. Therefore, the definition of epineurium vessel wall damage, type of vascular lesion, characterization of lymphocyte populations, antibodies, and inflammatory factors, as well as the identification of direct nerve damage or degeneration, are the common goals for pathologists and clinicians, who will both benefit for data integration and findings translation. Nevertheless, to date, treatment is still largely empiric and, in some cases, unsatisfactory, thus often precluding precise prognostic prediction. In this context, new diagnostic techniques and multidisciplinary management will be essential in the proper diagnosis and prompt management of PNSV, as highlighted in the present review. Summary Thirty to fifty percent of all patients with vasculitis have signs of polyneuropathy. Neuropathies associated with systemic vasculitis are best managed according to the guidelines of the underlying disease because appropriate workup and initiation of treatment can reduce morbidity. Steroids, or in severe or progressive cases, cyclophosphamide pulse therapy is the standard therapy in non-systemic vasculitic neuropathies. Some patients need long-term immunosuppression. The use of novel technologies for high-throughput genotyping will permit to determine the genetic influence of related phenotypes in patients with PNSV. Supplementary Information The online version contains supplementary material available at 10.1007/s11910-023-01249-3.

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MRI detects peripheral nerve and adjacent muscle pathology in non-systemic vasculitic neuropathy (NSVN)

Cited by 12 publications

References 19 publications

MR neurography of lumbosacral nerve roots for differentiating chronic inflammatory demyelinating polyneuropathy from acquired axonal polyneuropathies: a cross-sectional study

MR neurography of lumbosacral nerve roots for differentiating chronic inflammatory demyelinating polyneuropathy from acquired axonal polyneuropathies: a cross-sectional study

Utilising clinical parameters to improve the selection of nerve biopsy candidates

Central and Peripheral Nervous System Complications of Vasculitis Syndromes from Pathology to Bedside: Part 2—Peripheral Nervous System

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