MRI of the cervical nerve roots in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy: a single-institution, retrospective case–control study

Abstract

ObjectiveTo systematically evaluate the usefulness of assessing the cervical nerve roots by MRI for the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).DesignSingle-institution, retrospective case–control study.SettingA regional referral hospital.ParticipantsWe retrospectively enrolled 15 consecutive patients with CIDP who satisfied the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) typical and definite criteria and underwent cervical MRI. 30 control patients who had also undergone cervical MRI were included, matched with regard to sex, age and MRI system. The diagnoses of the control patients included cervical spondylosis (n=19), cervical spine trauma (n=2), infection (n=1), malignancies (n=4), demyelinating disorders (n=2) and neurodegenerative disorders (n=2).MeasurementA radiologist determined the C5–C8 root diameters on the coronal short tau inversion recovery (STIR) images. Signal intensities of these roots were quantified as nerve-to-muscle contrast-to-noise ratios (CNRs), which were calculated using mean signal intensities of the roots and sternocleidomastoid muscle as well as SD of background noise. Statistical analyses were performed to determine the diagnostic accuracy of the diameters and nerve-to-muscle CNRs. Another radiologist reviewed MRI for ensuring reproducibility.ResultsThe root diameters showed no significant differences between the patients with CIDP and control patients. The nerve-to-muscle CNRs were significantly higher in the patients with CIDP. We defined the sum of nerve-to-muscle CNRs of C5–C8 roots as the CNR score to serve as an index of overall signal intensity. The area under the receiver operating characteristic curve of CNR scores was 0.731. The reproducibility of the assessment procedure was satisfactory.ConclusionsOur results suggest that assessment of the cervical nerve roots by MRI is useful for CIDP diagnosis when the signal intensities, rather than the diameters, are paid more attention on STIR images.

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

“…However, abnormal plexus MRI was two to three times less frequent in our cohort than what is reported in typical CIDP [6,7,17,21]. This cannot be explained by the large number (64%) of our patients who received immunomodulatory drugs, as this proportion is similar to those reported in previous studies [6,7,22], nor by our high proportion (36%) of multifocal acquired demyelinating sensory and motor neuropathy, as these forms have been shown to predominantly involve peripheral nerves [17,23]. The prospective multicenter design of our study is unique in the evaluation of plexus MRI in CIDP and probably accounts for this low prevalence of abnormal MRI.…”

A comparative study of brachial plexus sonography and magnetic resonance imaging in chronic inflammatory demyelinating neuropathy and multifocal motor neuropathy

“…Brachial plexus MRI is an accepted technique for the diagnostic work-up of both CIDP and MMN [5][6][7]11,20,[26][27][28], in particular in the case of abnormal NCS that do not fulfill all electrophysiological consensus criteria for demyelination [3,4]. Several HRUS studies have revealed nerve thickening in patients with chronic inflammatory neuropathies [8][9][10][11][12][13]23,[29][30][31] but, as yet, HRUS abnormalities are not included in sets of diagnostic criteria.…”

“…Gadolinium-DTPA was administered in all patients and the T1-weighted spinecho sequence was repeated after contrast [5,17]. MRIs were rated by experienced neuroradiologists (blinded to the diagnosis, NCS and sonographic findings) for the presence of thickened nerve roots or increased T2 signal and contrast enhancement [5,7,[17][18][19][20].…”

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

“…For more distal segments, such as cords, divisions or terminal branches, as cut‐off values between normal subjects and CIDP patients still have not been reported, the definition of hypertrophy was based on obvious left–right asymmetries and intraneural fascicular heterogeneity. The target thresholds of nerve intensity to characterize hypersignals that have been reported in the literature were used as a guide . Characteristics of abnormalities: symmetrical or asymmetrical; unifocal (segmental demyelination of a nerve root, plexus or nerve trunk), diffuse (diffuse involvement of neural parenchyma) or multifocal forms; other possible abnormalities – nerve atrophy, muscle abnormalities, loss of normal fascicular pattern (loss of fat signal between the fascicles and nerve segments).…”