Neuromuscular ultrasound standardized scanning techniques and protocols: Expert panel recommendations

Abstract

Neuromuscular ultrasound has become an integral part of the diagnostic workup of neuromuscular disorders at many centers. Despite its growing utility, uniform standard scanning techniques do not currently exist. Scanning approaches for similar diseases vary in the literature creating heterogeneity in the studies as reported in several meta‐analysis. Moreover, neuromuscular ultrasound experts including the group in this study have different views with regards to technical aspects, scanning protocols, and the parameters that should be assessed. Establishing standardized neuromuscular scanning protocols is essential for the development of the subspeciality to ensure uniform clinical and research practices. Therefore, we aimed to recommend consensus‐based standardized scanning techniques and protocols for common neuromuscular disorders using the Delphi approach. A panel of 17 experts participated in the study, which consisted of three consecutive electronic surveys. The first survey included voting on six scanning protocols addressing the general scanning technique and five common categories of suspected neuromuscular disorders. The subsequent surveys focused on refining the protocols and voting on new steps, rephrased statements, or areas of non‐agreement. A high degree of consensus was achieved on the general neuromuscular ultrasound scanning technique and the scanning protocols for focal mononeuropathies, brachial plexopathies, polyneuropathies, amyotophic lateral sclerosis, and muscle diseases. In this study, a group of neuromuscular ultrasound experts developed six consensus‐based neuromuscular ultrasound scanning protocols that may serve as references for clinicians and researchers. The standardized protocols could also aid in achieving high‐quality uniform neuromuscular ultrasound practices.

Neuromuscular ultrasound protocols: First steps, future challenges

“…In this issue of the Journal, Tawfik et al present important basic recommendations for neuromuscular ultrasound scanning techniques. 5 This largely complements their previous panel recommendation on training and indications for neuromuscular ultrasound. 6,7 In their attempt to cover the experiences and available body of literature, they again used a Delphi approach with three rounds to reach panel consensus.…”

“…In this issue of the Journal, Tawfik et al present important basic recommendations for neuromuscular ultrasound scanning techniques 5 . This largely complements their previous panel recommendation on training and indications for neuromuscular ultrasound 6,7 .…”

Updates in diagnostic tools for diagnosing nerve injury and compressions

“…As a standard for nerve ultrasound, transverse imaging using a linear high-frequency probe is performed for anatomical identification of the nerve of interest and to assess its size and architecture for abnormalities. The international agreement is that nerve size is best measured as a cross-sectional area (CSA) within the hyperechoic outer epineurial rim (Tawfik et al, 2023). CSA reference values (Figure 2) are available for most limb nerves in different populations and should be used to interpret CSA findings (Abdelnaby et al, 2023;Boers et al, 2023;Cartwright et al, 2008Cartwright et al, , 2013Fisse et al, 2021).…”

“…There is an active international community in neuromuscular imaging that creates guidelines and knowledge (Tawfik et al, 2019(Tawfik et al, , 2021(Tawfik et al, , 2023. This community encourages cross-disciplinary collaboration, especially between diagnostic specialists such as clinical neurophysiologists, radiologists and surgeons.…”