Peripheral nerve size in normals and patients with polyneuropathy: An ultrasound study

Abstract

Ultrasound has been used for visualizing peripheral nerve pathology. Our goal was to use ultrasound to quantitate the sizes of upper extremity nerves along their length in control subjects and patients with neuropathy. We measured median and ulnar nerve cross-sectional areas (NCSA) in the arms of 190 subjects, including 100 with neuropathies and 90 controls. We found that NCSAs in healthy child and adult controls were greater with increasing height, at proximal sites, and at sites of entrapment. Nerves were enlarged in all Charcot-Marie-Tooth 1A (CMT-1A) (11 of 11; 100%), most chronic inflammatory demyelinating polyneuropathy (CIDP) (31 of 36; 86%), half of Guillain-Barré syndrome (GBS) (8 of 17; 47%), but few axonal neuropathy (7 of 36, 19%) subjects. In GBS, nerve enlargement occurred early and with minimal electrodiagnostic abnormalities in some patients. We conclude that NCSA measured by ultrasound is a quantifiable marker of nerve features that should be corrected for patient characteristics and nerve site. NCSA is generally larger in demyelinating than it is in axonal polyneuropathies.

High-Resolution Ultrasonography of Peripheral Nerves: Measurements on 14 Nerve Segments in 56 Healthy Subjects and Reliability Assessments

“…The increase of CSA of the involved nerve allows precise localization in entrapment neuropathies and peripheral nerve tumors [1][2][3][4]. Moreover, enlargements of multiple nerves in acquired and hereditary polyneuropathies are also described [5][6][7][8][9]. Therefore, it is essential to compare nerve size parameters measured in patients to reference values.…”

“…On the lower limb, transverse scan of the peroneal nerve was obtained at the level of the fibular neck with the subject lying on the side, and the knee propped up and slightly flexed (20° to 30°) [5]. The tibial nerve was examined at the level of the medial malleolus, just posterior to the tibial artery.…”

“…Neurosonography provides a reliable diagnosis and localization in entrapment neuropathies, traumatic peripheral nerve injuries and tumors of the peripheral nerves, and it has become a useful supplementary tool for electrodiagnostic studies in these conditions [1][2][3][4]. Characteristic nerve size changes in polyneuropathies have been reported as well [5][6][7][8][9].…”

Ultrasound of the Hypoglossal Nerve in the Neck: Visualization and Initial Clinical Experience with Patients

“…Given that some pathologies, for example polyneuropathies, might lead to nerve thickening or thinning over a long segment, [25][26][27] in such cases, reference data might be helpful in detecting the pathology. The marginally smaller cross-sectional area of the hypoglossal nerve at the distal measurement point (1.9 versus 2.1 mm 2 ) can be explained by the branching of the ansa cervicalis.…”

The Role of Neuromuscular Ultrasound in the Diagnostic of the Chronic Inflammatory Demyelinating Polyneuropathy

“…The first description of the sonographic findings in cidP was published from Taniguchi et al 33, [39][40] although this seemed to be a promising development, it is worth noting that Zaidman et al failed to confirm these findings in a later study. 15 Systematic studies on the sensitivity and specificity of this finding failed in the literature. a novel approach to the quantification of the pathological acquired demyelinating sensory and motor neuropathy (MadSaM).…”