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Diffusion tensor imaging can be used to detect lesions in peripheral nerves in patients with chronic inflammatory demyelinating polyneuropathy treated with subcutaneous immunoglobulin

  • Diagnostic Neuroradiology
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Abstract

Introduction

Magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) has shown that fractional anisotropy (FA) is lower in peripheral nerves in chronic inflammatory demyelinating polyneuropathy (CIDP). We examined whether DTI correlates to muscle strength or impairment.

Methods

MRI of sciatic and tibial nerves was performed on 3-T MR scanner by obtaining T2- and DTI-weighted sequences with fat saturation. On each slice of T2-weighted (T2w) and DTI, the tibial and sciatic nerves were segmented and served for calculation of signal intensity. On DTI images, pixel-by-pixel calculation of FA and apparent diffusion coefficient (ADC) was done. Muscle strength at knee and ankle was determined by isokinetic dynamometry and severity of CIDP by neuropathy impairment score (NIS).

Results

Fourteen CIDP patients treated with subcutaneous immunoglobulin were compared to gender- and age-matched controls. T2w values expressed as a nerve/muscle ratio (nT2w) were unchanged in CIDP versus controls 0.93 ± 0.21 versus 1.02 ± 0.21 (P = 0.10). FA values were lower in CIDP compared to controls 0.38 ± 0.07 versus 0.45 ± 0.05 (P < 0.0001), and ADC values were higher in CIDP versus controls 1735 ± 232 versus 1593 ± 116 × 10−6 mm2/s (P = 0.005). In CIDP, FA values correlated to clinical impairment (NIS) (r = −0.57, P = 0.03), but not to muscle strength. FA value in the sciatic nerve distinguishes CIDP from controls with a sensitivity and a specificity of 92.9 %.

Conclusion

CIDP patients have unchanged nT2w values, lower FA values, and higher ADC values of sciatic and tibial nerves compared to controls. FA values correlated to NIS but were unrelated to muscle strength. DTI of sciatic nerves seems promising to differentiate CIDP from controls.

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Acknowledgments

This work is funded by Octapharma, the UNIK Partnership Foundation, Siemens A/G Copenhagen, the Danish Diabetes Academy supported by the Novo Nordisk Foundation and Aarhus University, and the BEVICA Foundation.

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Authors and Affiliations

  1. Department of Neurology, Aarhus University Hospital, Noerrebrogade 44, DK-8000, Aarhus C, Denmark

    Lars H. Markvardsen, Michael Vaeggemose & Henning Andersen

  2. Department of Diagnostic Imaging: MR Research Centre, Aarhus University Hospital, Aarhus, Denmark

    Michael Vaeggemose & Steffen Ringgaard

Authors
  1. Lars H. Markvardsen
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  2. Michael Vaeggemose
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  4. Henning Andersen
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Corresponding author

Correspondence to Lars H. Markvardsen.

Ethics declarations

We declare that all human studies have been approved by the ethics committee of the Central Region of Denmark and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

LHM receives speaker fees and a travelling grant from Octapharma and Baxter. HA receives a research and travelling grant from Octapharma and CSL Behring.

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Markvardsen, L.H., Vaeggemose, M., Ringgaard, S. et al. Diffusion tensor imaging can be used to detect lesions in peripheral nerves in patients with chronic inflammatory demyelinating polyneuropathy treated with subcutaneous immunoglobulin. Neuroradiology 58, 745–752 (2016). https://doi.org/10.1007/s00234-016-1692-z

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