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Large coverage MR neurography in CIDP: diagnostic accuracy and electrophysiological correlation

Abstract

The objective of this study was to evaluate large coverage magnetic resonance neurography (MRN) in chronic inflammatory demyelinating polyneuropathy (CIDP). In this prospective study, 18 patients with CIDP and 18 healthy controls were examined by a standardized MRN protocol at 3 T. Lumbosacral plexus was imaged by a T2-weighted 3D sequence and peripheral nerves of the upper and lower extremity by axial T2-weighted turbo spin-echo sequences. Lesions were characterized by nerve cross-sectional area (CSA) and T2-weighted signal (nT2). Additionally, T2 relaxometry of the sciatic nerve was performed using a multi-spin-echo sequence. All patients received a complementary electrophysiological exam. Patients with CIDP exhibited increased nerve CSA and nT2 compared to controls (p < 0.05) in a proximally predominating pattern. Receiver operating characteristic analysis revealed the best diagnostic accuracy for CSA of the lumbosacral plexus (AUC = 0.88) and nT2 of the sciatic nerve (AUC = 0.88). CSA correlated with multiple electrophysiological parameters of demyelinating neuropathy (F wave latency, nerve conduction velocity) of sciatic and median nerve, while nT2 only correlated with F wave latency of sciatic and not median nerve. T2 relaxometry indicated that MR signal increase in CIDP was due to an increase in proton-spin-density (p < 0.05), and not due to the increase in T2 relaxation time. Both nT2 and CSA might aid in the diagnosis of CIDP, but CSA correlates more robustly with established electrophysiological parameters for CIDP. Since the best diagnostic accuracy was shown for proximal nerve locations, MRN may be a useful complementary tool in selected CIDP cases.

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Correspondence to Moritz Kronlage.

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Conflicts of interest

Kalliopi Pitarokoili received travel Grants from Biogen Idec and Bayer Pharmaceuticals and speakers’ honoraria from Biogen Idec. Ralf Rold received speaker’s fees and board honoraria from Baxter, Bayer Schering, Biogen Idec, Chugai, CLB Behring, Genzyme, Merck Serono, Novartis, Talecris, TEVA and Wyeth. RG’s department received Grant support from Bayer Schering, BiogenIdec, Genzyme, Merck Serono, Novartis and TEVA. Martin Bendszus received Grants and personal fees from Novartis, Guerbet and Codman; personal fees from Vascular Dynamics, Roche, Teva, Springer, Boehringer and Bayer Vital; and Grants from Siemens, Hopp Foundation, Stryker, Medtronic and DFG, all not related to the current study. Min-Suk Yoon received a scientific Grant from CSL Behring and speakers’ honoraria from CSL Behring, Grifols. Moritz Kronlage, Philipp Bäumer, Daniel Schwarz, Véronique Schwehr, Tim Godel and Sabine Heiland report no disclosures.

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This study was approved by the institutional ethics committee. The study was conducted in accordance with the ethical standards laid down in the declaration of Helsinki of 1964 and its later amendments.

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Written informed consent was obtained from all participants.

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Kronlage, M., Bäumer, P., Pitarokoili, K. et al. Large coverage MR neurography in CIDP: diagnostic accuracy and electrophysiological correlation. J Neurol 264, 1434–1443 (2017) doi:10.1007/s00415-017-8543-7

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Keywords

  • MRI
  • Chronic inflammatory demyelinating polyneuropathy
  • Electrophysiology