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


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.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 199

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Van den Bergh PY, Hadden RD, Bouche P, Cornblath DR, Hahn A, Illa I, Koski CL, Leger JM, Nobile-Orazio E, Pollard J, Sommer C, van Doorn PA, van Schaik IN, European Federation of Neurological S, Peripheral Nerve S (2010) European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society—first revision. Eur J Neurol 17(3):356–363. doi:10.1111/j.1468-1331.2009.02930.x

  2. 2.

    Adachi Y, Sato N, Okamoto T, Sasaki M, Komaki H, Yamashita F, Kida J, Takahashi T, Matsuda H (2011) Brachial and lumbar plexuses in chronic inflammatory demyelinating polyradiculoneuropathy: MRI assessment including apparent diffusion coefficient. Neuroradiology 53(1):3–11. doi:10.1007/s00234-010-0684-7

  3. 3.

    Duggins AJ, McLeod JG, Pollard JD, Davies L, Yang F, Thompson EO, Soper JR (1999) Spinal root and plexus hypertrophy in chronic inflammatory demyelinating polyneuropathy. Brain 122(Pt 7):1383–1390

  4. 4.

    Lozeron P, Lacour MC, Vandendries C, Theaudin M, Cauquil C, Denier C, Lacroix C, Adams D (2016) Contribution of plexus MRI in the diagnosis of atypical chronic inflammatory demyelinating polyneuropathies. J Neurol Sci 360:170–175. doi:10.1016/j.jns.2015.11.048

  5. 5.

    Shibuya K, Sugiyama A, Ito S, Misawa S, Sekiguchi Y, Mitsuma S, Iwai Y, Watanabe K, Shimada H, Kawaguchi H, Suhara T, Yokota H, Matsumoto H, Kuwabara S (2015) Reconstruction magnetic resonance neurography in chronic inflammatory demyelinating polyneuropathy. Ann Neurol 77(2):333–337. doi:10.1002/ana.24314

  6. 6.

    Di Pasquale A, Morino S, Loreti S, Bucci E, Vanacore N, Antonini G (2015) Peripheral nerve ultrasound changes in CIDP and correlations with nerve conduction velocity. Neurology 84(8):803–809. doi:10.1212/WNL.0000000000001291

  7. 7.

    Goedee HS, van der Pol WL, van Asseldonk JH, Franssen H, Notermans NC, Vrancken AJ, van Es MA, Nikolakopoulos S, Visser LH, van den Berg LH (2016) Diagnostic value of sonography in treatment-naive chronic inflammatory neuropathies. Neurology. doi:10.1212/WNL.0000000000003483

  8. 8.

    Grimm A, Vittore D, Schubert V, Rasenack M, Decard BF, Heiling B, Hammer N, Axer H (2016) Ultrasound aspects in therapy-naive CIDP compared to long-term treated CIDP. J Neurol 263(6):1074–1082. doi:10.1007/s00415-016-8100-9

  9. 9.

    Merola A, Rosso M, Romagnolo A, Peci E, Cocito D (2016) Peripheral nerve ultrasonography in chronic inflammatory demyelinating polyradiculoneuropathy and multifocal motor neuropathy: correlations with clinical and neurophysiological data. Neurol Res Int 2016:9478593. doi:10.1155/2016/9478593

  10. 10.

    Zaidman CM, Pestronk A (2014) Nerve size in chronic inflammatory demyelinating neuropathy varies with disease activity and therapy response over time: a retrospective ultrasound study. Muscle Nerve 50(5):733–738. doi:10.1002/mus.24227

  11. 11.

    Rizzuto N, Morbin M, Cavallaro T, Ferrari S, Fallahi M, Galiazzo Rizzuto S (1998) Focal lesions area feature of chronic inflammatory demyelinating polyneuropathy (CIDP). Acta Neuropathol 96(6):603–609

  12. 12.

    Merkies IS, Schmitz PI, van der Meche FG, Samijn JP, van Doorn PA, Inflammatory Neuropathy C, Treatment g (2002) Clinimetric evaluation of a new overall disability scale in immune mediated polyneuropathies. J Neurol Neurosurg Psychiatry 72(5):596–601

  13. 13.

    Stöhr M (2014) Klinische Elektromyographie und Neurographie, 6th edn. Koehlhammer, Stuttgart

  14. 14.

    Milford D, Rosbach N, Bendszus M, Heiland S (2015) Mono-exponential fitting in T2-relaxometry: relevance of offset and first echo. PLoS One 10(12):e0145255. doi:10.1371/journal.pone.0145255

  15. 15.

    Thorpe JW, Barker GJ, Jones SJ, Moseley I, Losseff N, MacManus DG, Webb S, Mortimer C, Plummer DL, Tofts PS et al (1995) Magnetisation transfer ratios and transverse magnetisation decay curves in optic neuritis: correlation with clinical findings and electrophysiology. J Neurol Neurosurg Psychiatry 59(5):487–492

  16. 16.

    Tofts P (2005) Quantitative MRI of the brain: measuring changes caused by disease, 1st edn. Wiley, Oxford

  17. 17.

    Baumer P, Weiler M, Bendszus M, Pham M (2015) Somatotopic fascicular organization of the human sciatic nerve demonstrated by MR neurography. Neurology 84(17):1782–1787. doi:10.1212/WNL.0000000000001526

  18. 18.

    Ishikawa T, Asakura K, Mizutani Y, Ueda A, Murate KI, Hikichi C, Shima S, Kizawa M, Komori M, Murayama K, Toyama H, Ito S, Mutoh T (2016) MR neurography for the evaluation of CIDP. Muscle Nerve. doi:10.1002/mus.25368

  19. 19.

    Tanaka K, Mori N, Yokota Y, Suenaga T (2013) MRI of the cervical nerve roots in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy: a single-institution, retrospective case-control study. BMJ Open 3(8):e003443. doi:10.1136/bmjopen-2013-003443

  20. 20.

    Tazawa K, Matsuda M, Yoshida T, Shimojima Y, Gono T, Morita H, Kaneko T, Ueda H, Ikeda S (2008) Spinal nerve root hypertrophy on MRI: clinical significance in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy. Intern Med 47(23):2019–2024

  21. 21.

    MacKay A, Whittall K, Adler J, Li D, Paty D, Graeb D (1994) In vivo visualization of myelin water in brain by magnetic resonance. Magn Reson Med 31(6):673–677

  22. 22.

    Tofts PS, du Boulay EP (1990) Towards quantitative measurements of relaxation times and other parameters in the brain. Neuroradiology 32(5):407–415

  23. 23.

    Tofts P (2003) Proton density of tissue water. In: Tofts P (ed) Quantitative MRI of the brain: measuring changes caused by disease. Wiley, Oxford, pp 83–108

  24. 24.

    Pham M, Oikonomou D, Hornung B, Weiler M, Heiland S, Baumer P, Kollmer J, Nawroth PP, Bendszus M (2015) Magnetic resonance neurography detects diabetic neuropathy early and with Proximal Predominance. Ann Neurol 78(6):939–948. doi:10.1002/ana.24524

  25. 25.

    Kollmer J, Hund E, Hornung B, Hegenbart U, Schonland SO, Kimmich C, Kristen AV, Purrucker J, Rocken C, Heiland S, Bendszus M, Pham M (2015) In vivo detection of nerve injury in familial amyloid polyneuropathy by magnetic resonance neurography. Brain 138(Pt 3):549–562. doi:10.1093/brain/awu344

Download references

Author information

Correspondence to Moritz Kronlage.

Ethics declarations

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.

Ethical standards

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.

Informed consent

Written informed consent was obtained from all participants.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 2 (M4 V 4899 kb)

Supplementary material 3 (M4 V 5825 kb)

Supplementary material 4 (M4 V 4834 kb)

Supplementary material 5 (M4 V 4394 kb)

Supplementary material 1 (PDF 40 kb)

Supplementary material 2 (M4 V 4899 kb)

Supplementary material 3 (M4 V 5825 kb)

Supplementary material 4 (M4 V 4834 kb)

Supplementary material 5 (M4 V 4394 kb)

Supplementary material 6 (PDF 16 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation


  • MRI
  • Chronic inflammatory demyelinating polyneuropathy
  • Electrophysiology