Abstract
Objective
Chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) are caused by inflammatory changes of peripheral nerves. It is unknown if the intra-spinal roots are also affected. This MRI study systematically visualized intra-spinal nerve roots, i.e., the ventral and dorsal roots, in patients with CIDP, MMN and motor neuron disease (MND).
Methods
We performed a cross-sectional study in 40 patients with CIDP, 27 with MMN and 34 with MND. All patients underwent an MRI scan of the cervical intra-spinal roots. We systematically measured intra-spinal nerve root sizes bilaterally in the transversal plane at C5, C6 and C7 level. We calculated mean nerve root sizes and compared them between study groups and between different clinical phenotypes using a univariate general linear model.
Results
Patients with MMN and CIDP with a motor phenotype had thicker ventral roots compared to patients with CIDP with a sensorimotor phenotype (p = 0.012), while patients with CIDP with a sensory phenotype had thicker dorsal roots compared to patients with a sensorimotor phenotype (p = 0.001) and with MND (p = 0.004).
Conclusion
We here show changes in the morphology of intra-spinal nerve roots in patients with chronic inflammatory neuropathies, compatible with their clinical phenotype.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Availability of data and materials
The data that support the findings of this study will be available on request from the corresponding author.
Code availability
Not applicable.
References
Castillo M, Mukherji SK (1996) MRI of enlarged dorsal ganglia, lumbar nerve roots, and cranial nerves in polyradiculoneuropathies. Neuroradiology 38:516–520
van Es HW, van den Berg LH, Franssen H et al (1997) Magnetic resonance imaging of the brachial plexus in patients with multifocal motor neuropathy. Neurology 48:1218–1224
Herraets IJT, Goedee HS, Telleman JA et al (2020) Nerve ultrasound for the diagnosis of chronic inflammatory neuropathy: a multicenter validation study. Neurology. https://doi.org/10.1212/WNL.0000000000010369
van den Bergh PYK, Hadden RDM, Bouche P et al (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 Peripher. Eur J Neurol 17:356–363
Vlam L, Van Der Pol WL, Cats EA et al (2012) Multifocal motor neuropathy: Diagnosis, pathogenesis and treatment strategies. Nat Rev Neurol 8:48–58
Jongbloed BA, Haakma W, Goedee HS et al (2016) Comparative study of peripheral nerve Mri and ultrasound in multifocal motor neuropathy and amyotrophic lateral sclerosis. Muscle Nerve 54:1133–1135. https://doi.org/10.1002/mus.25391
Goedee HS, Jongbloed BA, van Asseldonk J-TH et al (2017) A comparative study of brachial plexus sonography and magnetic resonance imaging in chronic inflammatory demyelinating neuropathy and multifocal motor neuropathy. Eur J Neurol 24:1307–1313
Mandija S, Froeling M, van der Kolk A et al (2019) Large field-of-view high resolution 3D imaging of the thoracolumbar nerve roots inside the spinal canal. In: ISMRM 2019 Abstracts. p 2883
Van Schaik IN, Léger JM, Nobile-Orazio E et al (2010) European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of multifocal motor neuropathy. Report of a Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society—First revis. J Peripher Nerv Syst 15:295–301
Brooks BR, Miller RG, Swash M, Munsat TL (2000) El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis. ALS Mot neuron Disord 1:293–299. https://doi.org/10.1080/146608200300079536
van Rosmalen MHJ, Goedee HS, van der Gijp A et al (2020) Quantitative assessment of brachial plexus MRI for the diagnosis of chronic inflammatory neuropathies. J Neurol. https://doi.org/10.1007/s00415-020-10232-8
Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163
Kimura J (1984) Principles and pitfalls of nerve conduction studies. Ann Neurol 16:415–429
Goedee H (2017) High-resolution ultrasound in diagnosis of polyneuropathies. ISBN 9789462336841. pp 167–190
Carvalho GA, Nikkhah G, Matthies C et al (1997) Diagnosis of root avulsions in traumatic brachial plexus injuries: Value of computerized tomography myelography and magnetic resonance imaging. J Neurosurg 86:69–76. https://doi.org/10.3171/jns.1997.86.1.0069
Wade RG, Takwoingi Y, Wormald JCR et al (2018) Magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries: protocol for a systematic review of diagnostic accuracy. Syst Rev 7:4–9. https://doi.org/10.1186/s13643-018-0737-2
Wade RG, Takwoingi Y, Wormald JCR et al (2019) MRI for detecting root avulsions in traumatic adult brachial plexus injuries: a systematic review and meta-analysis of diagnostic accuracy. Radiology 293:125–133. https://doi.org/10.1148/radiol.2019190218
Berciano J, Sedano MJ, Pelayo-Negro AL et al (2017) Proximal nerve lesions in early Guillain-Barré syndrome: implications for pathogenesis and disease classification. J Neurol 264:221–236. https://doi.org/10.1007/s00415-016-8204-2
Byun WM, Park WK, Park BH et al (1998) Guillain-Barré syndrome: MR imaging findings of the spine in eight patients. Radiology 208:137–141
Yikilmaz A, Doganay S, Gumus H et al (2010) Magnetic resonance imaging of childhood Guillain-Barré syndrome. Child’s Nerv Syst 26:1103–1108. https://doi.org/10.1007/s00381-010-1197-8
Coskun A, Kumandas S, Pac A et al (2003) Childhood Guillain-Barré syndrome: MR imaging in diagnosis and follow-up. Acta Radiol 44:230–235
Mulkey SB, Glasier CM, El-Nabbout B et al (2010) Nerve root enhancement on spinal MRI in pediatric Guillain-Barré syndrome. Pediatr Neurol 43:263–269. https://doi.org/10.1016/j.pediatrneurol.2010.05.011
Acknowledgements
This work was supported by the Prinses Beatrix Spierfonds (W.OR17-21).
Funding
This study is funded by the Prinses Beatrix Spierfonds (W.OR17-21).
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design, and revised the manuscript. MHJR: collected data, performed statistical analysis, interpreted the data and wrote the first draft of the manuscript. MF and SM: contributed to development of the MRI protocol. All authors revised the manuscript and approved with the final version of the manuscript.
Corresponding author
Ethics declarations
Conflicts of interest
M.H.J. van Rosmalen, S. Mandija and M. Froeling declare that they have no conflicts of interest. H.S. Goedee has received support from the Prinses Beatrix Spierfonds and a travel grant from Shire. W.L. van der Pol has received support from the Prinses Beatrix Spierfonds, Vriendenloterij and Stichting Spieren voor Spieren. J. Hendrikse has received research support from the Netherlands Organization for Scientific Research (NWO) under grant no. 91712322 and the European Research Council under grant agreements no. 637024.
Ethical approval
The medical ethical committee of the UMCU approved this study (18-349/NL 62866.041.17). This study was performed in line with the principles of the 1964 Declaration of Helsinki and its later amendments.
Consent to participate
Written informed consent was obtained from all study participants.
Consent for publication
Written informed consent was obtained from all study participants.
Rights and permissions
About this article
Cite this article
van Rosmalen, M.H.J., Froeling, M., Mandija, S. et al. MRI of the intraspinal nerve roots in patients with chronic inflammatory neuropathies: abnormalities correlate with clinical phenotypes. J Neurol 269, 3159–3166 (2022). https://doi.org/10.1007/s00415-021-10864-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-021-10864-4