Die Sonografie der peripheren Nerven hat sich in den letzten Jahren zu einem festen Bestandteil der Diagnostik neuromuskulärer Erkrankungen entwickelt. Dieses nicht invasive, schmerzlose, zeitsparende und schnell verfügbare Verfahren liefert ergänzend zur elektrophysiologischen Untersuchung Informationen über Ursache der Kompression und Lage der Engstelle. Es wird aber auch als Alternative bei Patienten eingesetzt, bei denen elektrophysiologische Untersuchungen nicht durchführbar sind.
Literatur
Fornage BD. Peripheral nerves of the extremities: imaging with US. Radiology. 1988;167:179–182
Viviano SL, Chandler LK, Keith JD. Ultrahigh Frequency Ultrasound Imaging of the Hand: A New Diagnostic Tool for Hand Surgery. HAND 2018, 13(6): 720–25
Stokvis A, van Neck JW, van Dijke CF, van Wamel A, Coert JH. High-resolution ultrasonography of the cutaneous nerve branches in the hand and wrist. J Hand Surg Eur Vol 2009; 34:766–771
Grimm A, Axer H, Heiling B, Winter N. Nerve ultrasound normal values — Readjustment of the ultrasound pattern sum score UPSS. Clin Neurophysiol. 2018;129(7):1403–1409
Cartwright MS, Chloros GD, Walker FO, et al. Diagnostic ultrasound for nerve transection. Muscle Nerve 2007;35 (6):796–9
Cartwright MS, Shin HW, Passmore LV, Walker FO. Ultrasonographic findings of the ulnar nerve in adults. Arch Phys Med Rehabil 2007; 88:394–396
Cartwright MS, Passmore LV, Yoon J et al. Cross-sectional area reference values for nerve ultrasonography. Muscle Nerve 2008;37:566–571
Cartwright MS, Mayans DR, Gillson NA, et al. Nerve cross-sectional area in extremes of age. Muscle Nerve 2013;47:890–893
Zaidman CM, Lozi MA, Pestronk A. Peripheral nerve size in normals and patients with polyneuropathy: an ultrasound study. Muscle Nerve. 2009;40:733–738
Kronlage M, Schwehr V, Schwarz D, et al. Magnetic Resonance Neurography: Normal Values and Demographic Determinants of Nerve Caliber and T2 Relaxometry in 60 healthy individuals. Clin Neuroradiol. 2017 [Epub ahead of print]
Bäumer T, Grimm A, Schelle T. Diagnostische Nervensonographie. Radiologe 2017;57:157–165
Leitlinie der Deutschen Gesellschaft für Neurologie — Karpaltunnelsyndrom. (2008). [epdf] p.1. Available at: https://www.dgn.org/images/red_leitlinien/LL_2008/archiv/ll08kap_049.pdf [Accessed 8 Dec. 2018].
Donato G, Galasso O, Valentino P et al. Pathological findings in subsynovial tissue in idiopathic carpal tunnel syndrome. Clin Neurophathol. 2009;28:129–35
Cartwright MS, Hobson-Webb LD, Boon AJ, et al. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve 2012; 46: 287–293
Tai TW, Wu CY, Su FC, Chern TC, Jou IM. Ultrasonography for diagnosing carpal tunnel syndrome: a meta-analysis of diagnostic test accuracy. Ultrasound Med Biol 2012;38:1121–28
Visser LH, Smidt MH, Lee ML. High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome. J Neurol Neurosurg Psychiatr 2008; 79:63–67
Baumer T, Buhring N, Schelle T, Munchau A, Muschol N. Nerve ultrasound in clinical management of carpal tunnel syndrome in mucopolysaccharidosis. Dev Med Child Neurol 2016;58:1172–1179
Hobson-Webb LD, Massey JM, Juel VC, Sanders DB. The ultrasonographic wrist-to-forearm median nerve area ratio in carpal tunnel syndrome. Clin Neurophysiol 2008;119:1353–1357
Karadag YS, Karadag O, Cicekli E, et al. Severity of Carpal tunnel syndrome assessed with high frequency ultrasonography. Rheumatol Int 2010;30:761–765
Mohammadi A, Ghasemi-Rad M; Mladkova-Suchy N, Ansari S. Correlation between the severity of carpal tunnel syndrome and color Doppler sonography findings. AJR Am J Roentgenol. 2012; 198:W181–184
Evans KD, Roll SC, Volz KR, Freimer M. Relationship between intraneural vascular flow measured with sonography and carpal tunnel syndrome diagnosis based on electrodiagnostic testing. J Ultrasound Med. 2012; 31:729–736
Padua L, Pazzaglia C, Caliandro P, et al. Carpal tunnel syndrome: ultrasound, neurophysiology, clinical and patient-oriented assessment. Clin Neurophysiol 2008; 119:2064–2069
Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a metaanalysis. Clin Orthop Relat Res. 2011; 469:1089–94
Kerasnoudis A, Tsivgoulis G. Nerve ultrasound in peripheral neuropathies: a review. J Neuroimaging 2015; 25:528–538
Klauser AS, Halpern EJ, Faschingbauer R et al. Bifid median nerve in carpal tunnel syndrome: assessment with US cross-sectional area measurement. Radiology 2011;259:808–815
Cartwright MS, Walker FO, Newman JC, et al. Muscle intrusion as a potential cause of carpal tunnel syndrome. Muscle Nerve 2014;50:517–522.
Abicalaf CA, de Barros N, Sernik RA, et al. Ultraosund evaluation of patients with carpal tunnel syndrome before and after endoscopic release of the transverse carpal ligament. Clin Radiol. 2007;62:891–894
Smidt MH, Visser LH. Carpal tunnel syndrome: clinical and sonographic follow-up after surgery. Muscle Nerve 2008;38:987–991
Vögelin E, Nüesch E, Jüni P, et al. Sonographic follow-up of patients with carpal tunnel syndrome undergoing surgical or nonsurgical treatment: prospective cohort study. J Hand Surg Am. 2010;39:409–412
Kim JY, Yoon JS, Kim SJ, Won SJ, Jeong JS. Carpal tunnel syndrome: clinical, electrophysiological, and ultrasonographic ratio after surgery. Muscle Nerve 2012;45:183–188
Lee CH, Kim TK, Yoon ES, Dhong ES. Postoperative morphologic analysis of carpal tunnel syndrome using high-resolution ultrasonography. Ann Plast Surg 2005; 54:143–146
Suk J, Walker FO, Cartwrigth MS. Ultrasound of the peripheral nerves. Curr Neurol Neurosci Rep. 2013;13:328
Karabay N, Kayalar M, Ada S; Sonographic assessment of transverse carpal ligament after open surgical release of the carpal tunnel. Acta Orthop Traumatol Turc 2013;47:73–78
Schelle T, Schneider W. Is high resolution ultrasound of the median nerve helpful before reintervention after failed carpal tunnel surgery? Handchir Mikrochir Plast Chir 2011;43:313–316
Bayrak AO, Bayrak IK, Turker H, Elmali M, Nural MS. Ultrasonography in patients with ulnar neuropathy at the elbow: comparison of cross-sectional area and swelling ratio with electrophysiological severity. Muscle Nerve 2010;41:661–666
Kim JH, Won SJ, Rhee WI, Park HJ, Hong HM. Diagnostic cutoff value for ultrasonography in the ulnar neuropathy at the elbow. Ann Rehabil Med 2015;39:170–175
Yoon JS, Walker FO, Cartwright MS. Ultrasonographic swelling ratio in the diagnosis of ulnar neuropathy at the elbow. Muscle Nerve 2008;38:1231–1235
Scheidl E, Bohm J, Farbaky Z, Simo M, Bereczki D, Aranyi. Ultrasonography of ulnar neuropathy at the elbow: axonal involvement leads to greater nerve swelling than demyelinating nerve lesion. Clin Neurophysiol 2013;124:619–625
Frijlink DW, Brekelmans GJ, Visser LH. Increased nerve vascularization detected by color Doppler sonography in patients with ulnar neuropathy at the elbow indicates axonal damage. Muscle Nerve 2013;47:188–193
Ng ES, Vijayan J, Therimadasamy A, et al. The added value of preoperative ultrasonography of the ulnar nerve: an observational study. MuscleNerve 2010;42:613–614
Ng ES, Vijayan J, Therimadasamy AK, et al. High resolution ultrasonography in the diagnosis of ulnar nerve lesions with particular reference to post-traumatic lesions and sites outside the elbow. Clin Neurophysiol 2010;122(1):188–193.
Yoo MJ, Kim D, Oh-Park M. Exacerbation of habitual dislocation of ulnar nerve by concurrent dislocation of triceps muscle: complementary role of dynamic ultrasonography to electrodiagnosis. Am J Phys Med Rehabil 2007;86:1030
Beckman R, Van Der Plas JP, Uitdehaag BM, et al. Clinical, electrodiagnostic, and sonographic studies in ulnar neuropathy at the elbow. Muscle Nerve 2004;30:202–208
Padua L, Di Pasquale A, Liotta G, et al. Ultrasound as a useful tool in the diagnosis and management of traumatic nerve lesions, Clin Neurophysiol 2013;124:1237–43
Lee FC, Singh H, Nazarian LN, Ratliff JK. High-resolution ultrasonsography in the diagnosis and intraoperative management of peripheral nerve lesions. J Neurosurg 2011;114:206–11
Tang P, Wang Y, Zhang L, He C, Liu X. Sonographic evaluation of peripheral nerve injuries following the Wen-chuan earthquake. J Clin Ultrasound. 2012;40:7–13
Chiou HJ, Chou YH, Chiou SY, Liu JB, Chang CY. Peripheral nerve lesions: role of high-resolution US. Radiographics 2003;23:e15
Gruber H, Peer S, Meirer R, Bodner G. Peroneal nerve palsy associated with knee luxation: evaluation by sonography — initial experiences. AJR 2005;185:1119–25
Toros T, Karabay N, Ozaksar K et al. Evaluation of peripheral nerves of the upper limb with ultrasonography: a comparison of ultrasonographic examination and the intra-operative findings. J Bone Joint Surg (Br) 2009;91:762–5
Peer S, Bodner G, Meirer R, Willeit J, Piza-Katzer H. Examination of postoperative peripheral nerve lesions with high-resolution sonography. AJR 2001;177:415–9
Beekman R, Visser LH. High-resolution sonography of the peripheral nervous system — a review of the literature. Europ J Neurol 2004;11:305–14
Hollister AM et al. High frequency ultrasound evaluation of traumatic peripheral nerve injuries. Neurol Res. 2012;34:98–103
Karabay N, Toros T, Ademoglu Y, Ada S. Ultrasonographic evaluation of the iatrogenic peripheral nerve injuries in upper extremity. Eur J Radiol 2010; 73:234–40
Koenig RW et al. High-resolution ultrasonography in evaluating peripheral nerve entrapment and trauma. Neuro-surgical focus 2009;26 (2) pp. E13
Lee FC, Singh H, Nazarian LN, Ratliff JK. High-resolution ultrasonography in the diagnosis and intraoperative management of peripheral nerve lesions. J Neurosurg 2011;114:206–11
Grimm A, Decard BF, Axer H. Ultrasonography of the peripheral nervous system in the early stage of Guillain-Barre syndrome. J Peripher Nerv Syst 2014;19:234–241
Scheidl E, Bohm J, Simo M, Bereznai B, Bereczki D, Aranyi Z. Different patterns of nerve enlargement in polyneuropathy subtypes as detected by ultrasonography. Ultrasound Med Biol 2014;40:1138–1145
Zaidman CM, Harms MB, Pestronk A. Ultrasound of inherited vs. acquired demyelinating polyneuropathies. J Neurol 2013;260:3115–3121
Goedee HS, Brekelmans GJ, Visser LH. Multifocal enlargement and increased vascularization of peripheral nerves detected by sonography in CIDP: a pilot study. Clin Neurophysiol 2014;125:154–159
Visser LH, Jain S, Lokesh B, Suneetha S, Subbanna J. Morphological changes of the epineurium in leprosy: a new finding detected by high resolution sonography. Muscle Nerve 2012;46:38–41
Grimm A, Hubertus A. Chronisch immunvermittelte Neuropathien. Fortschr. Neurol Psychiatr 2018; 86:439–452
Latov N. Diagnosis and treatment of chronic acquired demyelinating polyneuropathies. Nat Rev Neurol 2014; 10: 435–446
Dalakas MC. Advances in the diagnosis, pathogenesis and treatment of CIDP. Nat Rev Neurol 2011; 7: 507–517
Sinnreich M, Klein CJ, Daube JR et al. Chronic immune sensory polyradiculopathy: a possibly treatable sensory ataxia. Neurology 2004;63:1662–1669
Gasparotti R, Padua L, Briani C, et al. New technologies for the assessment of neuropathies. Nat Rev Neurol 2017;13:203–216
Grimm A, Vittore D, Schubert V, et al. Ultrasound aspects in therapy- CIDP compared to long-term treated CIDP. J Neurol. 2016;263:1074–1082
Härtig F, Ross M, Dammeier NM, et al. Nerve Ultrasound Predicts Treatment Response in Chronic Inflammatory Demyelinating Polyradiculoneuropathy-a Prospective Follow-Up. Neurotherapeutics. 2018; 15(2):439–451
Almeida V, Mariotti P, Veltri S, Erra C, Padua L. Nerve ultrasound follow-up in a child with Guillain-Barré syndrome. Muscle Nerve. 2012;46:270–275.
Telleman JA, Grimm A, Goedee S, Visser LH, Zaidman C. Nerve ultrasound in polyneuropathies. Muscle Nerve. 2018;57(5):716–728.
Adachi Y, Sato N, Okamoto T, et al. Brachial and lumbar plexuses in chronic inflammatory demyelinating polyradiculopathy: MRI assessment including apparent diffusion coefficient. Neuroradiology. 2011;53:3–11
Shen J, Cartwright M. Neuromuscular Ultrasound in the Assessment of Polyneuropathies and Motor Neuron Disease. J Clin Neurophysiol. 2016;33(2): 86–93
Nobile-Orazio E, Gallia F. Multifocal motor neuropathy: current therapies and novel strategies. Drugs 2013; 73: 397–406
Rattay TW, Winter N, Décard B et al. Nerve ultrasound as follow-up tool in treated multifocal motor neuropathy. Eur J Neurol 2017; 24: 1125–1134
Gwathmey KG, Burns TM, Collins MP, et al. Vasculitic neuropathies. Lancet Neurol 2014;13:67–82
Burns TM, Schaublin GA, Dyck PJB. Vasculitic neuropathies. Neurol Clin 2007;25:89–113
Grimm A, Décard BF, Bischof A et al. Ultrasound of the peripheral nerves in systemic vasculitic neuropathies. J Neurol Sci 2014;347:44–49
Heinemeyer O, Reimers CD. Ultrasound of radial, ulnar, medial, and sciatic nerves in healthy subjects and patients with hereditary motor and sensory neuropathies. Ultrasound Med Biol. 1999;25:481–485
Martinoli C, Schenone A, Bianchi S, et al. Sonography of the median nerve in Charcot-Marie-Tooth disease. AJR AM J Roentgenol. 2002; 178:1553–1556
Grimm A, Rasenack M, Athanasopoulou IM et al (2016b) The modified ultrasound pattern sum score mUPSS as additional diagnostic tool for genetically distinct hereditary neuropathies. J Neurol 263:221–230
Noto Y, Shiga K, Tsuji Y, et al. Nerve ultrasound depicts peripheral nerve enlargement in patients with genetically distinct Charcot-Marie-Tooth disease. J Neurol Neurosurg Psychiatr 2015;86:378–384
Schreiber S, Oldag A, Kornblum C, et al. Sonography of the median nerve in CMT1A, CMT2A, CMTX, and HNPP. Muscle Nerve 2013;47:385–395
Sugimoto T, Ochi K, Hosomi N et al. Ultrasonographic nerve enlargement of the median and ulnar nerves and the cervical nerve roots in patients with demyelinating Charcot-Marie-Tooth disease: distinction from patients with chronic inflammatory demyelinating polyneuropathy. J Neurol 2013;260:2580–2587
Hooper DR, Lawson W, Smith L, Baker SK. Sonographic features in hereditary neuropathy with liability to pressure palsies. Muscle Nerve 2011;44:862–867.
Lucchetta M, Dalla Torre C, Granata G, Briani C, Padua L. Sonographic features in hereditary neuropathy with liability to pressure palsies. Muscle Nerve 2012;45:920–921
Grimm A, Vittore D, Schubert V, et al. Ultrasound pattern sum score, homogeneity score and regional nerve enlargement index for differentiation of demyelinating inflammatory and hereditary neuropathies. Clin Neurophysiol 2016;127: 2618–2624
Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS. Nerve ultrasound score in distinguishing chronic from acute inflammatory demyelinating polyneuropathy. Clin Neurophysiol 2014;125:635–641
Kerasnoudis A, Pitarokoili K, Gold R, Yoon MS. Bochum ultrasound score allows distinction of chronic inflammatory from multifocal acquired demyelinating polyneuropathies. J Neurol Sci 2015;348: 211–215
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Winter, N., Grimm, A. Neurosonografie erleichtert Diagnostik von Polyneuropathien. DNP 20, 24–30 (2019). https://doi.org/10.1007/s15202-019-2138-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15202-019-2138-3