Ultrasound and EMG–NCV study (electromyography and nerve conduction velocity) correlation in diagnosis of nerve pathologies

Abstract

Purpose

Nerve disorders are commonly encountered in clinical practice. Ultrasonography (USG) is a useful modality in the evaluation of most of the peripheral and superficial pathologies amenable to penetration by ultrasound. The primary objective is to study the USG findings of various peripheral nerve pathologies and to correlate them with electrophysiological (EMG–NCV) findings.

Method

42 patients referred with suspicion of peripheral nervous system affection were evaluated with USG along with EMG–NCV. After reviewing detailed anatomy of the region, the affected nerve was visualized along the major neurovascular bundle or at a known anatomical landmark with a high-frequency (9–20 MHz) linear/hockey stick transducer.

Results

The USG parameters, namely loss of fibrillary pattern, hypoechogenicity and nerve thickening, showed significant p value (p < 0.05) on the tests of significance, suggesting these parameters are significant predictors of nerve affection/pathology on USG. Each ultrasound parameter was correlated individually with SNAP and CMAP. The results revealed positive correlation of echogenicity (r = 0.210, p = 0.05), fibrillary pattern (r = 0.209, p = 0.05) and thickening (r = 0.387, p < 0.05) with sensory nerve action potential (SNAP) and compound muscle action potential (CMAP).

Conclusion

USG can be used as corroborative investigation to strengthen the findings of EMG–NCV. This combination represents a powerful tool in enabling appropriate planning for treatment, preventing unnecessary intervention and thus improving overall outcomes in patients with peripheral neuropathy.

Sommario

Obiettivo

le malattie neurologiche periferiche sono comuni nella pratica clinica. L’ ecografia (US) è una modalità utile nella valutazione della maggior parte delle patologie periferiche e superficiali. L’ obiettivo primario del lavoro è studiare i reperti delle varie patologie del nervo periferico e correlarli con quelli elettrofisiologici (EMG–NCV).

Metodo

42 Pazienti con sospette patologie del sistema nervoso periferico sono stati valutati con US ed EMG–NCV. Dopo un dettagliato studio anatomico della regione, il nervo affetto è stato visualizzato lungo tutto il fascio neurovascolare o in prossimità di un repere anatomico noto, con una sonda lineare/hockey stick ad alta frequenza (9-20 MHz).

Risultati

alcuni parametri ecografici quali la perdita del pattern fibrillare, l’ ipoecogenicità e l’ ispessimento del nervo hanno mostrato un p value significativo (p < 0.05), suggerendo che essi sono indicatrori ecografici affidabili della patologia dei nervi. Ogni parametro ecografico è stato correlato singolarmente con il SNAP ed il CMAP. I risultati hanno rivelato una correlazione positiva tra ecogenicità (r = 0.210; p = 0.05), pattern fibrillare (r = 0.209; p = 0.05), ispessimento (r = 0.387; p < 0.05) ed il potenziale d’ azione del nervo sensitivo (SNAP) ed il potenziale d’ azione della componente muscolare.

Conclusioni

L’ ecografia può essere utilizzata come strumento diagnostico aggiuntivo per aumentare l’accuratezza dei reperti EMG–NCV. Questa combinazione rappresenta un valido strumento al fine di programmare il trattamento, prevenire interventi non necessari e conseguentemente migliorare l’ outcome dei Pazienti con neuropatia periferica.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

References

  1. 1.

    Lawande AD, Warrier SS, Joshi MS (2014) Role of ultrasound in evaluation of peripheral nerves. Indian J Radiol Imaging 24(3):254–258

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Willis JD (1999) A non-neurologist’s guide to understanding the EMG/NCV report. Clin Podiatr Med Surg 16(1):19–28

    CAS  PubMed  Google Scholar 

  3. 3.

    Silvestri E et al (1995) Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Radiology 197(1):291–296

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Martinoli C et al (1996) Ultrasonography of peripheral nerves. J Peripher Nerv Syst 1(3):169–178

    CAS  PubMed  Google Scholar 

  5. 5.

    Martinoli C, Bianchi S, Derchi LE (2000) Ultrasonography of peripheral nerves. Semin Ultrasound CT MR 21(3):205–213

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Demondion X et al (2003) Sonographic mapping of the normal brachial plexus. AJNR Am J Neuroradiol 24(7):1303–1309

    PubMed  Google Scholar 

  7. 7.

    Burnett MG, Zager EL (2004) Pathophysiology of peripheral nerve injury: a brief review. Neurosurg Focus 16(5):E1

    Article  PubMed  Google Scholar 

  8. 8.

    Umans H et al (2010) Sonographic assessment of volar digital nerve injury in the context of penetrating trauma. AJR Am J Roentgenol 194(5):1310–1313

    Article  PubMed  Google Scholar 

  9. 9.

    Lee FC et al (2011) High-resolution ultrasonography in the diagnosis and intraoperative management of peripheral nerve lesions. J Neurosurg 114(1):206–211

    Article  PubMed  Google Scholar 

  10. 10.

    Koenig RW et al (2011) Intraoperative high-resolution ultrasound: a new technique in the management of peripheral nerve disorders. J Neurosurg 114(2):514–521

    Article  PubMed  Google Scholar 

  11. 11.

    Peer S et al (2002) High-resolution sonography of lower extremity peripheral nerves: anatomic correlation and spectrum of disease. J Ultrasound Med 21(3):315–322

    Article  PubMed  Google Scholar 

  12. 12.

    Martinoli C et al (2002) Brachial plexus sonography: a technique for assessing the root level. AJR Am J Roentgenol 179(3):699–702

    Article  PubMed  Google Scholar 

  13. 13.

    Kerasnoudis A (2013) Nerve ultrasound in a case of chronic inflammatory demyelinating neuropathy. Muscle Nerve 47(3):443–446

    Article  PubMed  Google Scholar 

  14. 14.

    Goedee HS, Brekelmans GJ, Visser LH (2014) Multifocal enlargement and increased vascularization of peripheral nerves detected by sonography in CIDP: a pilot study. Clin Neurophysiol 125(1):154–159

    CAS  Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Shilpa Domkundwar.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Domkundwar, S., Autkar, G., Khadilkar, S.V. et al. Ultrasound and EMG–NCV study (electromyography and nerve conduction velocity) correlation in diagnosis of nerve pathologies. J Ultrasound 20, 111–122 (2017). https://doi.org/10.1007/s40477-016-0232-3

Download citation

Keywords

  • Nerve
  • EMG–NCV
  • Ultrasound
  • SNAP
  • CMAP
  • Trauma