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Peripheral nerve ultrasound scoring systems: benchmarking and comparative analysis

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Abstract

Ultrasound of the nerves is an additive diagnostic tool to evaluate polyneuropathy. Recently, the need for standardized scoring systems has widely been discussed; different scores are described so far. Therefore, 327 patients with polyneuropathy were analyzed by ultrasound in our laboratory. Consequently, several ultrasound scoring tools were applied, i.e., the nerve pattern classification according to Padua et al. in all patients with CIDP and variants, the Bochum ultrasound score (BUS) and the neuritis ultrasound protocol in immune-mediated neuritis, the ultrasound pattern sum score, the homogeneity score, and the nerve enlargement distribution score in all neuropathies if possible. For all scores good accuracy was found. Most patients with CIDP revealed hypoechoic enlarged nerves (Class 1), the BUS/NUP was useful to identify GBS (sensitivity >85%), MMN (100%) and CIDP (>70%), while the UPSS showed high sensitivity and positive/negative predictive values (N/PPV) in the diagnosis of GBS (>70%), CIDP (>85%) and axonal non-inflammatory neuropathies (>90%). Homogeneous nerves were found in most CMT1 patients (66.7%), while immune-mediated neuropathies mostly show regional nerve enlargement. The HS was suitable to identify CMT patients with an HS ≥5 points. All scores were easily applicable with high accuracy. The former-reported results could be similarly confirmed. However, all sores have some incompleteness concerning unselected polyneuropathy population, particularly rare and focal types. Scoring systems are useful and easily applicable. They show high accuracy in certain neuropathies, but also offer some gaps and can, therefore, only be used in addition to standard diagnostic routines such as electrophysiology.

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References

  1. Dyck P, Thomas P, Griffin J et al (1993) Peripheral neuropathy, 3rd edn. W. B. Saunders Company, Philadelphia

    Google Scholar 

  2. Grimm A, Décard BF, Bischof A, Axer H (2014) Ultrasound of the peripheral nerves in systemic vasculitic neuropathies. J Neurol Sci. doi:10.1016/j.jns.2014.09.017

    PubMed  Google Scholar 

  3. Beekman R, van den Berg LH, Franssen H, Visser LH, van Asseldonk JT, Wokke JH (2005) Ultrasonography shows extensive nerve enlargements in multifocal motor neuropathy. Neurology 65(305):307

    Google Scholar 

  4. Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS (2014) Correlation of nerve ultrasound, electrophysiological and clinical findings in chronic inflammatory demyelinating polyneuropathy. J Neuroimaging. doi:10.1111/jon.12079 (Epub ahead of print)

    Google Scholar 

  5. Scheidl E, Böhm J, Simó M, Bereznai B, Bereczki D, Arányi Z (2014) Different patterns of nerve enlargement in polyneuropathy subtypes as detected by ultrasonography. Ultrasound Med Biol 35(5):459–467

    Google Scholar 

  6. Zaidman CM, Al-Lozi M, Pestronk A (2009) Peripheral nerve size in normals and patients with polyneuropathy: an ultrasound study. Muscle Nerve 40:960–966

    Article  PubMed  Google Scholar 

  7. Grimm A, Decard B, Axer H (2014) Ultrasonography of the peripheral nerve system in the early stage of Guillain-Barré syndrome. J Peripher Nerv Syst. doi:10.1111/jns.12091 (Epub ahead of print)

    PubMed  Google Scholar 

  8. 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 125:154–159

    Article  CAS  PubMed  Google Scholar 

  9. Grimm A, Heiling B, Schumacher U, Witte OW, Axer H (2014) Ultrasound differentiation of axonal and demyelinating neuropathies. Muscle Nerve 50:976–983

    Article  PubMed  Google Scholar 

  10. Lucchetta M, Padua L, Granata G et al (2014) Nerve ultrasound findings in neuropathy associated with anti-myelin-associated glycoprotein antibodies. Eur J Neurol. doi:10.1111/ene.12554 (Epub ahead of print)

    PubMed  Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. Gallardo E, Sedano MJ, Orizaola P et al. (2014) Spinal nerve involvement in early Guillain-Barré syndrome: a clinico-electrophysiological, ultrasonographic and pathological study. Clin Neurophysiol 126:810–819

    Article  PubMed  Google Scholar 

  13. Kerasnoudis A, Pitarokoili K, Gold R, Yoon MS (2015) Nerve ultrasound and electrophysiology for therapy monitoring in chronic inflammatory demyelinating polyneuropathy. J Neuroimaging. doi:10.1111/jon.12279 (Epub ahead of print)

    Google Scholar 

  14. Grimm A, Décard BF, Schramm A, Pröbstel AK, Rasenack M, Axer H, Fuhr P (2015) Ultrasound and electrophysiologic findings in patients with Guillain-Barré syndrome at disease onset and over a period of six months. Clin Neurophysiol 127(2):1657–1663

    Article  PubMed  Google Scholar 

  15. Noto Y, Shiga K, Tsuji Y, Mizuta I, Higuchi Y, Hashiguchi A, Takashima H, Nakagawa M, Mizuno T (2015) Nerve ultrasound depicts peripheral nerve enlargement in patients with genetically distinct Charcot-Marie-Tooth disease. J Neurol Neurosurg Psychiatry 86(4):378–384

    Article  PubMed  Google Scholar 

  16. Grimm A, Rasenack M, Athanasopoulou IM, Dammeier NM, Lipski C, Wolking S, Vittore D, Décard BF, Axer H (2016) The modified ultrasound pattern sum score mUPSS as additional diagnostic tool for genetically distinct hereditary neuropathies. J Neurol 263(2):221–230

    Article  CAS  PubMed  Google Scholar 

  17. Grimm A, Vittore D, Schubert V, Lipski C, Heiling B, Décard BF, Axer H (2016) Ultrasound pattern sum score, homogeneity score and regional nerve enlargement index for differentiation of demyelinating inflammatory and hereditary neuropathies. Clin Neurophysiol. (Epub ahead of print)

  18. Zaidman CM, Harms MB, Pestronk A (2013) Ultrasound of inherited vs. acquired demyelinating polyneuropathies. J Neurol 260(12):3115–3121

    Article  PubMed  PubMed Central  Google Scholar 

  19. Grimm A, Schubert V, Axer H, Ziemann U (2016) Giant nerves in chronic inflammatory polyradiculoneuropathy. Muscle Nerve. doi:10.1002/mus.25272

    Google Scholar 

  20. Padua L, Granata G, Sabatelli M et al (2014) Heterogeneity of root and nerve ultrasound pattern in CIDP patients. Clin Neurophysiol 125:160–165

    Article  CAS  PubMed  Google Scholar 

  21. Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS (2015) Bochum ultrasound score versus clinical and electrophysiological parameters in distinguishing acute-onset chronic from acute inflammatory demyelinating polyneuropathy. Muscle Nerve 51(6):846–852

    Article  PubMed  Google Scholar 

  22. Kerasnoudis A, Pitarokoili K, Haghikia A, Gold R, Yoon MS (2016) Nerve ultrasound protocol in differentiating chronic immune-mediated neuropathies. Muscle Nerve. doi:10.1002/mus.25138

    Google Scholar 

  23. Grimm A, Décard BF, Axer H, Fuhr P (2015) The ultrasound pattern sum score—UPSS. A new method to differentiate acute and subacute neuropathies using ultrasound of the peripheral nerves. Clin. Neurophysiology. doi:10.1016/j.clinph.2015.01.011

    Google Scholar 

  24. Joint Task Force of the EFNS and the PNS (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. J Peripher Nerv Syst 15:1–9

    Article  Google Scholar 

  25. Kerasnoudis A, Pitarokoili K, Gold R, Yoon MS (2015) Nerve ultrasound and electrophysiology for therapy monitoring in chronic inflammatory demyelinating polyneuropathy. J Neuroimaging 25(6):931–939

    Article  PubMed  Google Scholar 

  26. Grimm A, Vittore D, Schubert V, Rasenack M, Décard 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

    Article  PubMed  Google Scholar 

  27. 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

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sugimoto T, Ochi K, Hosomi N, Takahashi T, Ueno H, Nakamura T, Nagano Y, Maruyama H, Kohriyama T, Matsumoto M (2013) 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 260(10):2580–2587

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research Eberhard-Karls University Tübingen, Tübingen, Germany

    Alexander Grimm, Tim W. Rattay & Natalie Winter

  2. German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany

    Tim W. Rattay

  3. Hans Berger Department of Neurology, Jena University Hospital Friedrich-Schiller University Jena, Jena, Germany

    Hubertus Axer

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  1. Alexander Grimm
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  2. Tim W. Rattay
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  3. Natalie Winter
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  4. Hubertus Axer
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Correspondence to Alexander Grimm.

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Alexander Grimm, Tim W. Rattay and Natalie Winter participated in study design, acquisition of data, analysis and interpretation of data, and helped to draft the manuscript. Hubertus Axer participated in the design of the study, was involved in the analysis and interpretation of data, and helped to draft the manuscript. All authors read, critically revised and approved the final manuscript.

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Grimm, A., Rattay, T.W., Winter, N. et al. Peripheral nerve ultrasound scoring systems: benchmarking and comparative analysis. J Neurol 264, 243–253 (2017). https://doi.org/10.1007/s00415-016-8305-y

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  • DOI: https://doi.org/10.1007/s00415-016-8305-y

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