Diagnostic value of sonography in treatment-naive chronic inflammatory neuropathies
Diagnostic value of sonography in treatment-naive chronic inflammatory neuropathies
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DOI：
10.1212/wnl.0000000000003483
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发表时间：
2017-01-10
期刊：
影响因子：
9.9
通讯作者：
van den Berg, Leonard H.
中科院分区：
文献类型：
--
作者：
Goedee, H. Stephan;van der Pol, W. Ludo;van den Berg, Leonard H.
目的：探讨高分辨率超声(HRUS)对慢性炎症性脱髓鞘多神经病(CIDP)、Lewis-Sumner综合征(LSS)和多灶性运动神经病(MMN)的诊断价值。我们进行了广泛的神经传导和标准化的双侧大臂、大腿神经和臂丛的HRUS研究。结果：正中神经前臂10 mm(2例)、上臂13 mm(2例)和臂丛主干8 mm(2例)增粗对慢性炎症性神经病具有99%的特异性。一种缩短的HRUS检测异常神经增大的方法显示出高灵敏度(83%-95%)、阳性预测价值(100%)和阴性预测价值(98%)来区分临床模拟的CIDP、LSS和MMN。结论：臂和臂丛近端正中神经节段超声增大是慢性炎症性神经病的关键特征，这有助于可靠地将它们与轴索神经病和肌萎缩性侧索硬化症区分开来。证据分类：本研究提供了II类证据，在没有提示遗传性脱髓鞘神经病的临床特征的情况下，超声显示近端正中神经节段和臂丛神经节段增大准确地识别出慢性炎症性神经病变。
Objective: To determine the diagnostic value of high-resolution ultrasound (HRUS) for detection of chronic inflammatory demyelinating polyneuropathy (CIDP), Lewis-Sumner syndrome (LSS), and multifocal motor neuropathy (MMN).Methods: Between January 2013 and January 2015, we enrolled 75 consecutive treatment-naive patients with chronic inflammatory neuropathies and 70 disease controls. We performed extensive nerve conduction and standardized HRUS studies bilaterally of large arm and leg nerves and brachial plexus. We determined optimal sonographic cutoff values of nerve size and used receiver operating characteristic analysis and logistic regression models to identify nerve combinations with optimal diagnostic performance.Results: Enlargement of median nerve at forearm >10mm(2), upper arm >13mm(2), and any trunk of brachial plexus >8 mm(2) was 99% specific for chronic inflammatory neuropathies. A shortened HRUS protocol for detecting this abnormal nerve enlargement showed high sensitivity (83%-95%), positive predictive value (100%), and negative predictive value (98%) in discriminating CIDP, LSS, and MMN from clinical mimics.Conclusions: Sonographic enlargement of proximal median nerve segments in the arms and brachial plexus is a key feature of chronic inflammatory neuropathies, which helps to reliably distinguish them from axonal neuropathies and amyotrophic lateral sclerosis.Classification of evidence: This study provides Class II evidence that, in absence of clinical features that suggest a hereditary demyelinating neuropathy, sonographic enlargement of proximal median nerve segments and brachial plexus accurately identifies patients with chronic inflammatory neuropathies.