Submitted by: Elliot Bodofsky, MD
Edited by: Clark W. Pinyan, MD, MPH
Walker F, Cartwright M, Alter K, et al. Indications for neuromuscular ultrasound: Expert opinion and review of the literature
. Clinical Neurophysiology
, 2018, 129:2658-79.
In this study, 19 worldwide experts in clinical neurophysiology (neurologists, physiatrists and neurophysiologists) completed detailed surveys about indications for diagnostic ultrasound (US) for a wide variety of disorders. Over 250 articles were reviewed. For each condition, they were to indicate whether US should be used in some cases, or as the first diagnostic modality.
A majority of the experts used US (in some cases) for all types of focal nerve disorders (e.g. CTS), demyelinating polyneuropathies, ALS, most regional or multifocal nerve disorders (e.g. brachial plexopathy), generalized muscle disorders (e.g. inclusion body myositis), and situational indications, including palpable masses, variant anatomy, young children and phobic patients. Over 25% recommended US as the first diagnostic tool for focal nerve disorders, regional or multifocal nerve disorders (47% for nerve tumors and neuromas), focal muscle disorders (40% for diaphragm paresis), 47% for palpable masses and 67% for phobic patients or young children. The group outlined many ways that US can improve diagnosis. A large majority felt that US helps to demonstrate local anatomy, complements electrodiagnostic findings, and identify unexpected findings. An even larger majority (90%) felt that US will improve over time, more EMG labs will offer US, US will be used more for research, and residencies will include US training. Overall, they believe that NM US is becoming a third component of neurodiagnostic testing, in addition to NCS and EMG.
NM US can improve diagnosis for many common and important areas of neurodiagnostic medicine, either as the first test, or a secondary test to be used in appropriate cases. The vast majority of world experts see the role of US increasing. More research is needed and residents need NM US training.