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Science News: Nerve Ultrasound Improves Detection of Treatment-responsive Chronic Inflammatory Neuropathies

Submitted by Bryan X. DeSouza, MD
Edited by Francisco Gomez, MD

Nerve ultrasound improves detection of treatment-responsive chronic inflammatory neuropathies
Ingrid J.T. Herraets, MD,* H. Stephan Goedee, MD, PhD,* Johan A. Telleman, MD,* Ruben P.A. van Eijk, MD, J. Thies van Asseldonk, MD, PhD, Leo H. Visser, MD, PhD, Leonard H. van den Berg, MD, PhD, and W. Ludo van der Pol, MD, PhD
Neurology 2020;94:1-10
The authors had previously shown brachial plexus and median nerve enlargement were reliably discoverable via ultrasound in patients with inflammatory neuron. Authors evaluated diagnostic accuracy of nerve ultrasound in a prospective study including 100 consecutive patients, with aim of determining whether ultrasound in as well as nerve conduction studies can aid in detecting treatment-responsive patients. Patient included were under suspicion of chronic inflammatory neuropathies (CIN), including CIDP and variants (Lewis Sumner syndrome, and Multifocal Motor Neuropathy).
100 consecutive patients referred for suspected CIN were evaluated by nerve ultrasound (NUS), standardized nerve conduction studies (NCS) and other diagnostic tests.  A diagnosis of CIN  variants was established upon fulfillment of clinical criteria, NCS, NUS and or  treatment response criteria was met. NUS criteria was determined as enlargement, that is increased in cross section of a nerve was found at 1 or more of the measured sites set at proximal median nerve and brachial plexus.
The cohort was divided  into 4 groups based on NCS and NUS findings, and monitored over one year save group 3 whom were excluded.

  NCS Ultrasound Number of patients
Group 1 + + 31
Group 2 + - 3
Group 3 - - 41
Group 4 - + 25

A diagnosis of chronic inflammatory neuropathy was established in 38 patients. Sensitivity and specificity of nerve ultrasound and NCS were 97.4% and 69.4%  and 78.9% and 93.5%, respectively. Investigators found that 8/38 patients with normal NCS yet abnormal NUS responded to treatment. They concluded that NUS was highly sensitive, discovering an additional 21.1% of CIN that subsequently responded to treatment.
Comments: The importance of this study cannot be understated, given NUS is an emerging technique with an increased sensitivity over NCS. NUS also offers greater patient comfort, as a non-invasive evaluation method, and may incur decreased costs and shorter exam time. If these results can be replicated in Class I or II studies, then ultrasound may be incorporated in the EFNS/PNS diagnostic criteria for CIDP. Clinicians should then strongly consider adding this technique to their practice. The ability to detect additional cases of CIN that would otherwise be missed and ,more importantly, offer treatment and an improved quality of life to several patients whom may otherwise go undiagnosed.

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