Nerve echogenicity and intranerve CSA variability in high-resolution nerve ultrasound (HRUS) in chronic inflammatory demyelinating polyneuropathy (CIDP)
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HRUS is increasingly being used in the diagnosis and evaluation of autoimmune neuropathies such as CIDP. Recently, studies focused not only on changes of nerves size, but also the fascicular structure and the echogenicity changes in CIDP. However, little is known about the alterations of echogenicity in the long-term course in CIDP. The aim of this study was to evaluate echogenicity in CIDP patients in a long-term follow-up period and to analyze the benefit of the evaluation of echogenicity compared to nerve size.
20 patients fulfilling the definite diagnostic criteria of CIDP received clinical examination, nerve conduction studies and HRUS every 6 months over a median follow-up time of 34 months. Patients were divided into clinically stable/regressive disease course or progressive disease course according to the development of the inflammatory neuropathy cause and treatment overall disability sum score. Echogenicity of peripheral nerves was measured semi-automated and quantitative. Echogenicity was divided into three classes by fraction of black: hypoechogenic, mixed hypo-/hyperechogenic, hyperechogenic.
Patients with hyperechogenic arm nerves more frequently show clinical worsening, whereas patients with hypoechogenic arm nerves remain stable or even improved over time. In the long-term course of the disease, echogenicity mostly did not change, and if changes occured echogenicity did not correspond to ODSS changes.
Echogenicity of the arm nerves in CIDP may be used as a prognostic marker, but not as a follow-up tool for evaluating clinical changes. Further studies in a larger cohort are needed to confirm these results.
KeywordsCIDP Nerve ultrasound Echogenicity Intranerve CSA variability
ALF: Study design, data collection, drafting and revising the manuscript. KP: Study design, data collection, drafting and revising the manuscript. DG: Data collection, drafting and revising the manuscript. JM: Data collection, drafting and revising the manuscript. AK: Data collection, drafting and revising the manuscript. RG: Critical comments during data collection and manuscript revision. M-SY: Study design, critical comments during data collection and manuscript revision.
Compliance with ethical standards
Conflicts of interest
Anna Lena Fisse: none. Kalliopi Pitarokoili: received travel grants and speakers’ honoraria from Novartis, Biogen idec, Teva, Bayer and Grifols all not related to the manuscript. Donata Gamber: none. Jeremias Motte: received travel grants from Biogen idec. Antonios Kerasnoudis: received travel grants and speakers’ honoraria from Grifols and Genesis all not related to the manuscript. Ralf Gold: received consultation fees and speaker honoraria from Bayer Schering, Biogen idec, Merck Serono, Novartis, Sanofi-Aventis and TEVA. He also acknowledges grant support from Bayer Schering, Biogen idec, Merck Serono, Sanofi-Aventis and TEVA, none related to this manuscript. Min-Suk Yoon: Dr. Yoon received speakers’ honoraria from CSL Behring, Grifols and scientific grant from CSL Behring.
The ethics committee of the medical faculty of Ruhr University Bochum approved the study protocol and all patients signed informed consent (vote no. 4382-12, ethics committee of the medical faculty of the Ruhr University Bochum).
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