Research articleMR neurography of lumbosacral nerve roots: Diagnostic value in chronic inflammatory demyelinating polyradiculoneuropathy and correlation with electrophysiological parameters
Introduction
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is the most common immune-mediated inflammatory polyneuropathy, which is typically characterized by symmetrical involvement and proximal as well as distal muscle weakness [1,2]. The pathological hallmarks of CIDP are demyelination and remyelination [3]. Evidence from postmortem and electrophysiology studies proved that demyelinative lesions initially affected spinal nerve roots, and then extended to nerve trunks and distal nerve segments [[4], [5], [6], [7], [8]]. Clinical treatments for CIDP include intravenous immunoglobulin, corticosteroids and plasm exchange. Timely treatment for the CIDP patients requires early and accurate diagnosis by evaluating proximal spinal nerve roots, which is crucial to rescue patients in early stages and prevent secondary axon injury [2]. However, existing examinations like nerve conduction studies and high-resolution ultrasound are unable to detect abnormalities of spinal nerve roots due to the deep anatomy.
MR neurography(MRN), also known as MR imaging of peripheral Nerves, is an advanced MR technique that can help delineate deep nerves conspicuously and locate lesions accurately. First proposed by Filler in 1992, it combined fat suppression technique and T2-weighted sequence to suppress fat tissue around peripheral nerves and emphasize nerve signal [[9], [10], [11]]. To date, MRN has been widely applied for the diagnosis of various peripheral neuropathies, including entrapment, injury, neoplasm and inflammatory neuropathies such as CIDP [10,[12], [13], [14], [15], [16], [17], [18], [19]]. Previous studies of CIDP mainly focused on the imaging of the brachial plexus and cervical nerve roots, whereas few studies have evaluated morphologic changes in the lumbosacral region [2,20,21]. To the best of our knowledge, lumbosacral nerve roots and cauda equina were reported to be more frequently involved in CIDP patients [5].
Therefore, in this study, we aimed to explore the value of lumbosacral nerve roots on MRN in the diagnosis of CIDP by quantifying cross-sectional areas (CSAs) and signal intensity(SI) of L3 to S1 nerve roots, and to analyze their correlations with electrophysiological parameters of lower extremities.
Section snippets
Subjects
Inclusion criteria: patients who met the diagnostic criteria of CIDP by European Federation of Neurological Societies/Peripheral Nerve Society 2010 from June 2016 to April 2019 from our neuromuscular clinic (n = 34) [22]. Exclusion criteria: a) patients in combination with other peripheral neuropathies, such as Charcot-Marie-Tooth disease type 1A (n = 2) b) patients suffering from severe lumbar disc herniation (n = 7) c) patients with injury (n = 1), neoplasm (n = 0) and operation history (n =
Clinical characteristics
A total of 21 subjects were enrolled in CIDP group including 8 females and 13 males. Their ages ranged from 28 to 67 years old and mean age ± SD was 51.3 ± 14.7 years old. Disease duration at the time of study varied dramatically, ranging from 2 months to 84 months and the median disease duration was 7 months. In CIDP group, one patient was diagnosed as Lewis-Sumner Syndrome and another one as distal acquired demyelinating symmetric neuropathy. All the rest patients met the diagnostic criteria
Discussion
In this study, we quantified the size and signal of L3 to S1 nerve roots in 21 CIDP patients and 21 volunteers with MR Neurography. Compared to healthy controls, CIDP patients exhibited significantly increased cross-sectional areas as well as signal intensity in every single nerve root, which was caused by the proliferation of Schwann cell and the edema in the endoneurium [6,26].
Up to now, few studies have systematically evaluated the morphological features of lumbosacral nerve roots of CIDP
Declaration of Competing Interest
The authors have no conflicts of interest to declare.
Acknowledgments
This work was supported by the National Key Research and Development Plan (Grant No. 2017YFC0112904). We are grateful to Jing Wang for her writing assistance and Kai Qiao for her job in nerve conduction examinations.
References (28)
- et al.
Progress in diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy
Lancet Neurol.
(2019) - et al.
Chronic inflammatory demyelinating polyradiculoneuropathy: diagnostic and therapeutic challenges for a treatable condition
Lancet Neurol.
(2010) - et al.
Brachial plexus hypertrophy in chronic inflammatory demyelinating polyradiculoneuropathy
Neuromuscular Disord.
(2006) - et al.
Magnetic resonance neurography of peripheral nerve tumors and tumorlike conditions
Neuroimag. Clin. N. Am.
(2014) - et al.
MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature
Neurol. Clin.
(2004) - et al.
Chronic inflammatory demyelinating polyneuropathy: update on diagnosis, immunopathogenesis and treatment
J. Neurol. Neurosurg. Psychiatry
(2019) - et al.
Distribution patterns of demyelination correlate with clinical profiles in chronic inflammatory demyelinating polyneuropathy
J. Neurol. Neurosurg. Psychiatry
(2002) - et al.
Spinal root and plexus hypertrophy in chronic inflammatory demyelinating polyneuropathy
Brain
(1999) - et al.
Chronic inflammatory demyelinating polyradiculoneuropathy: from pathology to phenotype
J. Neurol. Neurosurg. Psychiatry
(2015) - et al.
Different electrophysiological profiles and treatment response in’ typical’ and’ atypical’ chronic inflammatory demyelinating polyneuropathy
J. Neurol. Neurosurg. Psychiatry
(2015)
Magnetic resonance neurography
Magn. Reson. Med.
New technologies for the assessment of neuropathies
Nat. Rev. Neurol.
Magnetic resonance neurography: current perspectives and literature review
Eur. Radiol.
MRI assessment of recurrent carpal tunnel syndrome after open surgical release of the median nerve
AJR Am. J. Roentgenol.
Cited by (8)
Development of three-dimensional MR neurography using an optimized combination of compressed sensing and parallel imaging
2022, Magnetic Resonance ImagingCitation Excerpt :Magnetic resonance neurography (MRN) is a useful for the evaluations of nerve shapes and nerve conditions [1–3], and it has been applied for the assessment of patients with diseases such as chronic inflammatory demyelinating polyneuropathy (CIDP) and Charcot-Marie-Tooth neuropathies [4–10].
Multisequence magnetic resonance neurography of brachial and lumbosacral plexus in chronic inflammatory demyelinating polyneuropathy: correlations with electrophysiological parameters and clinical features
2023, Therapeutic Advances in Neurological DisordersResearch advances in chronic inflammatory demyelinating polyradiculoneuropathy
2023, Chinese Journal of NeurologyQuantitative magnetic resonance neurography in chronic inflammatory demyelinating polyradiculoneuropathy: A longitudinal study over 6 years
2023, Annals of Clinical and Translational NeurologyMR neurography of lumbosacral nerve roots for differentiating chronic inflammatory demyelinating polyneuropathy from acquired axonal polyneuropathies: a cross-sectional study
2022, Quantitative Imaging in Medicine and Surgery
- 1
These authors contributed equally to this work.