Abstract
Neuroimaging is increasingly used in the study of peripheral nerve diseases, and sometimes may have a pivotal role in the diagnostic process. We report on three patients with atypical chronic inflammatory polyradiculoneuropathy (CIDP) in whom magnetic resonance imaging (MRI) and nerve Ultrasound (US) were crucial for a correct diagnostic work-out. A literature review on MRI and US in acquired demyelinating polyneuropathies is also provided. Awareness of the imaging features of CIDP will assist in confirmation of the diagnosis, institution of the appropriate therapy, and prevention of inadequate or delayed treatment in atypical CIDP.
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Mathey EK, Park SB, Hughes RA, Pollard JD, Armati PJ, Barnett MH, Taylor BV, Dyck PJ, Kiernan MC, Lin CS (2015) Chronic inflammatory demyelinating polyradiculoneuropathy: from pathology to phenotype. J Neurol Neurosurg Psychiatry. doi:10.1136/jnnp-2014-309697
Khadilkar SV, Yadav RS, Soni G (2015) A practical approach to enlargement of nerves, plexuses and roots. Pract Neurol. doi:10.1136/practneurol-2014-001004
European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of multifocal motor neuropathy (2010) Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society–first revision. J Peripher Nerv Syst 15:295–301
Van den Bergh PY, Hadden RD, Bouche P, Cornblath DR, Hahn A, Illa I, Koski CL, Leger JM, Nobile-Orazio E, Pollard J, Sommer C, van Doorn PA, van Schaik IN (2010) European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society—first revision. Eur J Neurol 17:356–363
Thawait SK, Chaudhry V, Thawait GK, Wang KC, Belzberg A, Carrino JA, Chhabra A (2011) High-resolution MR neurography of diffuse peripheral nerve lesions. AJNR Am J Neuroradiol 32:1365–1372
Chhabra A, Deune GE, Murano E, Prince JL, Soldatos T, Flammang A (2012) Advanced MR neurography imaging of radial nerve entrapment at the spiral groove: a case report. J Reconstr Microsurg 28:263–266
Hobson-Webb LD, Padua L (2009) Median nerve ultrasonography in carpal tunnel syndrome: findings from two laboratories. Muscle Nerve 40:94–97
Padua L, Liotta G, Di PA, Granata G, Pazzaglia C, Caliandro P, Martinoli C (2012) Contribution of ultrasound in the assessment of nerve diseases. Eur J Neurol 19:47–54
Zaidman CM, Al-Lozi M, Pestronk A (2009) Peripheral nerve size in normals and patients with polyneuropathy: an ultrasound study. Muscle Nerve 40:960–966
Franca MC Jr, Faria AV, Queiroz LS, Nucci A (2007) Myositis with sensory neuronopathy. Muscle Nerve 36:721–725
Tazawa K, Matsuda M, Yoshida T, Shimojima Y, Gono T, Morita H, Kaneko T, Ueda H, Ikeda S (2008) Spinal nerve root hypertrophy on MRI: clinical significance in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy. Intern Med 47:2019–2024
Won SJ, Kim BJ, Park KS, Kim SH, Yoon JS (2012) Measurement of cross-sectional area of cervical roots and brachial plexus trunks. Muscle Nerve 46:711–716
Schady W, Goulding PJ, Lecky BR, King RH, Smith CM (1996) Massive nerve root enlargement in chronic inflammatory demyelinating polyneuropathy. J Neurol Neurosurg Psychiatry 61:636–640
Mizuno K, Nagamatsu M, Hattori N, Yamamoto M, Goto H, Kuniyoshi K, Sobue G (1998) Chronic inflammatory demyelinating polyradiculoneuropathy with diffuse and massive peripheral nerve hypertrophy: distinctive clinical and magnetic resonance imaging features. Muscle Nerve 21:805–808
Crino PB, Grossman RI, Rostami A (1993) Magnetic resonance imaging of the cauda equina in chronic inflammatory demyelinating polyneuropathy. Ann Neurol 33:311–313
Bertorini T, Halford H, Lawrence J, Vo D, Wassef M (1995) Contrast-enhanced magnetic resonance imaging of the lumbosacral roots in the dysimmune inflammatory polyneuropathies. J Neuroimaging 5:9–15
Midroni G, de Tilly LN, Gray B, Vajsar J (1999) MRI of the cauda equina in CIDP: clinical correlations. J Neurol Sci 170:36–44
Duarte J, Martinez AC, Rodriguez F, Mendoza A, Sempere AP, Claveria LE (1999) Hypertrophy of multiple cranial nerves and spinal roots in chronic inflammatory demyelinating neuropathy. J Neurol Neurosurg Psychiatry 67:685–687
Duggins AJ, McLeod JG, Pollard JD, Davies L, Yang F, Thompson EO, Soper JR (1999) Spinal root and plexus hypertrophy in chronic inflammatory demyelinating polyneuropathy. Brain 122(Pt 7):1383–1390
Kuwabara S, Nakajima M, Matsuda S, Hattori T (1997) Magnetic resonance imaging at the demyelinative foci in chronic inflammatory demyelinating polyneuropathy. Neurology 48:874–877
Bradley LJ, Wilhelm T, King RH, Ginsberg L, Orrell RW (2006) Brachial plexus hypertrophy in chronic inflammatory demyelinating polyradiculoneuropathy. Neuromuscul Disord 16:126–131
Vlam L, van der Pol WL, Cats EA, Straver DC, Piepers S, Franssen H, van den Berg LH (2012) Multifocal motor neuropathy: diagnosis, pathogenesis and treatment strategies. Nat Rev Neurol 8:48–58
van Asseldonk JT, van den Berg LH, Van den Berg-Vos RM, Wieneke GH, Wokke JH, Franssen H (2003) Demyelination and axonal loss in multifocal motor neuropathy: distribution and relation to weakness. Brain 126:186–198
Ellegala DB, Monteith SJ, Haynor D, Bird TD, Goodkin R, Kliot M (2005) Characterization of genetically defined types of Charcot-Marie-Tooth neuropathies by using magnetic resonance neurography. J Neurosurg 102:242–245
Sinclair CD, Miranda MA, Cowley P, Morrow JM, Davagnanam I, Mehta H, Hanna MG, Koltzenburg M, Reilly MM, Yousry TA, Thornton JS (2011) MRI shows increased sciatic nerve cross sectional area in inherited and inflammatory neuropathies. J Neurol Neurosurg Psychiatry 82:1283–1286
Filler AG, Maravilla KR, Tsuruda JS (2004) MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature. Neurol Clin 22:643–647
Shibuya K, Sugiyama A, Ito SI, Misawa S, Sekiguchi Y, Mitsuma S, Iwai Y, Watanabe K, Shimada H, Kawaguchi H, Suhara T, Yokota H, Matsumoto H, Kuwabara S (2015) Reconstruction magnetic resonance neurography in chronic inflammatory demyelinating polyneuropathy. Ann Neurol 77:333–337
Adachi Y, Sato N, Okamoto T, Sasaki M, Komaki H, Yamashita F, Kida J, Takahashi T, Matsuda H (2011) Brachial and lumbar plexuses in chronic inflammatory demyelinating polyradiculoneuropathy: MRI assessment including apparent diffusion coefficient. Neuroradiology 53:3–11
Kakuda T, Fukuda H, Tanitame K, Takasu M, Date S, Ochi K, Ohshita T, Kohriyama T, Ito K, Matsumoto M, Awai K (2011) Diffusion tensor imaging of peripheral nerve in patients with chronic inflammatory demyelinating polyradiculoneuropathy: a feasibility study. Neuroradiology 53:955–960
Beekman R, Visser LH (2004) High-resolution sonography of the peripheral nervous system—a review of the literature. Eur J Neurol 11:305–314
Bianchi S (2008) Ultrasound of the peripheral nerves. Joint Bone Spine 75:643–649
Matsuoka N, Kohriyama T, Ochi K, Nishitani M, Sueda Y, Mimori Y, Nakamura S, Matsumoto M (2004) Detection of cervical nerve root hypertrophy by ultrasonography in chronic inflammatory demyelinating polyradiculoneuropathy. J Neurol Sci 219:15–21
Cartwright MS, Passmore LV, Yoon JS, Brown ME, Caress JB, Walker FO (2008) Cross-sectional area reference values for nerve ultrasonography. Muscle Nerve 37:566–571
Granata G, Pazzaglia C, Calandro P, Luigetti M, Martinoli C, Sabatelli M, Padua L (2009) Ultrasound visualization of nerve morphological alteration at the site of conduction block. Muscle Nerve 40:1068–1070
Scheidl E, Bohm J, Simo M, Rozsa C, Bereznai B, Kovacs T, Aranyi Z (2012) Ultrasonography of MADSAM neuropathy: focal nerve enlargements at sites of existing and resolved conduction blocks. Neuromuscul Disord 22:627–631
Zaidman CM, Harms MB, Pestronk A (2013) Ultrasound of inherited vs. acquired demyelinating polyneuropathies. J Neurol 260:3115–3121
Zaidman CM, Seelig MJ, Baker JC, Mackinnon SE, Pestronk A (2013) Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology 80:1634–1640
Padua L, Granata G, Sabatelli M, Inghilleri M, Lucchetta M, Luigetti M, Coraci D, Martinoli C, Briani C (2014) Heterogeneity of root and nerve ultrasound pattern in CIDP patients. Clin Neurophysiol 125:160–165
Jang JH, Cho CS, Yang KS, Seok HY, Kim BJ (2014) Pattern analysis of nerve enlargement using ultrasonography in chronic inflammatory demyelinating polyneuropathy. Clin Neurophysiol 125:1893–1899
Rajabally YA, Nicolas G, Pieret F, Bouche P, Van den Bergh PY (2009) Validity of diagnostic criteria for chronic inflammatory demyelinating polyneuropathy: a multicentre European study. J Neurol Neurosurg Psychiatry 80:1364–1368
Bouchard C, Lacroix C, Plante V, Adams D, Chedru F, Guglielmi JM, Said G (1999) Clinicopathologic findings and prognosis of chronic inflammatory demyelinating polyneuropathy. Neurology 52:498–503
Said G, Krarup C (2013) Chronic inflammatory demyelinative polyneuropathy. Handb Clin Neurol 115:403–413
Chhabra A, Andreisek G, Soldatos T, Wang KC, Flammang AJ, Belzberg AJ, Carrino JA (2011) MR neurography: past, present, and future. AJR Am J Roentgenol 197:583–591
Yamashita T, Kwee TC, Takahara T (2009) Whole-body magnetic resonance neurography. N Engl J Med 361:538–539
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Gasparotti, R., Lucchetta, M., Cacciavillani, M. et al. Neuroimaging in diagnosis of atypical polyradiculoneuropathies: report of three cases and review of the literature. J Neurol 262, 1714–1723 (2015). https://doi.org/10.1007/s00415-015-7770-z
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DOI: https://doi.org/10.1007/s00415-015-7770-z