Abstract
ObjectiveThe main objective of this study was to evaluate the correlation between the distribution of brachial plexus magnetic resonance imaging (MRI) abnormalities and clinical weakness, and to evaluate the value of brachial plexus MRI in predicting disease course and response to treatment in multifocal motor neuropathy (MMN), Lewis‐Sumner syndrome (LSS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).MethodsSixty‐seven patients with an inflammatory neuropathy diagnosed at our tertiary referral center for neuromuscular diseases had undergone bilateral T2‐weighted short tau inversion recovery (STIR) MRI of the brachial plexus. We obtained clinical follow‐up data and scored all MRIs for abnormalities and the symmetry of their distribution.ResultsBrachial plexus MRI abnormalities were detected in 45% of the patients. An abnormal MRI did not predict disease course in terms of patterns of weakness, sensory disturbances or response to treatment. Within the spectrum of radiological abnormalities, asymmetrical clinical syndromes, MMN and LSS were significantly associated with asymmetrical radiological abnormalities, whereas symmetrical abnormalities predominated in CIDP (p < .001, phi 0.791).ConclusionT2 STIR brachial plexus MRI abnormalities correspond with the distribution of neurological deficits in inflammatory neuropathies, but do not correlate with specific clinical characteristics, response to treatment or disease course.
Highlights
| INTRODUCTIONHyperintensity and hypertrophy of cervical nerves and nerve roots using T2-weighted short tau inversion recovery (STIR) magnetic resonance imaging (MRI) techniques have been described in patients with various types of demyelinating inflammatory neuropathies, including multifocal motor neuropathy (MMN) (Van Es et al, 1997), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
We identified a total of 267 patients with an inflammatory neuropathy, of which brachial plexus magnetic resonance imaging (MRI) had been performed in 67 patients; 40 patients had multifocal motor neuropathy (MMN), nine patients had Lewis- Sumner syndrome (LSS) and 18 patients had chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
This study shows that (a)symmetry of abnormalities on brachial plexus MR imaging is associated with the distribution of clinical findings in patients with an inflammatory neuropathy
Summary
Hyperintensity and hypertrophy of cervical nerves and nerve roots using T2-weighted short tau inversion recovery (STIR) magnetic resonance imaging (MRI) techniques have been described in patients with various types of demyelinating inflammatory neuropathies, including multifocal motor neuropathy (MMN) (Van Es et al, 1997), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). A number of smaller studies have mainly suggested that asymmetry is associated with MMN or LSS rather than CIDP, but others could not confirm this (Rajabally et al, 2014; Van den Berg-Vos et al, 2000; Van Es et al, 1997) It is not known whether MRI abnormalities predict disease course or response to treatment. We investigated patterns of brachial plexus MRI abnormalities in patients within the spectrum of inflammatory neuropathies, together with clinical follow-up data of all patients who had undergone an MRI to study their disease course and response to treatment. No significant differences in clinical presentation, response to treatment and follow-up data were detected between patients with and without abnormalities on MRI per diagnosis (Table 4). Combining the data from our study showed that clinical and radiological asymmetry coincided (p < .001, phi 0.791)
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