Multisequence Quantitative Magnetic Resonance Neurography of Brachial and Lumbosacral Plexus in Chronic Inflammatory Demyelinating Polyneuropathy.

Xiaoyun Su,Huiting Zhang,Zuneng Lu,Osamah Alwalid,Xiangquan Kong,Chuansheng Zheng,Jing Wang

doi:10.3389/fnins.2021.649071

Abstract

Background and PurposeChronic inflammatory demyelinating polyneuropathy (CIDP) is an uncommon demyelinating disorder. Although treatable, it is difficult to diagnose. The purpose of this study was to evaluate the diagnostic performance and abnormalities of plexus via quantitative multisequence magnetic resonance neurography (MRN) for CIDP.MethodsBrachial and lumbosacral (LS) plexus of 37 CIDP patients and 37 age- and gender-matched controls were examined by using multisequence MRN. Nerve diameter, nerve-to-muscle T2 signal intensity ratio (nT2), contrast-enhanced ratio (CR), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were determined in both plexus, and tractographies were performed. The disease histories and the Inflammatory Rasch-built Overall Disability Scale (I-RODS) questionnaire scores were documented before MRI scans.ResultsThe sizes of nerve roots were larger in CIDP (p < 0.01). CR, nT2, and ADC were significantly higher, while FA was lower in CIDP than in controls (p < 0.01). FA had the highest sensitivity (0.809) and area under the curve (AUC) (0.925), while the highest specificity was 0.961 for CR in single parameters. The combination of FA and CR has the highest sensitivity, specificity, accuracy, and AUC in the LS plexus. CR only had a weak correlation with nT2 (p < 0.05). ADC and diameter had a positive correlation with nT2, and the diameter and nT2 had a negative correlation with FA in CIDP (p < 0.05). FA had a negative correlation with the duration in the CIDP (r’s = −0.404, p < 0.05). There was no significant correlation between the I-RODS scores and MR multiparameters (p < 0.05).ConclusionMultisequence MRN possesses a high diagnostic performance in the LS plexus. Sampling perfection with application-optimized contrasts using different flip angle evolutions (SPACE) combined with DTI and contrast enhancement serves as a recommended composite protocol for CIDP.

Highlights

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired immune-mediated and treatable demyelinating disorder of the peripheral nervous system (Rotta et al, 2000; Vallat et al, 2010; Latov, 2014)
The contrast-enhanced ratios (CR), nerve-to-muscle T2 signal intensity ratios (nT2), and apparent diffusion coefficient (ADC) of the brachial and LS nerve roots were significantly higher in patients with CIDP than in controls, while fractional anisotropy (FA) was lower in CIDP (p < 0.01, Figure 4 and Table 2)
Our data confirmed the findings that the diameter, nT2, and ADC of nerve roots are increased while FA is reduced in CIDP patients and helped to analyze the diagnostic performance separately and in combination

Summary

Introduction

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired immune-mediated and treatable demyelinating disorder of the peripheral nervous system (Rotta et al, 2000; Vallat et al, 2010; Latov, 2014). The diagnosis and management of CIDP can be difficult and are mainly based on clinical features and nerve conduction studies (Latov, 2014; Querol et al, 2017; Rajabally et al, 2017). CIDP is characterized clinically by heterogeneous, sensory, and motor impairment with a chronic progressive or relapsing–remitting course (Rotta et al, 2000; Alabdali et al, 2017). Chronic inflammatory demyelinating polyneuropathy (CIDP) is an uncommon demyelinating disorder. The purpose of this study was to evaluate the diagnostic performance and abnormalities of plexus via quantitative multisequence magnetic resonance neurography (MRN) for CIDP

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