Enlargement Of Cross-sectional Area Research Articles

Flow Resistance Analysis of Clinically Significant Portal Hypertension in Patients with Liver Cirrhosis.

Cirrhosis-induced clinically significant portal hypertension (CSPH) is a fatal disease. Early detection of CSPH is vitally important to reduce the patients' mortality rate. In this study, combined with three-dimensional image construction technology and computational fluid dynamics (CFD), an image-based flow resistance analysis was proposed. The flow resistance analysis was performed for nine cirrhosis patients with CSPH and ten participants without liver diseases, respectively. The results showed that the flow resistance coefficient of the portal vein system in CSPH patients was significantly lower than that in the control group (0.97 ± 0.11 Pa/(mL/s) for CSPH patients; 1.80 ± 0.40 Pa/(mL/s) for the control group; P = 0.028). In contrast, although main portal vein dilation was found in CSPH patients, the cross-sectional area enlargement was not statistically significant (186.01 ± 57.48 mm2 for CSPH patients; 166.26 ± 33.74 mm2 for the control group; P = 0.39). The research outcomes indicated that the flow resistance analysis was more sensitive than the commonly used vessel size measurement in the detection of CSPH. In summary, we suggest using flow resistance analysis as a supplementary noninvasive method to detect cirrhosis patients with CSPH.

Ultrasonography for the diagnosis of carpal tunnel syndrome: an umbrella review.

Numerous sonographic modalities and parameters have been used to diagnose carpal tunnel syndrome (CTS), with varying accuracy. Our umbrella review aimed to summarize the evidence from systematic reviews and meta-analyses regarding the use of ultrasound imaging to diagnose CTS. Systematic reviews and meta-analyses meeting the inclusion criteria were searched in PubMed, Embase, Medline, Web of Science, and Cochrane databases from inception to March 2022. Critical appraisal, data extraction, and synthesis were performed in accordance with the criteria for conducting an umbrella review. Sixteen reviews were included. Three reviews were classified as high quality, one as moderate, four as low, and eight as critically low. The cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet demonstrated the best reliability and diagnostic accuracy among multiple parameters. A cutoff CSA value of 9-10.5mm2 gave the highest diagnostic performance in the general population. The degree of CSA enlargement was correlated with CTS severity. Sonoelastography and Doppler ultrasound might provide additional insights into CTS evaluation as median nerve stiffness and vascularity at the wrist were increased in these patients. Sonography is a reliable tool to diagnose CTS, with inlet CSA being the most robust parameter. Sonoelastography and Doppler ultrasound can serve as auxiliary tools to confirm CTS diagnoses. Further studies are needed to expand the use of sonography for diagnosing CTS, especially in the presence of concomitant neuromuscular disease(s).

The relationship between mandibular advancement, tongue movement, and treatment outcome in obstructive sleep apnea.

To characterize how mandibular advancement enlarges the upper airway via posterior tongue advancement in people with obstructive sleep apnea (OSA) and whether this is associated with mandibular advancement splint (MAS) treatment outcome. One-hundred and one untreated people with OSA underwent a 3T magnetic resonance (MRI) scan. Dynamic mid-sagittal posterior tongue and mandible movements during passive jaw advancement were measured with tagged MRI. Upper airway cross-sectional areas were measured with the mandible in a neutral position and advanced to 70% of maximum advancement. Treatment outcome was determined after a minimum of 9 weeks of therapy. Seventy-one participants completed the study: 33 were responders (AHI<5 or AHI≤10 events/hr with >50% AHI reduction), 11 were partial responders (>50% AHI reduction but AHI>10 events/hr), and 27 nonresponders (AHI reduction<50% and AHI≥10 events/hr). Responders had the greatest naso- and oropharyngeal tongue anterior movement (0.40 ± 0.08 and 0.47 ± 0.13 mm, respectively) and oropharyngeal cross-sectional area enlargement (6.41 ± 2.12%) per millimeter of mandibular advancement. A multivariate model that included tongue movement and percentage of airway enlargement per millimeter of mandibular advancement along with baseline AHI correctly classified 69.2% (5-fold cross-validated 62.5%, n = 39) of participants in response categories when the jaw was advanced in the range that would usually be regarded as sufficient for clinical efficacy (> 4 mm). In comparison, a model using only baseline AHI correctly classified 50.0% of patients (5-fold cross-validated 52.5%, n = 40). Tongue advancement and upper airway enlargement with mandibular advancement in conjunction with baseline AHI improve treatment response categorization to a satisfactory level (69.2%, 5-fold cross-validated 62.5%).

Differentiation of Critical Illness Myopathy and Critical Illness Neuropathy Using Nerve Ultrasonography.

Intensive care unit-acquired weakness occurs frequently in intensive care unit patients, including critical illness myopathy (CIM) and critical illness polyneuropathy (CIPN). The authors present a prospective study to assess the ultrasound pattern sum score to differentiate between confirmed CIM, sensory neuropathy, and CIPN cases. Cross-sectional areas of 12 predefined nerve segments in 16 patients were sonographically examined. Single-nerve cross-sectional areas and ultrasound pattern sum score values were compared; results are given as P-values and receiver operating characteristic area under the curve (AUC). In neuropathy, significant single-nerve cross-sectional area enlargement was observed in the median (P = 0.04), ulnar (P = 0.04), and fibular nerves (P = 0.0003). The ultrasound pattern sum score could reliably differentiate between pure CIM and neuropathy (P = 0.0002, AUC 0.92), CIM and sensory neuropathy (P = 0.001, AUC 0.88), and CIM and CIPN (P = 0.007, AUC 0.92), but not between sensory neuropathy and CIPN (P = 0.599, AUC 0.48). Nerve ultrasonography reliably identifies neuropathy in intensive care unit-acquired weakness, yet cannot differentiate between sensory neuropathy and CIPN. A standardized ultrasound algorithm can serve as a fast bedside test for the presence of neuropathy in intensive care unit-acquired weakness.

Peripheral neuropathy in systemic lupus erythematosus: what can neuromuscular ultrasonography (NMUS) tell us? A cross-sectional study

ObjectiveTo evaluate peripheral nerve involvement in patients with SLE with neuromuscular ultrasonography (NMUS) and understand its role in investigating SLE-related peripheral neuropathy.MethodsThis is an observational cross-sectional study on patients with...

Usefulness of Oblique Lumbar Interbody Fusion as Revision Surgery: Comparison of Clinical and Radiological Outcomes Between Primary and Revision Surgery

Oblique lumbar interbody fusion (OLIF) is useful as surgical treatment of degenerative lumbar disease. However, revision surgery has often resulted in worse surgical outcomes than primary surgery. Thus, we compared the usefulness of OLIF as primary surgery (PS) versus revision surgery (RS). We retrospectively investigated 173 patients who had undergone single-level OLIF from 2016 to 2018. The radiological and clinical outcomes were compared between PS (n= 152) and RS (n= 21). The effects of RS on the clinical outcomes (Oswestry Disability Index [ODI] cutoff, 12) after surgery were investigated. The ODI and visual analog scale score at 6 and 12 months after surgery was worse in the RS group than in the PS group (P < 0.05). In the RS group, the visual analog scale score for leg pain of the previous laminectomy side was worse than that of the virgin side at 6 and 12 months after surgery (P < 0.05). The disc height, ligamentum flavum, and subsidence did not differ between the 2 groups. However, the cross-sectional area enlargement differed between the 2 groups (P < 0.05). Multivariate logistic regression analysis showed that RS and severe subsidence were risk factors for differences in the ODI (P= 0.006 and P= 0.017, respectively). Most radiological outcomes were similar between the RS and PS groups, with no differences in complications or the requirement for additional posterior decompression. However, OLIF resulted in relatively poor clinical outcomes when used as RS. Thus, revision spine surgery tends to result in poor outcomes compared with those of primary spine surgery; however, OLIF can be a tolerable option for revision spine surgery.

Diagnosis Accuracy of Carpal Tunnel Syndrome in Diabetic Neuropathy.

Background and objectives: Carpal tunnel syndrome (CTS) is a common pathology, but sometimes the diagnosis is delayed in patients with diabetic neuropathy (DN). The aim of the study is twofold: first, to compare the accuracy of ultrasound (US) with that of electroneurography (ENG) in the diagnosis of CTS associated with DN, using the clinical diagnosis as a reference standard, and second, to investigate the correlation between morphological US parameters and electrodiagnosis (EDX) measurements in patients with CTS and DN. Materials and Methods: This study included patients with DN. They were divided into two groups: Control (patients without CTS) and Cases (patients with CTS). We performed US and ENG in both hands, totaling 56 wrists, with 28 wrists in each group. Results: We found that the difference in the sensory distal latencies between the median and the ulnar nerves (ring finger) exhibited the highest diagnostic accuracy of all the US and ENG parameters, areas under the receiver operating characteristic (AUC) = 0.99 (95% CI 0.97–1), and it was significantly different from the best US diagnostic method. The wrist cross-sectional area (CSA) had the most accurate US diagnosis, while the wrist-to-forearm ratio had the worst AUC. Moreover, in the group of CTS and DN patients, the wrist CSA enlargement was statistically directly proportional to the median compound muscle action potential (CMAP) distal latency and inversely proportional to the antidromic median nerve conduction study (NCS) and the orthodromic median palm–wrist NCS. Conclusions: Both examinations can be used with confidence in the diagnosis of CTS overlapping with DN, but the EDX examination seems to be more accurate. Furthermore, we found a positive correlation between the US and EDX parameters.

Effect of Indirect Neural Decompression with Oblique Lateral Interbody Fusion Was Influenced by Preoperative Lumbar Lordosis in Adult Spinal Deformity Surgery.

Study DesignRetrospective clinical study on the indirect decompressive effect of oblique lateral interbody fusion (OLIF) for adult spinal deformity.PurposeTo evaluate the effect of interbody distraction by OLIF for the treatment of adult spinal deformity.Overview of LiteratureAdult spinal deformity with symptomatic stenosis has been addressed conventionally using a direct posterior decompression approach with fusion. However, stenotic symptoms can also be alleviated indirectly through restoration of intervertebral and foraminal heights and correction of spinal alignment.MethodsTwenty-eight patients with adult spinal deformity underwent OLIF combined with modified cortical bone trajectory screws at 94 lumbar levels with neuromonitoring. The patients were divided into three groups based on their preoperative lumbar lordosis: group A, <0°; group B, 0°–20°; and group C, >20°. The cross-sectional area (CSA) of the thecal sac was measured preoperatively and postoperatively on axial magnetic resonance images. Differences in CSA were evaluated, and the relationship between the CSA extension ratio and preoperative CSA was assessed. Changes in disc height and segmental disc angle were measured from plain radiographs.ResultsOLIFs were performed successfully without neural complications. In group A, the mean CSA increased from 120.6 mm2 preoperatively to 148.5 mm2 postoperatively (p <0.001). The mean CSA for group B increased from 120.1 mm2 preoperatively to 154.4 mm2 postoperatively (p <0.001). Group C had an increase in mean CSA from 114.7 mm2 preoperatively to 160.7 mm2 postoperatively (p <0.001). The mean CSA enlargement ratio was 27.5%, 32.1%, and 60.4% in groups A, B, and C, respectively. The mean CSA extension ratio was inversely correlated with preoperative CSA.ConclusionsThe effect of indirect neural decompression in adult spinal deformity with OLIF varies with the degree of preoperative lumbar lordosis.

Ultrasound, Clinical, and Electrophysiological Findings in Persistent Carpal Tunnel Syndrome.

We present the clinical, electrophysiological, and nerve ultrasound findings in cases of persistent carpal tunnel syndrome (PCTS). Eighteen PCTS patients underwent evaluation with the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), electrophysiology, and nerve ultrasound with a mean of 3.5 months (SD ±1.4) after open surgery. PCTS patients showed a mean symptom severity scale score of 3.1 (SD ±1.1) and functional severity scale score of 3.2 (SD ±0.9) in BCTSQ. Nerve conduction studies revealed axonal affection of the median nerve in 13/18 patients, ultrasound showed disturbed echogenicity in all patients, a pathological wrist to forearm ratio in 16/18 patients, and cross-sectional area enlargement of the median nerve at the distal wrist crease in 12/18 patients. Ultrasound documented scar tissue formation (in 12/18 patients), incomplete release of retinaculum flexorum (in 4/18 patients), and neuroma of the median nerve (in 2/18 patients) as PCTS cause. Our data show significant functional disability, axonal nerve damage, and scar tissue formation as common PCTS causes.

Relationship between Enlargement of the Cross-Sectional Area of the Dural Sac and Neurological Improvements after Cervical Laminoplasty: Differences between Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament.

Introduction The purpose of this study was to investigate the relationship between postoperative enlargement of the dural sac cross-sectional area at the symptomatic level and neurological improvements after laminoplasty. Methods The cross-sectional areas of the dural sac at the symptomatic level before and after laminoplasty and the expansion ratio (post-/preoperative cross-sectional area) were measured using magnetic resonance imaging in patients with ossification of the posterior longitudinal ligament (OPLL) (n = 25) and patients with cervical spondylotic myelopathy (CSM) (n = 49). The relationships between the expansion ratio and the Japanese Orthopedic Association (JOA) score, JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and postoperative laminae morphology were investigated. Results In the OPLL group, the expansion ratio was significantly positively correlated with the postoperative JOA score (P = 0.025), recovery rate of the JOA score (P = 0.026), and postoperative change in lower extremity sensory function according to the JOA score (P = 0.0375); furthermore, patients whose JOACMEQ responses indicated positive outcomes for lower extremity function had a significantly larger expansion ratio than patients with negative results (P = 0.027). In the CSM group, the expansion ratio showed no correlation with the JOA and JOACMEQ scores. The expansion ratio was significantly positively correlated with the width between bilateral gutters in both CSM (P = 0.025) and OPLL (P = 0.0451). In the OPLL group, the expansion ratio in those with a gutter position of less than 0.8 was significantly smaller than that those with a gutter position of more than 0.8 (P = 0.0156). However, there was no correlation between the gutter position and the recovery rate of the JOA score. Conclusions In OPLL, insufficient enlargement of the cross-sectional area of the dural sac at the symptomatic level leads to poor neurological improvements after laminoplasty.

Prognostic Value of Nerve Ultrasound and Electrophysiological Findings in Saturday Night Palsy.

We report on the prognostic role of the cross-sectional area (CSA) enlargement and conduction block (CB) in radial neuropathy (Saturday night palsy [SNP]). Reference CSA values were defined in 30 healthy subjects. Twenty-four patients with SNP underwent evaluation (Thessaloniki Hypesthesia Score [THS], Medical Research Council [MRC], ultrasound, electrophysiology). All patients were followed up 3 months after initial presentation. During initial evaluation, 13 patients showed pathological CSA (pCSA) and 11 normal CSA (nCSA). Fourteen patients showed conduction block (pCB) and 10 showed no conduction block (nCB). The site of lesion was recognized in 11 patients in the spiral groove, in 8 patients in the distal main trunk, just before the division to motor and sensory branch, while 5 patients showed a double site of lesion (spiral groove and supinators' canal). During follow-up, the pCSA group showed a mean MRC score of 2.8 (SD ± .7) and a THS of 1.8 (SD ± .4), while the nCSA group showed a mean MRC score of 4.1 (SD ± .9) and a THS of .7 (SD ± .3) (P < .001) (Table 4). On the other hand, the pCB group showed a mean MRC score of 3.7 (SD ± 1.1) and a THS of 2.7 (SD ± .9), and the nCB group showed a mean MRC score of 4.2 (SD ± 1.2) and a THS of 1.7 (SD ± .9) (P = .355, P = .013, respectively). The CSA enlargement, but not the CB, seems to have a negative prognostic role in patients with SNP.

Neuromuscular ultrasound in patients with carpal tunnel syndrome and normal nerve conduction studies.

Nerve conduction studies (NCS) are sensitive for carpal tunnel syndrome (CTS), but a small proportion of patients with clinical CTS have normal NCS. This retrospective study was designed to assess the neuromuscular ultrasound findings in a group of CTS patients. The electronic medical record was reviewed by a neurologist to identify patients who had a diagnosis of CTS with normal NCS, including either mixed median-ulnar comparison or transcarpal sensory studies, and complete neuromuscular ultrasound evaluation for CTS. Fourteen individuals (22 wrists) met all criteria. A total of 92.3% had median nerve cross-sectional area enlargement at the wrist (mean 16.3 mm2 ), 100% had increased wrist-to-forearm median nerve area ratio (mean 2.4), 82.4% had decreased median nerve echogenicity, 75.0% had decreased median nerve mobility, and 7.1% had increased median nerve vascularity. A large proportion of patients with clinical CTS but normal NCS have abnormal neuromuscular ultrasound findings. Muscle Nerve 55: 913-915, 2017.

Spectrum of sonographic changes in hereditary motor and sensory neuropathy with autosomal dominant and X-linked inheritance

Background . In the recent years interest towards nerve sonography has largely increased, specifically in terms of differentiating types of hereditary motor and sensory neuropathy (HMSN). The diagnostic possibilities of high-resolution ultrasound (HRUS) compared to standard neurophysiological tools in the peripheral nerve disorders is still a matter of debate. Objectives. Analysis of quantitative and qualitative ultrasound changes of limb nerves in patients with HMSN type 1 and its comparison with anthropometric and nerve conduction study data. Materials and methods. 44 HMSN patients were analyzed: 16 men, mean age 35,9 ± 6,8 years; 16 (37 %) with autosomal dominant type 1А, 11 (25 %) – with 1В type and 17 (38 %) with Х-linked inheritance. Control group included 44 subjects, 16 male; mean age 35,9 ± 6,8 years. HRUS parameters were analyzed bilaterally on the selected levels: cross-sectional area (CSA), visual cross sectional and longitudinal patterns of the median and ulnar nerves, C5, C6, C7 spinal nerves, tibial, peroneal and sciatic nerves. HRUS parameters were compared to standard anthropometric data, nerve conduction velocity and CMAP amplitude. Results . In all HMSN cases CSA was enlarged compared to healthy controls. Greater changes were found in patients with autosomal dominant inheritance. CSA enlargement in С5, С6, С7 spinal nerves was found in patients with HMSN 1A, С6, С7 – in HMSN 1В, С6 – in HMSN 1X, confirming the necessity to include those nerves in the sonographic protocol in patients with HMSN. Three qualitative cross sectional and longitudinal patterns of the investigated arm nerves were identified, distinct for each of the HMSN type. Absence of significant differences in CSA of the upper limb nerves among analyzed types of HMSN makes it unreliable as the differential parameter, opposite to the defined sonographic patterns. Methodological issues and absence of significant quantitative and qualitative data from the lower limb nerves makes it possible to exclude those from HRUS protocol in HMSN. Conclusions. Nerve sonography of the upper limbs could be a useful additional tool in the differential diagnosis of HMSN type 1 when applying described qualitative HRUS patterns.

Facing the diagnostic challenge: Nerve ultrasound in diabetic patients with neuropathic symptoms.

We describe the nerve ultrasound findings in patients with type II diabetes mellitus who have neuropathic symptoms and signs. Fifty-five healthy controls and 44 diabetic patients underwent clinical, sonographic, and electrophysiological evaluation. Patients were studied at a mean of 14.3 years after disease onset. Nerve ultrasound revealed increased cross-sectional area (CSA) in peripheral nerves at compression sites (although no clinical symptoms were present) and noncompression sites. No correlation was detected between sonographic and electrophysiological findings. A CSA increase of the tibial nerve in the popliteal fossa was detected in 5 patients with neuropathic symptoms, although electrophysiology was normal. Nerve ultrasound revealed crucial morphological alterations in diabetic patients. CSA enlargement at compression sites indicates subclinical nerve affection and may indicate susceptibility to entrapment syndromes. CSA increase at noncompression sites despite normal electrophysiology suggests early morphological abnormalities. Further longitudinal studies are required to confirm our results. Muscle Nerve, 2015 Muscle Nerve 54: 18-24, 2016 Muscle Nerve 54: 18-24, 2016.

Internal Jugular Vein Cross-Sectional Area Enlargement Is Associated with Aging in Healthy Individuals.

BackgroundInternal jugular vein (IJV) narrowing has been implicated in central nervous system pathologies, however normal physiological age- and gender-related IJV variance in healthy individuals (HIs) has not been adequately assessed.ObjectivesWe assessed the relationship between IJV cross-sectional area (CSA) and aging.Materials and MethodsThis study involved 193 HIs (63 males and 130 females) who received 2-dimensional magnetic resonance venography at 3T. The minimum CSA of the IJVs at cervical levels C2/C3, C4, C5/C6, and C7/T1 was obtained using a semi-automated contouring-thresholding technique. Subjects were grouped by decade. Pearson and partial correlation (controlled for cardiovascular risk factors, including hypertension, heart disease, smoking and body mass index) and analysis of variance analyses were used, with paired t-tests comparing side differences.ResultsMean right IJV CSA ranges were: in males, 41.6 mm2 (C2/C3) to 82.0 mm2 (C7/T1); in females, 38.0 mm2 (C2/C3) to 62.3 mm2 (C7/T1), while the equivalent left side ranges were: in males, 28.0 mm2 (C2/C3) to 52.2 mm2 (C7/T1); in females, 27.2 mm2 (C2/C3) to 47.8 mm2 (C7/T1). The CSA of the right IJVs was significantly larger (p<0.001) than the left at all cervical levels. Controlling for cardiovascular risk factors, the correlation between age and IJV CSA was more robust in males than in the females for all cervical levels.ConclusionsIn HIs age, gender, hand side and cervical location all affect IJV CSA. These findings suggest that any definition of IJV stenosis needs to account for these factors.

Peripheral Nerve Ultrasound in Small Fiber Polyneuropathy

Routine nerve conduction studies are normal in patients with small fiber neuropathy (SFN), and a definitive diagnosis is based on skin biopsy revealing reduced intra-epidermal nerve fiber density (IENFD). In large fiber polyneuropathy, ultrasound (US) parameters indicate enlargement in cross-sectional area (CSA). This study was aimed at determining if similar changes in large fibers on US are apparent in patients with SFN. Twenty-five patients with SFN diagnosed by reduced IENFD and 25 age- and body mass index (BMI)-matched healthy controls underwent US studies of sural and superficial peroneal sensory nerves. The mean CSA of the sural nerve in SFN patients was 3.2 ± 0.8 mm2, and in controls, 2.7 ± 0.6 mm2 (p < 0.0070), and this was independent of sex. There was no difference in the thickness-to-width ratio or echogenicity of the nerves. US of the sural nerve in patients diagnosed with small fiber neuropathy reveals an enlarged cross-sectional area similar to that in large fiber polyneuropathy.

P189. Sarcoid neuropathy: Correlation of nerve ultrasound, electrophysiological and clinical findings

Introduction We present the nerve ultrasound findings in sarcoid neuropathy and examine their correlation with electrophysiology and functional disability. Methods 40 healthy controls and 13 patients with sarcoid neuropathy underwent clinical, sonographic and electrophysiological evaluation a mean of 2.1years (SD±0.7) after disease onset. Results Nerve ultrasound revealed significantly higher cross sectional area (CSA) values of the ulnar (elbow, p p p p p p r =0.894, p Conclusions Sarcoid neuropathy seems to show predominantly CSA enlargement in peripheral nerves of the lower extremities, without any significant correlation to electrophysiological findings. The electroneurography documented signs of sensorimotor axonal loss in various peripheral nerves. Neither nerve sonography nor electrophysiology correlated with functional disability.

63. Multicenter protocol on the role of ultrasound in immune-mediated neuropathies

Immune-mediated neuropathies include clinically heterogeneous disorders such as Guillain–Barre syndrome (GBS) and its variants, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), multifocal motor neuropathy (MMN), neuropathy with monoclonal gammopathy and others. High-resolution ultrasound (US) is a helpful technique for the evaluation of peripheral nerves. In previous studies on immune-mediated neuropathies, nerve US showed diffuse enlargement of cross sectional area (CSA) of peripheral nerves trunks and cervical roots and morphological alterations at conduction block site. Data are however heterogeneous, correlations with clinical history or disease severity are lacking and there are no longitudinal studies in literature. The objective of the protocol is to prospectively evaluate, through a multicenter longitudinal study, nerve US findings in patients with newly diagnosed immune-mediated neuropathies and evaluate the relationship with clinical and neurophysiological findings and changes over time (natural history) or in response to therapy. The protocol includes clinical assessment, neurophysiological examination, US examination of median, ulnar, radial, fibular, tibial, sural nerves (and brachial plexus in extended protocol) with evaluation of maximal/minimal CSA for each nerve, inter- and intra-nerve variability, US classification depending on echogenicity and fascicles enlargement. US and neurophysiological follow-up timing examinations follow different schedules in acute and chronic immune-mediated disease. We present preliminary results and feasibility of the protocol.

103. Nerve ultrasound findings in neuropathy associated with anti-mag antibodies

We studied patients with neuropathy and anti-myelin-associated glycoprotein antibodies nerve ultrasound (US). 28 patients with anti-MAG neuropathy underwent nerve US. Echotexture, nerve cross sectional area (CSA), intra-nerve and inter-nerve CSA variability were assessed. Patients with IgM paraproteinemic neuropathy without anti-MAG antibodies and with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) associated with IgM paraprotein were studied as controls. US findings were correlated with disease duration and clinical severity (INCAT disability score). 26/28 patients had increased CSA (23 at atleast one nerve outside entrapment sites). Intra-nerve CSA variability was abnormal in 21/28 patients (in 14 for increased nerve CSA outside entrapment sites). Inter-nerve CSA variability was abnormal in 16 patients (in half of whom for CSA increase out of entrapment sites). No correlation was found between US findings and INCAT disability score or disease duration. Patients with IgM paraproteinemic neuropathy without anti-MAG antibodies had similar US abnormalities. Instead 4/5 patients with CIDP and IgM paraprotein presented significant and diffuse nerve CSA enlargement. The US findings in anti-MAG antibody neuropathy, different from those of CIDP, might express the diverse pathogenic mechanisms and contribute to diagnosis in atypical cases.

Sarcoid neuropathy: Correlation of nerve ultrasound, electrophysiological and clinical findings

IntroductionWe present the nerve ultrasound findings in sarcoid neuropathy and examine their correlation with electrophysiology and functional disability. Materials and methods40 healthy controls and 13 patients with sarcoid neuropathy underwent clinical, sonographic and electrophysiological evaluation, a mean of 2.1years (SD±0.7) after disease onset. ResultsNerve ultrasound revealed significantly higher cross sectional area (CSA) values of the ulnar (elbow, p<0.001), fibular (fibular head, p<0.001), sural (between the lateral and the medial head of the gastrocnemius muscle, p<0.001) and tibial nerves (ankle and popliteal fossa, p<0.001), when compared to controls. The electroneurography documented significantly lower values of the 1) compound muscle action potentials (cMAPs) in the median, fibular and tibial nerves (p<0.001), and 2) sensory nerve action potential (sNAP) in the median, ulnar and sural nerves (p<0.001). A significant correlation between sonographic and electrophysiological findings in the group with sarcoid neuropathy was found only between cMAP and CSA of the ulnar nerve at the elbow (r=0.894, p<0.001). Neither nerve sonography nor electrophysiology correlated with functional disability. DiscussionSarcoid neuropathy seems to show predominantly CSA enlargement in peripheral nerves of the lower extremities, without any significant correlation to electrophysiological findings. The electroneurography documented signs of sensorimotor axonal loss in various peripheral nerves. Neither nerve sonography nor electrophysiology correlated with functional disability.