Cross-sectional Area Variability Research Articles

Structural changes in spinal cord following optic neuritis: Insights from quantitative spinal MRI

ObjectivesPrevious studies have demonstrated that optic neuritis (ON) affects brain plasticity. However, whether ON affects the spinal cord remains unclear. We aimed to investigate the spinal cord changes in ON and their associations with disability. MethodsA total of 101 ON patients, and 41 healthy controls (HC) were retrospectively recruited. High-resolution imaging was conducted using a Magnetization Prepared Rapid Acquisition Gradient-Echo (MP-RAGE) sequence for T1-weighted images and an echo planar imaging (EPI) sequence for Diffusion Tensor Imaging (DTI) data collection. Additionally, patients' disability and cognitive impairment were evaluated using the Expanded Disability Status Scale (EDSS) and the Paced Auditory Serial Addition Test (PASAT), respectively. The quantitative spinal MRI was employed to examine the cross-sectional area (CSA) and diffusion indicators, with a specific focus on calculating the average values across the C2-C7 cervical spinal cord segments. CSA, fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were compared between groups. Correlation analyses were performed between CSA, diffusion indicators, and clinical variables. ResultsNo significant differences were found in CSA between ON patients and HCs. MD (p = 0.007) and RD (p = 0.018) were increased in ON patients compared with HCs, and AD was decreased in ON (p = 0.013). The AD values of the ON patients were significantly positively correlated with PASAT scores (r = 0.37, p < 0.001). ConclusionsThis study provided imaging evidence for DTI abnormalities in patients with ON. Spinal cord DTI can improve our knowledge of the path physiology of ON, and clinical progression.

Nerve ultrasound reference values in children and adolescents: Echogenicity and influence of anthropometric factors including hand volume.

Nerve cross-sectional area (CSA) reference values in high-resolution ultrasound for children and adolescents are influenced by demographic and anthropometric factors such as age, height and weight. The influence of hand volume as an additional morphometric factor was evaluated and nerve echogenicity was analyzed in a prospective cross-sectional study. CSA were measured in 30 healthy children and adolescents from 2 to 17years in the median, ulnar, radial, tibial, peroneal and sural nerves. Height, weight, age, handedness and gender were recorded, the volume of the hands was measured using the water displacement method. The intra-nerve CSA variability (INV), left/right ratios and absolute differences were calculated. Age groups were compared by the Kruskal-Wallis test. The influence of demographic factors was analyzed using Spearman correlation and multiple linear regression. Echogenicity and fraction of black were determined for each nerve segment. Nerve CSA values were consistently lower than those reported for adults and correlated in all measured nerve sites with age, height, weight and hand volume. Weight showed the highest correlation coefficient (R = .95) with the best fitting model predicting CSA. Correlation coefficients were higher in a linear than in a logarithmic model. Ratios were stable, the absolute differences increased with age and were significantly different between age groups. Most nerves showed a mixed or hypoechogenic pattern in echogenicity analysis, hyperechogenicity is less frequently observed. Nerve CSA in children and adolescents is lower than in adults and increases proportionally during growth with a constant INV and left/right ratio in different age groups. Weight and age are predominant anthropometric factors predicting nerve size. Hand volume is correlated with nerve size, but does not predict CSA independently. Echogenicity can provide additional information on nerve structure.

Nerve Ultrasound Score in Chronic Inflammatory Demyelinating Polyneuropathy.

Background and Objectives: Studies have suggested that, by applying certain nerve ultrasound scores, demyelinating and axonal polyneuropathies can be differentiated. In the current study, we investigated the utility of ultrasound pattern sub-score A (UPSA) and intra- and internerve cross-sectional area (CSA) variability in the diagnostic evaluation of demyelinating neuropathies. Materials and Methods: Nerve ultrasound was performed in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and acute inflammatory demyelinating polyneuropathy (AIDP) and compared to patients with axonal neuropathies. The UPSA, i.e., the sum of ultrasound scores at eight predefined measurement points in the median (forearm, elbow and mid-arm), ulnar (forearm and mid-arm), tibial (popliteal fossa and ankle) and fibular (lateral popliteal fossa) nerves, was applied. Intra- and internerve CSA variability were defined as maximal CSA/minimal CSA for each nerve and each subject, respectively. Results: A total of 34 CIDP, 15 AIDP and 16 axonal neuropathies (including eight axonal Guillain-Barré syndrome (GBS), four hereditary transthyretin amyloidosis, three diabetic polyneuropathy and one vasculitic neuropathy) were included. A total of 30 age- and sex-matched healthy controls were recruited for comparison. Significantly enlarged nerve CSA was observed in CIDP and AIDP with significantly higher UPSA in CIDP compared to the other groups (9.9 ± 2.9 vs. 5.9 ± 2.0 vs. 4.6 ± 1.9 in AIDP vs. axonal neuropathies, p < 0.001). A total of 89.3% of the patients with CIDP had an UPSA score ≥7 compared to the patients with AIDP (33.3%) and axonal neuropathies (25.0%) (p < 0.001). Using this cut-off, the performance of UPSA in differentiating CIDP from other neuropathies including AIDP was excellent (area under the curve of 0.943) with high sensitivity (89.3%), specificity (85.2%) and positive predictive value (73.5%). There were no significant differences in intra- and internerve CSA variability between the three groups. Conclusion: The UPSA ultrasound score was useful in distinguishing CIDP from other neuropathies compared to nerve CSA alone.

Diacutaneous Fibrolysis Intervention in Patients with Mild to Moderate Carpal Tunnel Syndrome May Avoid Severe Cases in Elderly: A Randomized Controlled Trial.

Background: Carpal Tunnel Syndrome (CTS) mainly affects adults of working age. The prevalence of severe cases is higher in elderly patients (>65 years old). Clinical guidelines recommend conservative treatment as the best option in the initial stages of CTS to avoid severe cases. Diacutaneous Fibrolysis (DF) has demonstrated to improve nerve conduction studies and mechanosensitivity. The main purpose was to quantify changes in the cross-sectional area (CSA) of the median nerve, transversal carpal ligament (TCL) thickness, numbness intensity, and the subjective assessment of clinical change after DF treatment in patients with CTS. Methods: a double-blind, randomized, placebo-controlled trial was designed. A number of 44 patients (60 wrists) with CTS were randomized to the DF group or the sham group. CSA and TCL thickness variables were registered by ultrasound. Clinical variables were assessed by the visual analogue scale and GROC scale. SPSS version 24.0 for MAC was used for statistical analysis. The group by time interaction between groups was analyzed using two-way repeated measures analysis of variance. Results: The DF group reduced CSA with a mean of 0.45 mm2 (IC 95% 0.05 to 0.86) and TCL thickness with a mean reduction of 0.4 mm (IC 95% 0.6 to 2.1) compared to the sham group (p < 0.01, p < 0,03, respectively). Additionally, the DF group decreased the numbness intensity with a mean reduction of 3.47 (IC 95% 2.50 to 4.44, p < 0.01) and showed a statistically significant improvement on the GROC scale (p < 0.01). Conclusions: DF treatment may significantly reduce CSA and TCL thickness, numbness intensity, and improved clinical perspective. DF applied in patients with mild to moderate CTS may prevent the progression of the disease as they age.

Muscle fat infiltration but not muscle cross-sectional area is independently associated with bone mineral density at the lumbar spine.

Although sarcopenia and osteoporosis are inter-related conditions that are common with advancing age, few studies have explored relationships between muscle quality and bone mineral density (BMD). We investigated age- and sex-specific paraspinal muscle fat infiltration (MFI), muscle cross-sectional area (CSA), and spine volumetric BMD (vBMD) in healthy Chinese adults. 605 healthy adults aged 20-59 years (340 women, mean age 39.2 years; 265 men, mean age 38.8 years) had axial T2WI MRI imaging of the lumbar spine and CSA (cm2) and MFI (%) were measured in the psoas and multifidus and erector spinae (MF-ES) muscles (L3-L4). MFI measurements were calibrated against a region of interest in an adjacent area of subcutaneous pure fat. L2-L4 vBMD was measured by quantitative CT. Age- and sex-specific subgroups were compared using the Mann-Whitney test. Multiple regression was used to test independent associations of MFI and CSA with vBMD. Females had lower CSA and higher MFI than males in both the psoas and MF-ES muscles (p < 0.001). In females and males, MF-ES MFI increased with age (p < 0.001) and in females age-related increases were observed for the psoas muscles (p < 0.05). Greater fat infiltration of the MS-ES muscle unit was associated with lower vBMD in both sexes (p < 0.001) but not with CSA. Following adjustment for demographic variables and CSA, MS-ES MFI remained predictive of vBMD (β = -0.408 to -0.157, p < 0.001). We have demonstrated that, independent of CSA and demographic variables, MFI of the MF-ES muscles is predictive of lower lumbar spine vBMD in both sexes. This is the first study to demonstrate that, independent of muscle size and demographic variables, MFI of the paraspinal MF-ES muscles is predictive of lower lumbar spine vBMD in both sexes.

P 83 Nerve ultrasound cross-sectional area reference values in children from 2 to 17 years and their correlation with demographic and anthropometric data

Question: High-resolution ultrasound (HRUS) is of growing importance in the routine workup of disorders of the peripheral nervous system. However, reference values for children and adolescents are not available in most ultrasound laboratories. The correlation of cross-sectional area (CSA) values with demographic and anthropometric data has been analysed in adults, the exact influence of anthropometric data on nerve ultrasound reference values in children and adolescents is discussed in the literature (1,2). The present prospective observational study analyses the influence of height, weight, age, gender, and the volume of the hands on CSA values in nerve HRUS in healthy children and adolescents from 2 – 17 years. Methods: CSA were measured in 30 healthy children and adolescents from 2 – 17 years in the median, ulnar and radial nerves in the upper extremity and in the tibial, peroneal and sural nerve in the lower extremity at different nerve sites. Height, weight, age, handedness and gender were recorded, the volume of the hands was measured using the water displacement method. The intra-nerve CSA variability and the side-to-side difference ratio of the intra-nerve CSA variability (SSDIVA) for the median, ulnar and tibial nerves was calculated. Normal distribution of the data was tested using the Shapiro-Wilk test. Spearman’s rho and Pearson's correlation coefficient was calculated for CSA, intra-nerve CSA variability, SSDIVA and age, weight, gender, hand volume. Multiple linear regression analysis with backward exclusion was used to calculate the best model predicting CSA. Model selection was based on the Akaike information criterion (AIC). Results: Nerve CSA values were consistently lower than those reported for adults and increased in all measured nerve sites with increasing age, height and weight (see Figure 1 for the ulnar nerve and age groups). This increase had a tendency to levell off at an age of 14 – 17 years. The highest correlation coefficients and best-fitting model predicting CSA were found for the variable “weight”. Correlation coefficients were higher in a linear than in logarithmic model (Figure 2). Hand volume showed a positive correlation with age, weight and nerve CSA. Conclusions: Normal values for CSA in high-resolution nerve ultrasound should be adapted for children and adolescents. Demographic data such as height, weight and age can be considered to stratify and adjust normal values to the individual child's development. Corresponding with the findings of Druzhinin (1) and in contrast to the results of Schubert (2) our data suggest that weight, and not age, has the maximum influence on nerve CSA measurements.

3D cell neighbour dynamics in growing pseudostratified epithelia.

During morphogenesis, epithelial sheets remodel into complex geometries. How cells dynamically organise their contact with neighbouring cells in these tightly packed tissues is poorly understood. We have used light-sheet microscopy of growing mouse embryonic lung explants, three-dimensional cell segmentation, and physical theory to unravel the principles behind 3D cell organisation in growing pseudostratified epithelia. We find that cells have highly irregular 3D shapes and exhibit numerous neighbour intercalations along the apical-basal axis as well as over time. Despite the fluidic nature, the cell packing configurations follow fundamental relationships previously described for apical epithelial layers, that is, Euler's polyhedron formula, Lewis' law, and Aboav-Weaire's law, at all times and across the entire tissue thickness. This arrangement minimises the lateral cell-cell surface energy for a given cross-sectional area variability, generated primarily by the distribution and movement of nuclei. We conclude that the complex 3D cell organisation in growing epithelia emerges from simple physical principles.

Quantification of Cervical Cord Cross-Sectional Area: Which Acquisition, Vertebra Level, and Analysis Software? A Multicenter Repeatability Study on a Traveling Healthy Volunteer.

Background: Considerable spinal cord (SC) atrophy occurs in multiple sclerosis (MS). While MRI-based techniques for SC cross-sectional area (CSA) quantification have improved over time, there is no common agreement on whether to measure at single vertebral levels or across larger regions and whether upper SC CSA can be reliably measured from brain images.Aim: To compare in a multicenter setting three CSA measurement methods in terms of repeatability at different anatomical levels. To analyze the agreement between measurements performed on the cervical cord and on brain MRI.Method: One healthy volunteer was scanned three times on the same day in six sites (three scanner vendors) using a 3T MRI protocol including sagittal 3D T1-weighted imaging of the brain (covering the upper cervical cord) and of the SC. Images were analyzed using two semiautomated methods [NeuroQLab (NQL) and the Active Surface Model (ASM)] and the fully automated Spinal Cord Toolbox (SCT) on different vertebral levels (C1–C2; C2/3) on SC and brain images and the entire cervical cord (C1–C7) on SC images only.Results: CSA estimates were significantly smaller using SCT compared to NQL and ASM (p < 0.001), regardless of the cord level. Inter-scanner repeatability was best in C1–C7: coefficients of variation for NQL, ASM, and SCT: 0.4, 0.6, and 1.0%, respectively. CSAs estimated in brain MRI were slightly lower than in SC MRI (all p ≤ 0.006 at the C1–C2 level). Despite protocol harmonization between the centers with regard to image resolution and use of high-contrast 3D T1-weighted sequences, the variability of CSA was partly scanner dependent probably due to differences in scanner geometry, coil design, and details of the MRI parameter settings.Conclusion: For CSA quantification, dedicated isotropic SC MRI should be acquired, which yielded best repeatability in the entire cervical cord. In the upper part of the cervical cord, use of brain MRI scans entailed only a minor loss of CSA repeatability compared to SC MRI. Due to systematic differences between scanners and the CSA quantification software, both should be kept constant within a study. The MRI dataset of this study is available publicly to test new analysis approaches.

P-NU004. Nerve ultrasound in multifocal motor neuropathy: Correlation with electrophysiology and functional disability

Introduction . Increased nerve cross-sectional area (CSA) on ultrasound is associated with conduction block in multifocal motor neuropathy (MMN). We investigated the ultrasound features of peripheral nerves in MMN and their correlation with electrophysiology and functional disability. Methods . MMN patients fulfilling the EFNS/PNS criteria were recruited from University Malaya Medical Centre, Kuala Lumpur, Malaysia. All patients underwent neurological assessment with MRC sumscore, grip strength, INCAT disability score, and had nerve conduction studies. Each patient also underwent nerve ultrasound study using a standardized protocol. Age- and gender-matched healthy controls were recruited for comparison. Results . Three MMN patients (2 men) aged 46.3±10.6 years and three normal controls were included. Mean disease duration was 4.3±2.5 years (ranged 1.5-6.0). CSF protein ranged 0.25-0.50 g/L with a mean 0.40±0.13 g/L. One patient was positive for anti-GM1 IgM. Mean MRC was 55.0±5.3 (range 49-59), handgrip (right: 13.2±8.1 kg; left: 21.7±11.9 kg) and INCAT 3.7±1.1 (range 3-5). Nerve CSAs were significantly larger in MMN patients than normal controls in median (forearm: p=0.043), ulnar (forearm: p=0.047), tibial (knee: p=0.002), radial (p=0.002) and sural (p<0.001) nerves. The side-to-side difference ratio of intranerve CSA variability (ICSAV) for ulnar nerve (p=0.046) was significantly larger in MMN patients. The nerve CSAs were significantly correlated with MRC [median midarm/forearm ratio (p=0.004); ulnar ICSAV (p=0.037)] and INCAT [median: elbow (p=0.029), midarm (p=0.030) and midarm/forearm ratio (p=0.007); ulnar ICSAV (p=0.029)]. Correlation analysis with electrophysiology found increased nerve CSAs significantly correlated with distal motor latency [median: wrist (p=0.042), ICSAV (p=0.005)]; and inversely correlated with motor conduction velocity [median ICSAV (p=0.042)] and proximal/distal CMAP ratio [tibial knee (p=0.005)]. Conclusion . In MMN, nerve enlargement was focal, at non-entrapment sites, asymmetrical and can involve the sensory nerve. Nerve ultrasound significantly correlates with functional disability and electrophysiological parameters suggesting that it may be useful as an additional diagnostic biomarker in MMN.

MRI Measurement of Upper Cervical Spinal Cord Cross-Sectional Area in Children.

Neurological and neurodegenerative diseases can affect the spinal cord (SC) of pediatric patients. Magnetic resonance imaging (MRI) allows for in vivo quantification of SC atrophy via cross-sectional area (CSA). The study of CSA values in the general population is important to disentangle disease-related changes from intersubject variability. This study aimed at providing normative values for cervical CSA in children, extending our previous work performed with adults. Seventy-eight children (age 7-17 years) were selected from a Developmental Dyslexia study. All subjects underwent a 3T brain MRI session and any incidental findings were reported on the scans. A sagittal 1 mm3 3-dimensional T1 -weighted brain acquisition extended to the upper cervical cord was used to measure CSA at C2-C3, as well as spinal canal area and skull volume (V-scale). These three metrics were linearly fitted as a function of age to extract trends and percentage annual changes. Sex differences of CSA were assessed using least squares regression analyses, adjusting for age. We tested normalization strategies proven to be effective in reducing the intersubject variability of adults' CSA. CSA changed as a function of age at a faster rate when compared with skull volume (CSA: 1.82% increase, V-scale: .60% reduction). Sex had a statistically significant effect on CSA. Normalization methods based on canal area and skull volume reduced the CSA intersubject variability up to 16.84%. We present CSA normative values in a large cohort of children, reporting on sources of intersubject variability and how to reduce them applying normalization methods previously developed.

Relationship Between Postural Stability and Paraspinal Muscle Adaptation in Lame Horses Undergoing Rehabilitation

Postural stability maintains balance, protects the spinal column, and allows accurate responses to destabilizing forces. The musculus multifidus (m. multifidus) is the major postural muscle located adjacent to the vertebrae along the length of the spinal column. Increased cross-sectional area (CSA) of the m. multifidus has been demonstrated in horses after a rehabilitation strengthening exercise program; however, correlation with functional postural stability has not been shown. The objective of the present study is to evaluate the relationship of the thoracolumbar m. multifidus CSA and measures of postural sway performance in lame horses undergoing rehabilitation exercises in clinical cases. Seven client-owned horses admitted to the equine rehabilitation service were included in the study. M. multifidus CSA was measured via ultrasonography at the start of a rehabilitation program (initial evaluation) and after 12 weeks of rehabilitation exercises (final evaluation). Postural sway data were also measured at initial and final evaluation. A significant increase in m. multifidus CSA was seen from initial to final evaluation. A moderate to strong correlation was present between m. multifidus CSA and postural sway variables. These results suggest that there is an association between postural stability and m. multifidus hypertrophy in lame horses undergoing individualized rehabilitation programs. However, more research is needed to provide a definitive answer on the nature of this relationship. Ideally, specific performance tests would better define and examine the relationship in which to guide clinicians in rehabilitation protocol development.

Nerve ultrasound normal values in children and young adults.

The objective of the study was to determine the reference values for cross-sectional area (CSA) of the nerves in healthy subjects between the age of 2 and 30 years. High-resolution ultrasonography (HRU) of the median, ulnar, tibial, sural, peroneal and spinal nerves C5-C7 was performed in 72 healthy subjects. The CSA of peripheral nerves demonstrated an age-dependent increase in size at all measurement sites in children up to around 14 years of age. This was most pronounced for large lower limb nerves and least for small nerves. Intra-nerve and inter-nerve variability of nerve CSA did not change with age. This study provides normative values for HRU of peripheral nerves in children and young adults. Adult reference values should not be used for children under the age of 14 years.

Estimation of lowland river cross-section changes for different soils

Abstract This paper involves a comparative analysis of cross-sectional changes at selected reaches of a lowland river, flowing through the areas of mineral and organic soils. The comparisons were made at the background of design and execution assumptions from the period 1967–1971. Main processes, responsible for the observed changes of riverbeds in mineral soils (silting, conservation works) and organic soils (subsidence, disappearance of the peat deposit), were identified. In case of organic soils, the decrease of cross-sectional area by approximately from 30 to 60% was estimated in comparison to the original project assumptions, and the subsidence of river banks reached even 0.5 m in relation to the level determined in 1967. In the area of mineral soils, more considerable variability of cross-sectional area was noted along with minor changes of river banks elevation, that resulted most likely from the performed maintenance works.

Clinical, Sonographic, and Electrophysiologic Longitudinal Features of Chronic Inflammatory Demyelinating Polyneuropathy.

Several studies have aimed to find potential biomarkers to simplify the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) and to monitor and predict the disease course. However, reliable markers are still lacking. We aimed to investigate whether high-resolution nerve ultrasound (HRUS) is suitable for monitoring the long-term clinical course of CIDP. Twenty patients fulfilling the definite diagnostic criteria of CIDP received clinical examination, evaluation of the INCAT (inflammatory neuropathy cause and treatment) overall disability sum score (ODSS) as well as nerve conduction studies, and HRUS every 6 months over a median follow-up time of 34 months. Patients were divided into clinically stable/regressive disease course or progressive disease course according to the development of the ODSS. The intranerve cross-sectional-area (CSA) variability of the nerves of the lower extremity increased with disease progression, whereas it remained unchanged in patients with a stable or remitting disease course. Nerve ultrasound can be used as a method to objectify the long-term disease course in CIDP patients. The intranerve CSA variability is suitable for monitoring the clinical course of patients with CIDP.

Nitrate Uptake Kinetics and Correlation Analysis in an Agricultural Drainage Ditch

To investigate the whole-reach nitrate (NO3--N) uptake dynamics in a headwater agricultural stream, we performed five pulse tracer additions of a reactive solute (as KNO3) and a conservative solute (as NaBr) in an agricultural drainage ditch in Hefei district, Chaohu Lake basin, from October 2016 to April 2017. The TASCC (tracer additions for spiraling curve characterization) approach and Michaelis-Menten (M-M) method were applied for the simulation of NO3--N uptake dynamics. Results showed that the ambient areal rate of total NO3--N uptake Uamb varied from 11.40 to 69.13 μg ·(m2 ·s)-1 with an average of 34.45 μg ·(m2 ·s)-1, and the ambient uptake velocity Vf-amb averaged 0.24 mm ·s-1 and varied from 0.07 to 0.43 mm ·s-1 across three well-mixed sub-reaches in the study. The ambient uptake length Sw-amb averaged 199.06 m with a range from 92.51 to 405.74 m, which was much smaller than the length of the drainage ditch (about 2.5 km), suggesting that the agricultural drainage ditch had a high potential for NO3--N retention. Generally, the M-M model fit the NO3--N uptake dynamics well, and the maximum uptake Umax ranged from 158 to 1280 μg ·(m2 ·s)-1 with a mean of 631.13 μg ·(m2 ·s)-1. The half saturation constant Km ranged from 0.16 to 5.52 mg ·L-1 with a mean of 1.46 mg ·L-1. According to correlation analysis, Sw-amb was negatively correlated with NO3--Namb, and Uambwas significantly positively correlated with NO3--Namb, while other nutrient spiraling metrics were not correlated with the NO3--N ambient concentration. Hydrological conditions had no distinct effect on the NO3--N retention, but both the width variability Фw and variability in cross-sectional area ФA were significantly correlated with most of the nutrient spiraling metrics, indicating that geomorphic features in the drainage ditch evidently impacted NO3--N uptake.

Association of visceral fat area with abdominal skeletal muscle distribution in overweight Japanese adults

Quantitative evaluation of visceral fat mass and skeletal muscle mass is important for health promotion. Recently, some studies suggested the existence of adipocyte-myocyte negative crosstalk. If so, abdominal skeletal muscles may easily and negatively affected not only by the age but also the visceral fat because age-related reduction in abdominal region is greater compared with limbs. We cross-sectionally examined the existence of quantitative associations between visceral fat area and abdominal skeletal muscle distribution in overweight people. A total of 230 Japanese males and females who aged 40-64 years and whose body mass index (BMI) was 28.0-44.8kg/m2 participated in this study. The cross-sectional area (CSA) of the visceral fat, subcutaneous fat, and abdominal skeletal muscles, namely, the rectus abdominis, abdominal oblique, erector spinae, and iliopsoas muscles were measured by the computed tomography images. Stepwise regression analyses revealed the existence of sex difference in the relation between visceral fat CSA and other morphological variables. In males, BMI was a positive, and the iliopsoas muscle group CSA was a negative contributor of the visceral fat CSA. In females, both age and BMI were selected as positive contributors. These data suggested that the visceral fat CSA may negatively associated with iliopsoas muscle group CSA in males. In females, the visceral fat CSA was not significantly related to the distribution of the abdominal skeletal muscle groups.

Comparison of the Cross-Sectional Area of Longus Colli Muscle Between Patients With Cervical Radicular Pain and Healthy Controls

BackgroundPrevious studies have shown atrophy of paravertebral lumbar muscles in patients with lumbar radicular pain and have proposed rehabilitative approaches based on these findings. However, changes in cervical paravertebral muscles in patients with cervical radicular pain are still unknown. ObjectiveThe aim of this study was to compare the cross-sectional area (CSA) of the longus colli muscle (LCM) in patients with cervical radicular pain and healthy controls via ultrasound measurement. Study DesignCase-control study. SettingOutpatients who came for treatment to the neurosurgery clinic. ParticipantsA total of 20 patients with more than 4 weeks of cervical radicular pain and 20 healthy matched (for body mass index, age, and gender) control subjects. InterventionsUltrasound measurements. Main Outcome MeasuresThe CSA of the LCM at the level of C5-C6 was measured by ultrasound with the subject in supine position. Also, Neck Disability Index (NDI), and visual analogue scale (VAS) scores were reported by patients. An independent-sample t test was used for investigation of differences in CSA and other variables in both groups. ResultsA total of 20 patients with cervical radicular pain with a mean age of 42.4 years (standard deviation [SD] = 7 years) and 20 healthy matched controls with mean age of 40.7 years (SD = 7 years) participated in the study. Patients with cervical radicular pain showed smaller CSA of the LCM bilaterally compared with controls (mean difference: 0.37 [SD = 0.15]; P < .001). In the patient group, there were no significant differences between the CSA of the LCM in the involved and noninvolved sides. No correlations between the CSA of the LCM and VAS, Neck Disability Index, symptom duration, gender, BMI, and age of the patients were found. ConclusionsThis is the first study to show via ultrasound assessment that patients with cervical radicular pain had smaller bilateral CSA of the LCM in comparison with healthy controls. It is also not clear whether atrophy of the LCM in patients with cervical radicular pain is a consequence or a cause of the pain. Reduction in the stability of the neck due to atrophy of the LCM could make the cervical spine region susceptible to more injuries, which might be prevented by functional and strengthening exercises. Level of EvidenceIII

Nerve Ultrasound and Electrophysiology for Therapy Monitoring in Chronic Inflammatory Demyelinating Polyneuropathy.

We evaluated prospectively nerve ultrasound and electrophysiology as monitoring methods of intravenous immunoglobulin (IVIG) therapy in chronic inflammatory demyelinating polyneuropathy (CIDP). Overall 15 healthy subjects and 11 CIDP patients undergoing IVIG therapy were recruited in the study. All patients underwent clinical, ultrasound, and electrophysiological evaluation at the time point of first onset of symptoms (<6 weeks of symptoms) and 4, 8, and 12 months after onset. The intranerve cross-sectional area (CSA) variability of each nerve, but not the CSA alone, correlated with the MRC Scale score during 12-month follow-up. On the other hand, none of the electrophysiological parameters correlated with the MRC Scale Score in each of the peripheral nerves. Interestingly, in ¾ of the CIDP patients, the resolution of the conduction block correlated with the improvement in the MRC Sum score. Nerve ultrasound and in particular the intranerve CSA variability seems to be a useful method in monitoring CIDP patients. Although the sample size is small, the intranerve CSA variability seems to be more promising than neurophysiology.

P190. Nerve ultrasound and electrophysiology as monitoring methods of immune therapy in early onset chronic inflammatory demyelinating polyneuropathy

Introduction Aim of this study was to document the time course of nerve ultrasound and electrophysiological findings and to evaluate prospectively the applicability of both nerve ultrasound and electrophysiology as monitoring methods of immune-therapy in chronic inflammatory demyelinating polyneuropathy (CIDP). Methods Overall 11 patients fulfilling the diagnostic criteria for CIDP were recruited in the study. All patients underwent a triple blinded clinical, ultrasound and electrophysiological evaluation at the time point of first onset of symptoms ( Results CIDP showed at the time point of first onset of symptoms pathological cross-sectional area (CSA) changes in the ulnar, radial, fibular, tibial and sural nerve. In addition, increased intranerve CSA variability (defined as maximal CSA/minimal CSA in the anatomical course of the nerve) was documented in the median nerve, while the nerve conduction studies revealed mainly a demyelinating lesion in various peripheral nerves. The intranerve CSA variability of each nerve, but not the CSA, correlated with the MRC Scale during 12 month follow-up, while a resolution of the conduction block could be documented during clinical improvement. Discussion Nerve ultrasound parameters, and especially the intranerve CSA variability, seem to be useful in the follow-up of patients with CIDP undergoing IVIG therapy.

Nerve Ultrasound in Peripheral Neuropathies: A Review.

Peripheral neuropathies are one of the most common reasons for seeking neurological care in everyday practice. Electrophysiological studies remain fundamental for the diagnosis and etiological classification of peripheral nerve impairment. The recent technological development though of high resolution ultrasound has allowed the clinician to obtain detailed structural images of peripheral nerves. Nerve ultrasound mainly focuses on the evaluation of the cross sectional area, cross sectional area variability along the anatomical course, echogenity, vascularity and mobility of the peripheral nerves. An increase of the cross sectional area, hypervascularity, disturbed fascicular echostructure and reduced nerve mobility are some of the most common findings of entrapments neuropathies, such as the carpal or cubital tunnel syndrome. Both the cross-sectional area increase and the hypervascularity detected with the Doppler technique seem to correlate significantly with the clinical and electrophysiological severity of the later mononeuropathies. Significantly greater cross sectional area values of the clinically affected cervical nerve root are often detected in cases of cervical radiculopathy. In such cases, the ultrasound findings seem also to correlate significantly with disease duration. On the other hand, multifocal cross sectional area enlargement of cervical roots and/or peripheral nerves is often documented in cases of immune-mediated neuropathies. None of the later pathological ultrasound findings seem to correlate significantly with the electrophysiological parameters or the functional disability. The aim of this review is to provide a timely update on the role of neuromuscular ultrasound in the diagnostic of the most common entrapment and immune-mediated peripheral neuropathies in clinical practice.