Detection of cervical nerve root hypertrophy by ultrasonography in chronic inflammatory demyelinating polyradiculoneuropathy
Introduction
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a demyelinating disease of the peripheral nerves, frequently involving spinal nerve roots and the plexus [1]. Abnormal findings of these lesions have been demonstrated in previous studies using magnetic resonance imaging (MRI), in which hypertrophy and gadolinium (Gd) enhancement of spinal nerve roots were considered to be major findings in MR images [2], [3]. In view of the location of the spinal nerve roots, such abnormalities of cervical nerve roots have been less commonly demonstrated [3], [4], [5], [6], [7], [8] than those of the lumbar spinal roots or the cauda equina [2], [9], [10], [11], [12], [13]. A few studies on the frequency of these findings on MR images have suggested that there is a high frequency of these findings in CIDP patients [2], [3].
High-resolution ultrasonography (US), regarded as a valid method for examining structures close to the surface of the body such as thyroid glands or carotid arteries [14], is also useful for evaluating peripheral nerves [15], [16], including the median, ulnar, sciatic nerves, and the brachial plexus [17], [18] and even vagus nerves [19]. This inspection method has been predominantly used to evaluate peripheral nerve tumors [15], [20], [21] and carpal tunnel syndrome [22]. Attempts have been made in some recent studies to evaluate the peripheral nerves of extremities by US in patients with hereditary motor and sensory neuropathy type 1 [16], [23], in which widespread hypertrophy of peripheral nerves, including nerve roots, can occur as well as CIDP. In contrast to the frequent use of US for evaluating these diseases, however, there has been only one case report on US findings of peripheral nerves and nerve roots in CIDP [24]. The purpose of this study was to determine whether US enables detection of hypertrophy of the cervical nerve roots in CIDP patients, how frequently nerve root hypertrophy occurs in CIDP, and whether US findings correlate with any clinical or laboratory features.
Section snippets
Subjects
The study included 13 patients (aged 19 to 70 years; mean age, 47.3 years; 9 males and 4 females) with CIDP who had been treated on an inpatient or outpatient basis in our hospital during the period from July 3, 2001 to July 29, 2002. The diagnosis of CIDP was made in accordance with the criteria of the Ad Hoc Subcommittee of the American Academy of Neurology [25] on the basis of clinical history and results of neurological and electrophysiological examinations performed by neurologists. Five
Results
All of the fifth cervical (C5), C6, and C7 nerve roots could be visualized by US in all of the CIDP patients and control subjects, but the eighth cervical nerve roots could be visualized only in 5 of the 13 CIDP patients and in 10 of the 33 control subjects. None of the first thoracic nerve roots were observed. As a C7 nerve root was delineated less articulately compared with C5 and C6 nerve roots due to its deeper position from the surface, both the C5 and C6 nerve root diameters were used for
Discussion
In this study, US showed an excellent capability for enabling detection of hypertrophy of cervical nerve roots and revealed a high frequency of this finding (69%) in CIDP patients. We also demonstrated the high reliability of US for measurement of cervical nerve roots diameters by means of showing the high reproducibility analyzed according to the method of Bland and Altman and by calculating the coefficient of variation. To the best of our knowledge, this is the first study in which the
Acknowledgments
This study was supported in part by grants for Neuroimmunological Diseases (TK) from the Ministry of Health, Labor and Welfare of Japan.
We thank Dr. Hideshi Kawakami, Dr. Sadao Katayama, Dr. Hirofumi Maruyama, Dr. Ken Inoue, and Dr. Takeshi Kitamura for patient referral, Dr. Hiroshi Fukuda, Dr. Kazuko Kozuka, and Dr. Hiromitsu Naka for their technical support, and Mayumi Yoshikawa and Hiromi Sumida for their secretarial assistance.
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