Nerve ultrasound improves detection of treatment-responsive chronic inflammatory neuropathies
Abstract
Objective
To examine the diagnostic accuracy of nerve ultrasound in a prospective cohort of consecutive patients with a clinical suspicion of chronic inflammatory neuropathies, including chronic inflammatory demyelinating polyneuropathy, Lewis-Sumner syndrome, and multifocal motor neuropathy, and to determine the added value in the detection of treatment-responsive patients.
Methods
Between February 2015 and July 2018, we included 100 consecutive incident patients with a clinical suspicion of chronic inflammatory neuropathy. All patients underwent nerve ultrasound, extensive standardized nerve conduction studies (NCS), and other relevant diagnostic investigations. We evaluated treatment response using predefined criteria. A diagnosis of chronic inflammatory neuropathy was established when NCS were abnormal (fulfilling criteria of demyelination of the European Federation of Neurological Societies/Peripheral Nerve Society) or when the degree of nerve enlargement detected by sonography was compatible with chronic inflammatory neuropathy and there was response to treatment.
Results
A diagnosis of chronic inflammatory neuropathy was established in 38 patients. Sensitivity and specificity of nerve ultrasound and NCS were 97.4% and 69.4% and 78.9% and 93.5%, respectively. The added value of nerve ultrasound in detection of treatment-responsive chronic inflammatory neuropathy was 21.1% compared to NCS alone.
Conclusions
Nerve ultrasound and NCS are complementary techniques with superior sensitivity in the former and specificity in the latter. Addition of nerve ultrasound significantly improves the detection of chronic inflammatory neuropathies. Therefore, it deserves a prominent place in the diagnostic workup of chronic inflammatory neuropathies.
Classification of evidence
This study provides Class IV evidence that nerve ultrasound is an accurate diagnostic tool to detect chronic inflammatory neuropathies.
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© 2020 American Academy of Neurology.
Publication History
Received: July 23, 2019
Accepted: November 7, 2019
Published online: January 20, 2020
Published in print: April 7, 2020
Disclosure
I. Herraets reports no disclosures relevant to the manuscript. S. Goedee receives research support from the Prinses Beatrix Spierfonds and received a travel grant and speaker fee from Takeda. J. Telleman, R. van Eijk, and T. van Asseldonk report no disclosures relevant to the manuscript. L. Visser receives research support from the Prinses Beatrix Spierfonds and The Netherlands Organisation for Health Research and Development. L. van den Berg serves on scientific advisory boards for Orion, Biogen, and Cytokinetics; received an educational grant from Takeda; serves on the editorial boards of Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration and the Journal of Neurology, Neurosurgery, and Psychiatry; and receives research support from the Prinses Beatrix Spierfonds, Netherlands ALS Foundation, and The Netherlands Organization for Health Research and Development (Vici Scheme, JPND [SOPHIA, STRENGTH, ALSCare]). W.L. van der Pol serves on a scientific advisory board for SAB SMA Europe, is a member of the Branaplam data monitoring committee for Novartis, provides ad hoc consultancy for Biogen and Avexis, and receives research support from the Prinses Beatrix Spierfonds, Vriendenloterij, and Stichting Spieren voor Spieren. Go to Neurology.org/N for full disclosures.
Study Funding
Supported by Prinses Beatrix Fonds (WAR.OR14-08). The funding source had no involvement in study design, data collection, analysis, interpretation of data, writing of the report, or the decision to submit the article for publication.
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