Grimm Alexander, Rattay Tim W, Winter Natalie, Axer Hubertus
Center for Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research Eberhard-Karls University Tübingen, Tübingen, Germany.
German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
J Neurol. 2017 Feb;264(2):243-253. doi: 10.1007/s00415-016-8305-y. Epub 2016 Nov 22.
Ultrasound of the nerves is an additive diagnostic tool to evaluate polyneuropathy. Recently, the need for standardized scoring systems has widely been discussed; different scores are described so far. Therefore, 327 patients with polyneuropathy were analyzed by ultrasound in our laboratory. Consequently, several ultrasound scoring tools were applied, i.e., the nerve pattern classification according to Padua et al. in all patients with CIDP and variants, the Bochum ultrasound score (BUS) and the neuritis ultrasound protocol in immune-mediated neuritis, the ultrasound pattern sum score, the homogeneity score, and the nerve enlargement distribution score in all neuropathies if possible. For all scores good accuracy was found. Most patients with CIDP revealed hypoechoic enlarged nerves (Class 1), the BUS/NUP was useful to identify GBS (sensitivity >85%), MMN (100%) and CIDP (>70%), while the UPSS showed high sensitivity and positive/negative predictive values (N/PPV) in the diagnosis of GBS (>70%), CIDP (>85%) and axonal non-inflammatory neuropathies (>90%). Homogeneous nerves were found in most CMT1 patients (66.7%), while immune-mediated neuropathies mostly show regional nerve enlargement. The HS was suitable to identify CMT patients with an HS ≥5 points. All scores were easily applicable with high accuracy. The former-reported results could be similarly confirmed. However, all sores have some incompleteness concerning unselected polyneuropathy population, particularly rare and focal types. Scoring systems are useful and easily applicable. They show high accuracy in certain neuropathies, but also offer some gaps and can, therefore, only be used in addition to standard diagnostic routines such as electrophysiology.
神经超声是评估多发性神经病的一种辅助诊断工具。最近，对标准化评分系统的需求已得到广泛讨论；目前已描述了不同的评分方法。因此，我们实验室对327例多发性神经病患者进行了超声分析。相应地，应用了几种超声评分工具，即在所有慢性炎性脱髓鞘性多发性神经病（CIDP）及其变异型患者中采用帕多瓦等人提出的神经模式分类，在免疫介导性神经炎中采用波鸿超声评分（BUS）和神经炎超声方案，在所有可能的神经病变中采用超声模式总和评分、同质性评分和神经增粗分布评分。所有评分均具有良好的准确性。大多数CIDP患者表现为低回声增粗神经（1类），BUS/NUP有助于识别吉兰-巴雷综合征（GBS）（敏感性＞85%）、多灶性运动神经病（MMN）（100%）和CIDP（＞70%），而超声模式总和评分在GBS（＞70%）、CIDP（＞85%）和轴索性非炎性神经病（＞90%）的诊断中显示出高敏感性和阳性/阴性预测值（N/PPV）。大多数遗传性运动感觉神经病1型（CMT1）患者的神经呈均匀性改变（66.7%），而免疫介导性神经病大多表现为局部神经增粗。同质性评分适用于识别同质性评分≥5分的CMT患者。所有评分都易于应用且准确性高。先前报道的结果可得到类似的证实。然而，所有评分在未选择的多发性神经病群体，特别是罕见和局灶性类型方面都存在一些不足之处。评分系统有用且易于应用。它们在某些神经病变中显示出高准确性，但也存在一些差距，因此只能作为电生理等标准诊断程序的补充使用。
