Department of Neurology, Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany.
Department of Neurology, Evangelisches Krankenhaus Hattingen, Hattingen, Germany.
J Neuroimaging. 2020 Jul;30(4):493-502. doi: 10.1111/jon.12717. Epub 2020 Jun 10.
Little is known about echogenicity and fascicular structure observed in high-resolution nerve ultrasound (HRUS) in both healthy subjects and patients with peripheral nerve disease. The aim of this study was to evaluate the reliability of echogenicity, fascicle count, and fascicle size analysis, to create standard values and compare these parameters to patients with chronic inflammatory demyelinating polyneuropathy (CIDP).
Median, ulnar, radial, tibial, and fibular nerve of 79 healthy subjects and patients were scanned by one examiner using HRUS. Image analysis regarding echogenicity, fascicle count, and fascicle cross-sectional area (CSA) was performed by two independent raters semiautomatically using ImageJ. Pearson correlation coefficient r reflected interrater reliability (IR), and intraclass correlation coefficient (ICC) determined intrarater reliability (IAR). Results of healthy subjects were compared to 20 patients with CIDP by analysis of variance.
IR was very good for echogenicity (r = .9) and good for fascicle count and size of the largest fascicle (r = .64/.56). IAR was very good for all three parameters (ICC = .9/.83/.74). Healthy subjects had a wide range of values. CIDP patients were in range of healthy subjects. Clinically progressive CIDP patients (defined as an increase in Overall Disability Sum Score by ≥1 point) had a lower fraction of black than healthy controls and stable CIDP patients (P < .001).
Semiautomated evaluation of echogenicity, fascicle count, and fascicle CSA is reliable. Cutoff values to differentiate between healthy persons and CIDP do not exist. Echogenicity is useful for detecting clinically progressive CIDP patients and should be used in clinical context or intraindividual course.
在健康受试者和周围神经疾病患者的高分辨率神经超声（HRUS）中，人们对回声强度和束状结构知之甚少。本研究旨在评估回声强度、束数和束横截面积（CSA）分析的可靠性，建立标准值，并将这些参数与慢性炎症性脱髓鞘性多发性神经病（CIDP）患者进行比较。
由一位检查者使用 HRUS 对 79 例健康受试者和患者的正中神经、尺神经、桡神经、胫神经和腓总神经进行扫描。使用 ImageJ 半自动进行图像分析，以评估回声强度、束数和束 CSA。Pearson 相关系数 r 反映了两位独立评估者的组内相关性（IR），而组内相关系数（ICC）则确定了组内相关性（IAR）。通过方差分析比较健康受试者与 20 例 CIDP 患者的结果。
回声强度的 IR 非常好（r =.9），束数和最大束 CSA 的 IR 良好（r =.64/.56）。三种参数的 IAR 均非常好（ICC =.9/.83/.74）。健康受试者的数值范围较宽。CIDP 患者的数值在健康受试者的范围内。临床进展型 CIDP 患者（定义为总残疾评分增加≥1 分）的黑纤维比例低于健康对照组和稳定型 CIDP 患者（P <.001）。
回声强度、束数和束 CSA 的半自动评估是可靠的。没有区分健康人与 CIDP 的截断值。回声强度有助于发现临床进展型 CIDP 患者，应在临床背景或个体内病程中使用。
