Yoshikawa Masaaki, Sekiguchi Kenji, Suehiro Hirotomo, Watanabe Shunsuke, Noda Yoshikatsu, Hara Hideo, Matsumoto Riki
Division of Neurology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima-cho, Saga 849-8501, Japan.
Clin Neurophysiol Pract. 2023 Nov 22;8:228-234. doi: 10.1016/j.cnp.2023.10.002. eCollection 2023.
We aimed to evaluate differences in ultrasonographic nerve enlargement sites among typical chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), distal CIDP, multifocal CIDP and multifocal motor neuropathy (MMN) in a Japanese population.
We retrospectively reviewed medical records and selected 39 patients (14 with typical CIDP, 7 with multifocal CIDP, 4 with distal CIDP, and 14 with MMN) who underwent ultrasonography. Median and ulnar nerve cross-sectional areas (CSAs) were measured at the wrist, forearm, elbow, and upper arm. CSA ratios for each nerve were calculated as: wrist-to-forearm index (WFI) = wrist CSA/forearm CSA; elbow-to-upper arm index (EUI) = elbow CSA/upper arm CSA; and intranerve CSA variability (INCV) = maximal CSA/minimal CSA.
Significant differences were observed among typical CIDP, multifocal CIDP, distal CIDP, and MMN in CSA at the forearm and upper arm in the median nerves (p < 0.05). Patients with multifocal CIDP had lower WFI and EUI and higher INCV than the other groups (p < 0.05).
Regardless of the untreated period, compared with other CIDP subtypes and MMN, multifocal CIDP showed a focal and marked nerve enlargement in the Japanese population.
Differences in nerve enlargement site may be an underlying feature of multifocal CIDP.
我们旨在评估典型慢性炎性脱髓鞘性多发性神经根神经病（CIDP）、远端型CIDP、多灶性CIDP和多灶性运动神经病（MMN）在日本人群中超声检查时神经增粗部位的差异。
我们回顾性分析病历，选取了39例行超声检查的患者（14例典型CIDP、7例多灶性CIDP、4例远端型CIDP和14例MMN）。在腕部、前臂、肘部和上臂测量正中神经和尺神经的横截面积（CSA）。计算每条神经的CSA比值：腕部与前臂指数（WFI）=腕部CSA/前臂CSA；肘部与上臂指数（EUI）=肘部CSA/上臂CSA；神经内CSA变异性（INCV）=最大CSA/最小CSA。
典型CIDP、多灶性CIDP、远端型CIDP和MMN在正中神经前臂和上臂的CSA存在显著差异（p<0.05）。多灶性CIDP患者的WFI和EUI低于其他组，INCV高于其他组（p<0.05）。
无论未治疗时间长短，与其他CIDP亚型和MMN相比，多灶性CIDP在日本人群中表现为局灶性且明显的神经增粗。
神经增粗部位的差异可能是多灶性CIDP的一个潜在特征。
