Lüling Benjamin, Preisner Fabian, Motte Jeremias, Fisse Anna Lena, Grüter Thomas, Klimas Rafael, Schäfer Emelie, Altenborg Annika, Colak Devrim, Philipps Jörg, Godel Tim, Schwarz Daniel, Heiland Sabine, Yoon Min-Suk, Gold Ralf, Bendszus Martin, Kronlage Moritz, Pitarokoili Kalliopi
Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.
Immune-Mediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany.
Ther Adv Neurol Disord. 2025 Jun 21;18:17562864251342336. doi: 10.1177/17562864251342336. eCollection 2025.
The novel criteria for the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) have established imaging with nerve ultrasound (NUS) and magnetic resonance neurography (MRN) as complementary methods for CIDP diagnosis.
Our goal was to investigate the role of MRN and NUS for CIDP monitoring.
We longitudinally examined 12 CIDP patients from 2016 to 2022 using NUS, MRN, nerve conduction studies (NCS), and clinical parameters (inflammatory neuropathy cause and treatment (INCAT)/overall disability sum score (ODSS)). NUS evaluated the cross-sectional area (CSA) of the median, ulnar, radial, tibial, fibular, and sural nerve as well as the intranerve CSA variability (INV) of the tibial, fibular, ulnar, and median nerve, whereas MRN evaluated T2-weighted sequences of the fibular and tibial nerve at the popliteal fossa.
Five patients showed clinical improvement/stability with corresponding improved or stable NCS/NUS parameters (number of nerves with increased CSA and INV). Seven deteriorating patients showed deteriorating NCS and either increasing or decreasing NUS markers possibly indicating inflammatory activity or degenerative CSA reduction. The difference ΔINCAT/ODSS correlated positively with NUS ΔINV ( = 0.007, = 0.731, = 12) and with NUS ΔCSA of the tibial nerve ( = 0.0005, = 0.865, = 12). Further, NUS-CSA of the tibial nerve in the popliteal fossa in 2016 correlated inversely with the difference of the INCAT/ODSS score (ΔINCAT/ODSS; = -0.653; = 0.033; = 11). Finally, the Bland-Altman analyses for the tibial and fibular nerve showed a bias of -1.903 and 2.195 mm (bias = NUS-CSA - MRN-CSA) accordingly revealing a difference between MRN and NUS measurements for deeper nerves.
CSA and INV of the tibial and fibular nerve can be used for monitoring in CIDP, and increased CSA of the tibial nerve is a good prognostic marker. MRN is more reliable for evaluating inflammation in proximal leg nerve segments.
慢性炎性脱髓鞘性多发性神经病（CIDP）的新诊断标准已将神经超声（NUS）和磁共振神经造影（MRN）成像确立为CIDP诊断的补充方法。
我们的目标是研究MRN和NUS在CIDP监测中的作用。
我们在2016年至2022年期间对12例CIDP患者进行了纵向检查，使用了NUS、MRN、神经传导研究（NCS）和临床参数（炎性神经病病因与治疗（INCAT）/总体残疾总分（ODSS））。NUS评估了正中神经、尺神经、桡神经、胫神经、腓总神经和腓肠神经的横截面积（CSA）以及胫神经、腓总神经、尺神经和正中神经的神经内CSA变异性（INV），而MRN评估了腘窝处腓总神经和胫神经的T2加权序列。
5例患者临床改善/稳定，相应的NCS/NUS参数改善或稳定（CSA和INV增加的神经数量）。7例病情恶化的患者NCS恶化，NUS指标可能增加或减少，这可能表明存在炎性活动或CSA的退行性减少。ΔINCAT/ODSS差异与NUS ΔINV呈正相关（=0.007，=0.731，=12），与胫神经的NUS ΔCSA呈正相关（=0.0005，=0.865，=12）。此外，2016年腘窝处胫神经的NUS-CSA与INCAT/ODSS评分差异（ΔINCAT/ODSS）呈负相关（= -0.653；=0.033；=11）。最后，对胫神经和腓总神经的Bland-Altman分析显示偏差分别为-1.903和2.195毫米（偏差=NUS-CSA - MRN-CSA），相应地揭示了MRN和NUS对深部神经测量的差异。
胫神经和腓总神经的CSA和INV可用于CIDP的监测，胫神经CSA增加是一个良好的预后指标。MRN在评估近端腿部神经节段的炎症方面更可靠。
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