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Yusuf I, Mork H, Erdlenbruch B, Schellinger PD, Philipps J. Nerve ultrasound reference values in children and adolescents: Echogenicity and influence of anthropometric factors including hand volume. J Cent Nerv Syst Dis 2023; 15:11795735231195778. [PMID: 37621670 PMCID: PMC10446961 DOI: 10.1177/11795735231195778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Background Nerve cross-sectional area (CSA) reference values in high-resolution ultrasound for children and adolescents are influenced by demographic and anthropometric factors such as age, height and weight. Objectives The influence of hand volume as an additional morphometric factor was evaluated and nerve echogenicity was analyzed in a prospective cross-sectional study. Methods CSA were measured in 30 healthy children and adolescents from 2 to 17 years in the median, ulnar, radial, tibial, peroneal and sural nerves. Height, weight, age, handedness and gender were recorded, the volume of the hands was measured using the water displacement method. The intra-nerve CSA variability (INV), left/right ratios and absolute differences were calculated. Age groups were compared by the Kruskal-Wallis test. The influence of demographic factors was analyzed using Spearman correlation and multiple linear regression. Echogenicity and fraction of black were determined for each nerve segment. Results Nerve CSA values were consistently lower than those reported for adults and correlated in all measured nerve sites with age, height, weight and hand volume. Weight showed the highest correlation coefficient (R = .95) with the best fitting model predicting CSA. Correlation coefficients were higher in a linear than in a logarithmic model. Ratios were stable, the absolute differences increased with age and were significantly different between age groups. Most nerves showed a mixed or hypoechogenic pattern in echogenicity analysis, hyperechogenicity is less frequently observed. Conclusions Nerve CSA in children and adolescents is lower than in adults and increases proportionally during growth with a constant INV and left/right ratio in different age groups. Weight and age are predominant anthropometric factors predicting nerve size. Hand volume is correlated with nerve size, but does not predict CSA independently. Echogenicity can provide additional information on nerve structure.
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Affiliation(s)
- Ifirae Yusuf
- Department of Neurology and Neurogeriatrics, Johannes-Wesling-Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Hannah Mork
- Department of Neurology and Neurogeriatrics, Johannes-Wesling-Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Bernhard Erdlenbruch
- Department of Pediatrics, Johannes-Wesling-Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Peter Dieter Schellinger
- Department of Neurology and Neurogeriatrics, Johannes-Wesling-Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Jörg Philipps
- Department of Neurology and Neurogeriatrics, Johannes-Wesling-Klinikum Minden, Ruhr-University Bochum, Minden, Germany
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Singh KP, Kaur S, Arora V. Reference Values for the Cross Sectional Area of Normal Tibial Nerve on High-resolution Ultrasonography. J Ultrason 2022; 22:e144-e152. [PMID: 36482929 PMCID: PMC9714288 DOI: 10.15557/jou.2022.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/02/2022] [Indexed: 07/30/2023] Open
Abstract
AIM The aim of the study was to establish reference values for the cross-sectional area of the tibial nerve on high-resolution ultrasonography and to investigate the relationship between the cross-sectional area of the tibial nerve and subject's age, gender, height (in cm), weight (in kg) and body mass index. METHODS Two hundred subjects of either gender and over 18 years of age with no history of peripheral neuropathy or trauma to the lower limb were evaluated with high-resolution ultrasonography. Mean cross-sectional areas of tibial nerves were measured at two different levels in both lower limbs, first at 1 cm below the bifurcation of the sciatic nerve into tibial and common peroneal nerves (level I) and the second at 1 cm superior and posterior to the medial malleolus (level II). RESULTS The mean cross-sectional area measured at level I (0.196 + 0.014 cm2) was larger than the one measured at level II (0.111 ± 0.011 cm2). A positive correlation was found between the mean cross-sectional area and height, weight, and body mass index (p <0.05). Women had smaller cross-sectional areas of the tibial nerves than men at both sites. In addition, no significant relationship was found with the age of the subjects (p >0.05). CONCLUSION The established reference values of the cross-sectional area of the tibial nerve will aid in early diagnosis of peripheral neuropathy.
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Affiliation(s)
| | - Sumanjeet Kaur
- Radiodiagnosis, Sgrd University of Health Sciences, India
| | - Vijinder Arora
- Radiodiagnosis, Sgrd University of Health Sciences, India
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Menashe SJ, Maloney E, Perez FA, Ngo AV, Otjen JP, Iyer RS, Friedman S, Thapa M. Normative Values for the Sonographic Measurement of the Pediatric Median and Ulnar Nerves. Acad Radiol 2022; 29 Suppl 3:S147-S156. [PMID: 34518058 DOI: 10.1016/j.acra.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/17/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
RATIONAL AND OBJECTIVES Ultrasound investigation of peripheral nerves, long used in the adult population, has been shown to be of value in diagnosing a variety of peripheral nerve abnormalities. More recently, nerve sonography has also been shown to be of use in pediatrics. However, normative values for nerve size in children have been lacking. As such, the goal of this research was to establish normative data for cross sectional area (CSA) measurements of the median and ulnar nerves in children. MATERIALS AND METHODS The median and ulnar nerves of 48 children ranging in age from 2 years to 17 years were imaged by ultrasound. CSA measurements were made at 2 separate sites for each nerve and measured independently by 6 pediatric radiologists. Reliability of ultrasound measurements between the radiologists was assessed by calculating intraclass correlation coefficients. Linear mixed-effects modeling was performed to develop prediction models for nerve cross sectional area for each nerve segment; 95% prediction values were generated from these models to approximate normal ranges. RESULTS Agreement in nerve cross-sectional area measurements among the 6 radiologists for all nerve segments was good (ICC 0.82, 95% CI 0.78 to 0.85). CSA for both the median and ulnar nerves is larger in older children. However, statistical models to predict CSA using height perform better rather than those using a child's age. The range of normal nerve segment CSA using these prediction models based on child height are reported. CONCLUSION Median and ulnar nerve CSA can be reliably measured with ultrasound. Normal reference values for ulnar and median nerve CSA correlate with patient age but may be more optimally determined based on a child's height.
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Affiliation(s)
- Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington.
| | - Ezekiel Maloney
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington
| | - Francisco A Perez
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington
| | - Anh-Vu Ngo
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington
| | - Jeff P Otjen
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington
| | - Seth Friedman
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington
| | - Mahesh Thapa
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle Washington
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Singh KP, Singh P, Gupta K. Reference values for the cross-sectional area of the normal sciatic nerve using high-resolution ultrasonography. J Ultrason 2021; 21:e95-e104. [PMID: 34258034 PMCID: PMC8264619 DOI: 10.15557/jou.2021.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/27/2021] [Indexed: 11/22/2022] Open
Abstract
Aim High-resolution ultrasonography is a new and promising technique to evaluate peripheral and spinal nerves. Its validity as a diagnostic tool in neurological diseases has been demonstrated in adults. The aims of study were to establish the reference values for the cross-sectional area of the normal sciatic nerve on high-resolution ultrasonography, and to determine the relationship between the cross-sectional area of the normal sciatic nerve and the subjects' age, gender, height (in cm), weight (in kg), and body mass index. Material and methods Two hundred subjects of both genders and above 18 years of age were studied with high-resolution ultrasonography. The subjects had no history of peripheral neuropathy or trauma to the lower limb. The cross-sectional areas of the normal sciatic nerves were obtained at two different levels in both lower limbs. The mean cross-sectional areas of the sciatic nerves were measured at two different levels, one located at 1 cm above the bifurcation of the sciatic nerve into the tibial and common peroneal nerves, and the other 4 cm above the bifurcation of the sciatic nerve into the tibial and common peroneal nerves. Results A positive correlation of the mean cross-sectional area was established with height, weight, and body mass index. Women had smaller cross-sectional areas of the normal sciatic nerves than men at both measuring sites. No significant relationship was established with the age of the subjects. Conclusions The established reference values of the cross-sectional area of the sciatic nerve can facilitate the analysis of pathological nerve conditions.
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Affiliation(s)
| | - Prabhjot Singh
- Radiodiagnosis, SGRD University of Health Sciences, India
| | - Kamlesh Gupta
- Radiodiagnosis, SGRD University of Health Sciences, India
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Nerve ultrasound reference data in children from two to seven years. Clin Neurophysiol 2020; 131:859-865. [PMID: 32066105 DOI: 10.1016/j.clinph.2019.12.404] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/12/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We examined selected peripheral and spinal nerves of children aged between two and seven years. METHOD High resolution ultrasound was performed in 116 children (2-7 years of age) at 19 predefined landmarks of median, ulnar, tibial, fibular, sural and radial nerves, the vagus as well as cervical spinal nerve 5 and 6. Further, side-to-side measuring and grey-scale analysis was done at selected nerve sites. RESULTS Nerves of children were on average smaller than those of adults. Nerve growth correlates significantly with age in all nerves, the mean values were similar in the age of two to four years and five to seven years. Body mass index (BMI) and gender showed moderate effect at some nerve sites, however not uniformly in all. A side-to-side difference of up to 30% in median, and up to 20% in tibial nerve can occur in healthy individuals. Grey-scale analysis for echointensity has been performed in median, ulnar and tibial nerves. CONCLUSION Nerve size increases with age, BMI and gender have moderate effect. A side-to-side-difference of up to 30% can exist. SIGNIFICANCE Reference values of nerve cross-sectional area, side-to-side-difference and echo intensity are necessary to detect nerve pathology in children as well as in adults.
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Takata SC, Kysh L, Mack WJ, Roll SC. Sonographic reference values of median nerve cross-sectional area: a protocol for a systematic review and meta-analysis. Syst Rev 2019; 8:2. [PMID: 30606255 PMCID: PMC6317213 DOI: 10.1186/s13643-018-0929-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Median nerve cross-sectional area (CSA) is the primary sonographic parameter for assessing and diagnosing median nerve pathology, such as carpal tunnel syndrome. However, variability in the sensitivity of diagnostic thresholds exists, which may be due to a lack of standardized normative reference values. Current estimates of normal median nerve CSA stem largely from small studies using a local pool of healthy controls. A systematic review and meta-analysis will be conducted to identify all available data for median nerve CSA in healthy, asymptomatic individuals to create a comprehensive set of normative reference values. METHODS Articles that include sonographic measures of median nerve CSA will be identified through a rigorous search of published evidence, a hand search through tables of contents of key journals, and the gray literature, including ClinicalTrials.gov and conference abstracts. Each abstract and full text will be reviewed by multiple raters to identify studies from 2000 to present that include original data. Any study that provides median nerve CSA values from healthy individuals will be included (e.g., reference value study, control participants in a diagnostic study). Studies will be assessed for quality using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, with primary focus on the use of a detailed and acceptable image acquisition and analysis protocol. Using data from included studies, reference values will be calculated for median nerve CSA by anatomical regions, including the distal forearm, wrist, and carpal tunnel at the level of the pisiform. Reference values will be stratified by gender, ethnicity, and age based upon the specificity of the data provided by the included articles. DISCUSSION A comprehensive set of normative reference values of median nerve CSA will reduce variability across studies, allowing future research to more accurately evaluate and establish diagnostic thresholds. Additionally, normative values can serve as a reference for evaluating treatment outcomes and provide a means to investigate and understand minor nuances in CSA changes that may be indicative of preclinical stages of median nerve pathology. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2016 CRD42016037286.
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Affiliation(s)
- Sandy C. Takata
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1640 Marengo St, Suite 505, Los Angeles, CA 90089-9256 USA
| | - Lynn Kysh
- Norris Medical Library, University of Southern California, Los Angeles, CA USA
- Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Wendy J. Mack
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - Shawn C. Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1640 Marengo St, Suite 505, Los Angeles, CA 90089-9256 USA
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Grimm A, Axer H, Heiling B, Winter N. Nerve ultrasound normal values – Readjustment of the ultrasound pattern sum score UPSS. Clin Neurophysiol 2018; 129:1403-1409. [DOI: 10.1016/j.clinph.2018.03.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/06/2018] [Accepted: 03/18/2018] [Indexed: 12/28/2022]
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Bedewi MA, Abodonya A, Kotb M, Kamal S, Mahmoud G, Aldossari K, Alqabbani A, Swify S. Estimation of ultrasound reference values for the lower limb peripheral nerves in adults: A cross-sectional study. Medicine (Baltimore) 2018; 97:e0179. [PMID: 29561431 PMCID: PMC5895347 DOI: 10.1097/md.0000000000010179] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The objective of this study is to estimate the reference values for the lower limb peripheral nerves in adults.The demographics and physical characteristics of 69 adult healthy volunteers were evaluated and recorded. The estimated reference values and their correlations with the age, weight, height, body mass index (BMI) were evaluated.The cross sectional area reference values were obtained at 5 predetermined sites for 3 important lower limb peripheral nerves. Our CSA values correlated significantly with age, weight, and BMI. The normal reference values for each nerve were as follows: Tibial nerve at the popliteal fossa 19 mm ± 6.9, tibial nerve at the level of the medial malleolus 12.7 mm ± 4.5, common peroneal nerve at the popliteal fossa 9.5 mm ± 4, common peroneal nerve fibular head 8.9 mm ± 3.2, sural nerve 3.5 mm ± 1.4.The reference values for the lower limb peripheral nerves were identified. These values could be used for future management of peripheral nerve disorders.
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Affiliation(s)
| | - Ahmed Abodonya
- College of Medicine, Prince Sattam Bin Abdulaziz University
- Al-Azhar University
| | - Mamdouh Kotb
- College of Medicine, Prince Sattam Bin Abdulaziz University
- Minia University, Cairo
| | - Sanaa Kamal
- College of Medicine, Prince Sattam Bin Abdulaziz University
| | - Gehan Mahmoud
- College of Medicine, Prince Sattam Bin Abdulaziz University
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Bedewi MA, Abodonya A, Kotb M, Mahmoud G, Kamal S, Alqabbani A, Alhariqi B, Alanazy MH, Aldossari K, Swify S, Al-Bader F. Estimation of ultrasound reference values for the upper limb peripheral nerves in adults: A cross-sectional study. Medicine (Baltimore) 2017; 96:e9306. [PMID: 29390395 PMCID: PMC5815807 DOI: 10.1097/md.0000000000009306] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The objective of this study is to estimate the reference values for the upper limb peripheral nerves in adults.The demographics and physical characteristics of 69 adult healthy volunteers were evaluated and recorded. In addition, the side to side differences of the estimated reference values and their correlations with the age, weight, height, and body mass index (BMI) were evaluated.Cross-sectional area reference values of the upper limb nerves did not correlate with height; however, they correlated with age, weight, and BMI in some scanned sites.The data obtained in this study could be helpful in future diagnosis of peripheral nerve disorders of the upper limb.
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Affiliation(s)
| | - Ahmed Abodonya
- College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, KSA
| | - Mamdouh Kotb
- College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, KSA
| | - Gehan Mahmoud
- College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, KSA
| | - Sanaa Kamal
- College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, KSA
| | - Abdullah Alqabbani
- College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, KSA
| | - Bader Alhariqi
- College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, KSA
| | - Mohammed H. Alanazy
- Department of Internal Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Khaled Aldossari
- College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, KSA
| | | | - Fahad Al-Bader
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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