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Fathi D, Naraghi A, White LM, Dodig D, Barnett-Tapia C, Breiner A, Bril V, Katzberg HD. Whole-body magnetic resonance neurography in patients with chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2024. [PMID: 38698725 DOI: 10.1002/mus.28098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 03/19/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION/AIMS Whole-body magnetic resonance neurography (MRN) is an imaging modality that shows peripheral nerve signal change in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). We aimed to explore the diagnostic potential of whole-body MRN and its potential as a monitoring tool after immunotherapy in treatment-naïve CIDP patients. METHODS Whole-body MRN using coronal 3-dimensional short tau inversion recovery (STIR) sampling perfection with application-optimized contrasts by using different flip angle evolution (SPACE) techniques was performed in patients being investigated for CIDP and in healthy controls. Baseline clinical neuropathy scales and electrophysiologic parameters were collected, and MRN findings were compared before and after CIDP treatment. RESULTS We found highly concordant symmetrical thickening and increased T2 signal intensities in the brachial/lumbosacral plexus, femoral, or sciatic nerves in five of the eight patients with a final diagnosis of CIDP and none of the healthy controls. There were no treatment-related imaging changes in five patients with CIDP who completed a follow-up study. Diffuse, symmetrical thickening, and increased T2 signal in root, plexus, and peripheral nerves were found in two patients ultimately excluded due to a diagnosis of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes (POEMS) syndrome in addition to signal changes in the muscles, bony lesions, organomegaly, and lymphadenopathy. DISCUSSION Whole-body MRN imaging shows promise in detecting abnormalities in proximal nerve segments in patients with CIDP. Future studies evaluating the role of MRN in assessing treatment response should consider follow-up scans after treatment durations of more than 4 months.
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Affiliation(s)
- Davood Fathi
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ali Naraghi
- Toronto Joint Department of Medical Imaging, Toronto, Ontario, Canada
- Sinai Health System, University Health Network and Women's College Hospital, Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence M White
- Toronto Joint Department of Medical Imaging, Toronto, Ontario, Canada
- Sinai Health System, University Health Network and Women's College Hospital, Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dubravka Dodig
- Division of Neurology, Department of Medicine, University of Toronto/Toronto Western Hospital, Toronto, Ontario, Canada
| | - Carolina Barnett-Tapia
- Division of Neurology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ari Breiner
- Division of Neurology, Department of Medicine, The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Vera Bril
- Division of Neurology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hans D Katzberg
- Division of Neurology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Kim SG, Jung JY. Role of MR Neurography for Evaluation of the Lumbosacral Plexus: A Scoping Review. J Korean Soc Radiol 2022; 83:1273-1285. [PMID: 36545407 PMCID: PMC9748467 DOI: 10.3348/jksr.2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 06/06/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022]
Abstract
Purpose MR neurography (MRN) is an imaging technique optimized to visualize the peripheral nerves. This review aimed to discover an optimized protocol for MRN of the lumbosacral plexus (LSP) and identify evidence for the clinical benefit of lumbosacral plexopathies. Materials and Methods We performed a systematic search of the two medical databases until September 2021. 'Magnetic resonance imaging', 'lumbosacral plexus', 'neurologic disease', or equivalent terms were used to search the literature. We extracted information on indications, MRN protocols for LSP, and clinical efficacy from 55 studies among those searched. Results MRN of the LSP is useful for displaying the distribution of peripheral nerve disease, guiding perineural injections, and assessing extraspinal causes of sciatica. Three-dimensional short-tau inversion recovery turbo spin-echo combined with vascular suppression is the mainstay of MRN. Conclusion Future work on the MRN of LSP should be directed to technical maturation and clinical validation of efficacy.
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Fargeot G, Gitiaux C, Magy L, Pereon Y, Delmont E, Viala K, Echaniz-Laguna A. French recommendations for the management of adult & pediatric chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Rev Neurol (Paris) 2022; 178:953-968. [PMID: 36182621 DOI: 10.1016/j.neurol.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 05/31/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare autoimmune disorder of the peripheral nervous system, primarily affecting the myelin sheath. The pathophysiology of CIDP is complex, involving both humoral and cellular immunity. The diagnosis of CIDP should be suspected in patients with symmetrical proximal and distal motor weakness and distal sensory symptoms of progressive onset, associated with decreased/abolished tendon reflexes. Treatments include intraveinous immunoglobulins, steroids and plasma exchange, with usually an induction phase followed by a maintenance therapy with progressive weaning. Treatment should be rapidly initiated to prevent axonal degeneration, which may compromise recovery. CIDP outcome is variable, ranging from mild distal paresthesiae to complete loss of ambulation. There have been several breakthroughs in the diagnosis and management of CIDP the past ten years, e.g. discovery of antibodies against the node of Ranvier, contribution of nerve ultrasound and magnetic resonance imaging to diagnosis, and demonstration of subcutaneous immunoglobulins efficiency. This led us to elaborate French recommendations for the management of adult & pediatric CIDP patients. These recommendations include diagnosis assessment, treatment, and follow-up.
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Affiliation(s)
- G Fargeot
- Neurophysiology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
| | - C Gitiaux
- Department of Paediatric Neurophysiology, Necker-Enfants-Malades Hospital, AP-HP, Paris University, Paris, France
| | - L Magy
- Department of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital of Limoges, Limoges, France
| | - Y Pereon
- CHU Nantes, Centre de Référence Maladies Neuromusculaires AOC, Filnemus, Euro-NMD, Explorations Fonctionnelles, Hôtel-Dieu, Nantes, France
| | - E Delmont
- Reference Center for Neuromuscular Diseases and ALS Timone University Hospital, Aix-Marseille University, Marseille, France
| | - K Viala
- Neurophysiology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - A Echaniz-Laguna
- Neurology Department, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France; French National Reference Center for Rare Neuropathies (NNERF), Le-Kremlin-Bicêtre, France; Inserm U1195, Paris-Saclay University, Le-Kremlin-Bicêtre, France
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4
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Peillet C, Adams D, Attarian S, Bouhour F, Cauquil C, Cassereau J, Chanson JB, Cintas P, Creange A, Delmont E, Fargeot G, Genestet S, Gueguen A, Kaminsky AL, Kuntzer T, Labeyrie C, Michaud M, Pereon Y, Puma A, Viala K, Chretien P, Adam C, Echaniz-Laguna A. Anti-disialosyl-IgM chronic autoimmune neuropathies: a nationwide multicenter retrospective study. Eur J Neurol 2022; 29:3547-3555. [PMID: 35969369 DOI: 10.1111/ene.15523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/30/2022] [Accepted: 08/11/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND & PURPOSE In this retrospective study involving 14 University Hospitals from France and Switzerland, we aimed at defining the clinicopathologic features of chronic neuropathies with anti-disialosyl ganglioside IgM antibodies (CNDA). RESULTS Fifty-five patients with a polyneuropathy evolving for more than 2 months and with at least one anti-disialosyl ganglioside IgM antibody, i.e., anti-GD1b, -GT1b, -GQ1b, -GT1a, -GD2 and -GD3 were identified. Seventy-eight percent of patients were male, mean age at disease onset was 55 years (30-76), and disease onset was progressive (82%) or acute (18%). Patients presented with limb sensory symptoms (94% of cases), sensory ataxia (85%), oculomotor weakness (36%), limb motor symptoms (31%), and bulbar muscles weakness (18%). Sixty-five percent of patients had a demyelinating polyradiculoneuropathy electrodiagnostic profile, and 24% a sensory neuronopathy profile. Anti-GD1b antibodies were found in 78% of cases, while other anti-disialosyl antibodies were each observed in less than 51% of patients. Other features included nerve biopsy demyelination (100% of cases), increased cerebrospinal fluid protein content (75%), IgM paraprotein (50%), and malignant hemopathy (8%). Eighty six percent of CNDA patients were intravenous immunoglobulins (IVIg)-responsive, and rituximab was successfully used as second-line treatment in 50% of cases. Fifteen percent of patients had mild symptoms and were not treated. CNDA course was progressive (55%) or relapsing (45%), and 93% of patients still walked after a mean disease duration of 11 years. CONCLUSION CNDA have a recognizable phenotype, are mostly IgIV-responsive, and present with a good outcome in a majority of cases.
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Affiliation(s)
- Claire Peillet
- Neurology Department, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France.,French National Reference Center for Rare Neuropathies (NNERF), Le Kremlin-Bicêtre, 94276, France
| | - David Adams
- Neurology Department, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France.,French National Reference Center for Rare Neuropathies (NNERF), Le Kremlin-Bicêtre, 94276, France.,INSERM U1195, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Shahram Attarian
- Neurology Department, CHU Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Françoise Bouhour
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69500, Bron, France
| | - Cécile Cauquil
- Neurology Department, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France.,French National Reference Center for Rare Neuropathies (NNERF), Le Kremlin-Bicêtre, 94276, France.,INSERM U1195, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Julien Cassereau
- Reference Centre for Neuromuscular Disorders, Department of Neurology, Angers University Hospital, 49933 Angers, France, Service de Neurologie, CHU Angers, Angers, France
| | - Jean-Baptiste Chanson
- Department of Neurology, Reference Center for Neuromuscular Disorders NEIDF, University Hospital of Strasbourg, France
| | | | - Alain Creange
- Service de Neurologie, CHU Henri Mondor, APHP, UPEC, Créteil, France
| | - Emilien Delmont
- Neurology Department, CHU Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Guillaume Fargeot
- Department of Clinical Neurophysiology, APHP, CHU Pitié-Salpêtrière, Paris, France
| | - Steeve Genestet
- Department of Clinical Neurophysiology, University Hospital Brest, France
| | - Antoine Gueguen
- Department of Neurology, Fondation Ophtalmologique A. de Rothschild, Paris, France
| | - Anne Laure Kaminsky
- Department of Neurology, Reference Center for Neuromuscular Disorders NEIDF, University Hospital of Nancy, France
| | - Thierry Kuntzer
- Nerve-muscle unit, Department of clinical neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland, Switzerland
| | - Céline Labeyrie
- Neurology Department, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France.,French National Reference Center for Rare Neuropathies (NNERF), Le Kremlin-Bicêtre, 94276, France.,INSERM U1195, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Maud Michaud
- Department of Neurology, Reference Center for Neuromuscular Disorders NEIDF, University Hospital of Nancy, France
| | - Yann Pereon
- Reference Centre for Neuromuscular Disorders AOC Filnemus, Euro-NMD, Hôtel-Dieu, Nantes University Hospital, Nantes, France
| | - Angela Puma
- Peripheral Nervous System and Muscle Department, Côte d'Azur University, Nice University Hospital, Nice, France
| | - Karine Viala
- Department of Clinical Neurophysiology, APHP, CHU Pitié-Salpêtrière, Paris, France
| | - Pascale Chretien
- Clinical Immunology Laboratory, APHP, CHU Bicêtre, 94276, France.,Université de Paris, CNRS, INSERM, UTCBS, Unité des technologies Chimiques et Biologiques pour la Santé, Paris, France
| | - Clovis Adam
- Pathology Department, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France
| | - Andoni Echaniz-Laguna
- Neurology Department, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France.,French National Reference Center for Rare Neuropathies (NNERF), Le Kremlin-Bicêtre, 94276, France.,INSERM U1195, Paris-Saclay University, Le Kremlin-Bicêtre, France
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Thirouin J, Petiot P, Antoine JC, André-Obadia N, Convers P, Gavoille A, Bouhour F, Rheims S, Camdessanché JP. Usefulness and prognostic value of diagnostic tests in patients with possible chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve 2022; 66:304-311. [PMID: 35661382 DOI: 10.1002/mus.27655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 05/23/2022] [Accepted: 05/28/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION/AIMS Recent guidelines define chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and possible CIDP. The aims of our study were to evaluate the value of diagnostic tests to support the diagnosis of CIDP in patients with possible CIDP and to identify prognostic factors of therapeutic success. METHODS We conducted an observational retrospective two-center study between 2014 and 2019. We selected patients with a clinical presentation suggesting CIDP, but whose electrodiagnostic (EDX) test results did not meet the EFNS/PNS 2021 criteria. We analyzed epidemiologic and clinical features, axonal loss on EDX, cerebrospinal fluid (CSF), somatosensory evoked potentials (SSEPs), plexus magnetic resonance imaging (MRI), nerve biopsy, and therapeutic response. RESULTS We selected 75 patients, among whom 30 (40%) responded to treatment. The positivity rates of CSF analysis, MRI and SSEPs were not influenced by the clinical presentation or by the delay between symptom onset and medical assessment. A high protein level in CSF, female gender, and a relapsing-remitting course predicted the therapeutic response. DISCUSSION It is important to properly diagnose suspected CIDP not meeting EFNS/PNS 2021 EDX criteria by using supportive criteria. Specific epidemiological factors and a raised CSF protein level predict a response to treatment. Further prospective studies are needed to improve diagnosis and the prognostic value of diagnostic tests in CIDP.
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Affiliation(s)
- Jeanne Thirouin
- Department of Neurology, Centre Hospitalier de Valence, Valence, France
| | - Philippe Petiot
- Electroneuromyography and Neuromuscular Diseases Department, Centre Médicina, Lyon, France
| | | | - Nathalie André-Obadia
- Department of Functional Neurology and Epileptology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Philippe Convers
- Department of Neurology, University Hospital, Saint-Etienne, France
| | - Antoine Gavoille
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
| | - Françoise Bouhour
- Department of Neurology, Centre Hospitalier de Valence, Valence, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
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Niu J, Zhang L, Fan J, Liu J, Ding Q, Guan Y, Wu S, Cui L, Liu M. Nerve ultrasound may help predicting response to immune treatment in chronic inflammatory demyelinating polyradiculoneuropathy. Neurol Sci 2022; 43:3929-3937. [DOI: 10.1007/s10072-022-05882-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/05/2022] [Indexed: 11/25/2022]
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Lozeron P. Polineuropatie infiammatorie demielinizzanti croniche. Neurologia 2022. [DOI: 10.1016/s1634-7072(21)46001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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8
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Koide K, Sugiyama A, Yokota H, Mukai H, Wang J, Nakamura K, Misawa S, Ito S, Kuwabara S. Nerve Hypertrophy and Altered Diffusion in Anti-Myelin-Associated Glycoprotein Neuropathy Detected by Brachial Plexus Magnetic Resonance Neurography. Eur Neurol 2021; 85:95-103. [PMID: 34583351 DOI: 10.1159/000519128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/14/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study assessed the morphological changes and diffusion tensor imaging (DTI)-derived parameters of the brachial plexus using magnetic resonance neurography (MRN) in patients with anti-myelin-associated glycoprotein (anti-MAG) neuropathy. METHODS Eight patients with anti-MAG neuropathy underwent MRN of the brachial plexus with 3-dimensional (3D) short tau inversion recovery (STIR) and DTI sequences. Two neuroradiologists and a neurologist qualitatively assessed nerve hypertrophy on 3D STIR MRN. The cross-sectional area (CSA) of the nerve roots was measured. Quantitative analyses of fractional anisotropy (FA) and axial, radial, and mean diffusivity (AD, RD, and MD) were obtained after postprocessing on DTI and manual segmentation. RESULTS There was nerve hypertrophy in 37.5% of the patients with anti-MAG neuropathy. All patients with anti-MAG neuropathy with nerve hypertrophy were refractory to rituximab therapy. The CSA of the nerve roots was inversely correlated with FA and positively correlated with MD and RD. FA decreased in the nerve roots and inversely correlated with disease duration. CONCLUSIONS Nerve hypertrophy appears in the proximal portion of peripheral nerves, such as the brachial plexus, in patients with anti-MAG neuropathy. Altered diffusion in the nerve roots might be associated with the loss of myelin integrity due to the demyelination process in anti-MAG neuropathy.
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Affiliation(s)
- Kyosuke Koide
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan,
| | - Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroki Mukai
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Jiaqi Wang
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keigo Nakamura
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sonoko Misawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shoichi Ito
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Medical Education, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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9
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Benoit C, Svahn J, Debs R, Vandendries C, Lenglet T, Zyss J, Maisonobe T, Viala K. Focal chronic inflammatory demyelinating polyradiculoneuropathy: Onset, course, and distinct features. J Peripher Nerv Syst 2021; 26:193-201. [PMID: 33660880 DOI: 10.1111/jns.12438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022]
Abstract
Focal chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is defined as involving the brachial or lumbosacral plexus, or one or more peripheral nerves in one upper or one lower limb (monomelic distribution). However, other auto-immune neuropathies such as Lewis-Sumner syndrome (LSS) and multifocal motor neuropathy (MMN) can also have a focal onset. From a retrospective cohort of 30 focal CIDP patients with a monomelic onset dating back at least 2 years, we distinguished patients with plexus involvement (focal demyelinating plexus neuropathy [F-PN], n = 18) from those with sensory or sensorimotor (F-SMN, n = 7), or purely motor (F-MN, n = 5) impairment located in one or several peripheral nerves. Few (39%) F-PN patients had motor nerve conduction abnormalities, but the majority showed proximal conduction abnormalities in somatosensory evoked potentials (80%), and all had focal hypertrophy and/or increased short tau inversion recovery image signal intensity on plexus MRI. Impairment remained monomelic in most (94%) F-PN patients, whereas abnormalities developed in other limbs in 57% of F-SMN, and 40% of F-MN patients (P = .015). The prognosis of F-PN patients was significantly better: none had an ONLS score > 2 at the final follow-up visit, vs 43% of F-SMN patients and 40% of F-MN patients (P = .026). Our findings from a large cohort of focal CIDP patients confirm the existence of different entities that are typically categorized under this one term: on the one hand, patients with a focal plexus neuropathy and on the other, patients with monomelic sensori-motor or motor involvement of peripheral nerves. These two last subgroups appeared to be more likely to evolve to LSS or MMN phenotype, when F-PN patients have a more distinctive long-term, focal, benign course.
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Affiliation(s)
- Charline Benoit
- Département de neurophysiologie clinique, Hôpital de la Pitié-Salpêtrière, APHP Paris VI Université, Paris, France
| | - Juliette Svahn
- Service de neurologie, Hôpital Pierre Wertheimer, Bron, France
| | - Rabab Debs
- Département de neurophysiologie clinique, Hôpital de la Pitié-Salpêtrière, APHP Paris VI Université, Paris, France
| | | | - Timothée Lenglet
- Département de neurophysiologie clinique, Hôpital de la Pitié-Salpêtrière, APHP Paris VI Université, Paris, France
| | - Julie Zyss
- Département de neurophysiologie clinique, Hôpital de la Pitié-Salpêtrière, APHP Paris VI Université, Paris, France
| | - Thierry Maisonobe
- Département de neurophysiologie clinique, Hôpital de la Pitié-Salpêtrière, APHP Paris VI Université, Paris, France
| | - Karine Viala
- Département de neurophysiologie clinique, Hôpital de la Pitié-Salpêtrière, APHP Paris VI Université, Paris, France
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van Rosmalen MHJ, Goedee HS, van der Gijp A, Witkamp TD, van Eijk RPA, Asselman FL, van den Berg LH, Mandija S, Froeling M, Hendrikse J, van der Pol WL. Quantitative assessment of brachial plexus MRI for the diagnosis of chronic inflammatory neuropathies. J Neurol 2020; 268:978-988. [PMID: 32965512 PMCID: PMC7914242 DOI: 10.1007/s00415-020-10232-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/22/2022]
Abstract
Objective This study aimed at developing a quantitative approach to assess abnormalities on MRI of the brachial plexus and the cervical roots in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) and to evaluate interrater reliability and its diagnostic value. Methods We performed a cross-sectional study in 50 patients with CIDP, 31 with MMN and 42 disease controls. We systematically measured cervical nerve root sizes on MRI bilaterally (C5, C6, C7) in the coronal [diameter (mm)] and sagittal planes [area (mm2)], next to the ganglion (G0) and 1 cm distal from the ganglion (G1). We determined their diagnostic value using a multivariate binary logistic model and ROC analysis. In addition, we evaluated intra- and interrater reliability. Results Nerve root size was larger in patients with CIDP and MMN compared to controls at all predetermined anatomical sites. We found that nerve root diameters in the coronal plane had optimal reliability (intrarater ICC 0.55–0.87; interrater ICC 0.65–0.90). AUC was 0.78 (95% CI 0.69–0.87) for measurements at G0 and 0.81 (95% CI 0.72–0.91) for measurements at G1. Importantly, our quantitative assessment of brachial plexus MRI identified an additional 10% of patients that showed response to treatment, but were missed by nerve conduction (NCS) and nerve ultrasound studies. Conclusion Our study showed that a quantitative assessment of brachial plexus MRI is reliable. MRI can serve as an important additional diagnostic tool to identify treatment-responsive patients, complementary to NCS and nerve ultrasound. Electronic supplementary material The online version of this article (10.1007/s00415-020-10232-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marieke H J van Rosmalen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Stephan Goedee
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands.
| | - Anouk van der Gijp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Theo D Witkamp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ruben P A van Eijk
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
- Biostatistics and Research Support, Julius Centre for Healthy Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Fay-Lynn Asselman
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Stefano Mandija
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
- Computational Imaging Group for MR Diagnostic and Therapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Ludo van der Pol
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
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Shah S, Morrow JM, Sinclair CDJ, Reilly MM, Thornton JS, Lunn MP, Yousry TA. MRI quantifies lumbosacral nerve root and sciatic nerve hypertrophy in chronic inflammatory demyelinating polyradiculoneuropathy. Eur J Radiol 2020; 130:109164. [PMID: 32688240 DOI: 10.1016/j.ejrad.2020.109164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a treatable, immune-mediated condition characterised by progressive or relapsing motor and sensory neurological deficits. The diagnosis is based on a combination of clinical, neurophysiological and supportive criteria, but can be challenging. In this study, we quantified the diameter and cross-sectional area of the lumbosacral nerve roots, and explored the imaging characteristics of the sciatic nerves, in patients with CIDP versus healthy controls using MRI. METHODS MRI of the lumbosacral plexus and both thighs was performed at 3 T. Orthogonal diameter and cross-sectional area of the lumbosacral nerve roots were measured, along with sciatic nerve cross-sectional area at the mid-thigh level. The MRI appearance of the sciatic nerves was also evaluated qualitatively. All measurements were performed by an observer blinded to the diagnosis. RESULTS 10 patients with CIDP and 10 healthy controls (age and sex-matched) were studied. Lumbosacral nerve root diameter and cross-sectional area were significantly increased in patients with CIDP compared to controls (mean diameter 6.0 ± 1.1 mm vs 4.8 ± 0.3 mm; p = 0.006), with a high sensitivity (89 %) and specificity (90 %) on ROC analysis. Sciatic nerve cross sectional area was also significantly increased in the CIDP group, and was accompanied by qualitative MRI changes. CONCLUSIONS Quantitative MRI reveals significant hypertrophy of the lumbosacral nerve roots and sciatic nerves in patients with CIDP compared to controls. This study provides further evidence for the inclusion of lumbosacral nerve root and sciatic nerve hypertrophy on MRI as a supportive feature in the diagnostic criteria for CIDP.
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Affiliation(s)
- Sachit Shah
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, UK.
| | - Jasper M Morrow
- Queen Square Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Christopher D J Sinclair
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, UK; Queen Square Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Mary M Reilly
- Queen Square Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - John S Thornton
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, UK; Queen Square Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Michael P Lunn
- Queen Square Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Tarek A Yousry
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, UK; Queen Square Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
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12
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Rajabally YA. The value of new tests: Magnetic resonance imaging for dysimmune neuropathy. Muscle Nerve 2020; 61:677-678. [PMID: 32293744 DOI: 10.1002/mus.26872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Yusuf A Rajabally
- Aston Medical School, Aston University, Birmingham, United Kingdom.,Inflammatory Neuropathy Clinic, University Hospitals Birmingham, Birmingham, United Kingdom
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13
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van Rosmalen MHJ, Goedee HS, van der Gijp A, Witkamp TD, Froeling M, Hendrikse J, van der Pol WL. Low interrater reliability of brachial plexus MRI in chronic inflammatory neuropathies. Muscle Nerve 2020; 61:779-783. [PMID: 32012299 PMCID: PMC7317832 DOI: 10.1002/mus.26821] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/15/2020] [Accepted: 01/28/2020] [Indexed: 12/13/2022]
Abstract
Introduction Magnetic resonance imaging of the brachial plexus shows nerve thickening in approximately half of the patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN). The reliability of qualitative evaluation of brachial plexus MRI has not been studied previously. Methods We performed an interrater study in a retrospective cohort of 19 patients with CIDP, 17 patients with MMN, and 14 controls. The objective was to assess interrater variability between radiologists by using a predefined scoring system that allowed the distinction of no, possible, or definite nerve thickening. Results Raters agreed in 26 of 50 (52%) brachial plexus images; κ‐coefficient was 0.30 (SE 0.08, 95% confidence interval 0.14–0.46, P < .0005). Discussion Our results provide evidence that interrater reliability of qualitative evaluation of brachial plexus MRI is low. Objective criteria for abnormality are required to optimize the diagnostic value of MRI for inflammatory neuropathies. See editorial on pages 679–680 in this issue.
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Affiliation(s)
- Marieke H J van Rosmalen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, The Netherlands
| | - H Stephan Goedee
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, The Netherlands
| | - Anouk van der Gijp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Theo D Witkamp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Ludo van der Pol
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, The Netherlands
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Corazza G, Le Corroller T, Grapperon AM, Salort-Campana E, Verschueren A, Attarian S, Delmont E. Comparison of MRI and motor evoked potential with triple stimulation technique for the detection of brachial plexus abnormalities in multifocal motor neuropathy. Muscle Nerve 2019; 61:325-329. [PMID: 31792993 DOI: 10.1002/mus.26773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Conduction blocks (CB) are the diagnostic hallmark of multifocal motor neuropathy (MMN). Conventional nerve conduction studies cannot detect CB above Erb's point. Our purpose was to compare the performance of the motor evoked potential with triple stimulation technique (MEP-TST) and MRI in the detection of abnormalities of the brachial plexus. METHODS Examinations were performed on 26 patients with MMN (11 definite, 6 probable, 9 possible), of whom 7 had no CB. RESULTS MEP-TST detected proximal CB in 19/26 patients. Plexus MRI showed T2 hyperintensity in 18/26 patients, with nerve enlargement in 14/18. A combination of both techniques increased the detection rate of brachial plexus abnormalities to 96% of patients (25/26). CONCLUSIONS MEP-TST and MRI have high sensitivities for detecting brachial plexus abnormalities. A combination of the two techniques increases the detection rate of supportive criteria for the diagnosis of MMN.
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Affiliation(s)
- Giovanni Corazza
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | - Thomas Le Corroller
- Department of Radiology, Institute for Locomotion, Hôpital Sainte-Marguerite, Marseille, France
| | - Aude-Marie Grapperon
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | | | - Annie Verschueren
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | - Shahram Attarian
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | - Emilien Delmont
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France.,Aix-Marseille University, Timone Neuroscience Institute, UMR CNRS 7289, Marseille, France
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15
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Franques J. [Chronic inflammatory demyelinating polyneuropathy: Diagnosis and therapeutic update]. Rev Med Interne 2019; 40:808-815. [PMID: 31677862 DOI: 10.1016/j.revmed.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 06/19/2019] [Accepted: 07/17/2019] [Indexed: 10/25/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathies are acquired demyelinating neuropathies belonging to the group of autoimmune neuropathies. Since specific biological markers are present in less than 10% of cases, the diagnosis is based on the clinical and electrophysiological analysis of each patient. Furthermore, a decision-making algorithm ranking all other available paraclinical tools will guide the physician to the diagnosis of atypical forms. In nearly 80% of cases, these dysimmune neuropathies are responsive to first-line treatments, namely intravenous immunoglobulins, corticosteroids and plasma exchanges. A second line treatment may be proposed in case of no response, intolerance or inaccessibility to the three reference treatments. While some immunosuppressants or monoclonal antibodies can sometimes be very effective, there is currently no predictive marker or recommendation available to determine which treatment will be most appropriate for which patient.
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Affiliation(s)
- J Franques
- Hôpital européen, 6, rue Désirée-Clary, 13003 Marseille, France; Hôpital La Casamance, 33, boulevard des Farigoules, 13400 Aubagne, France.
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Jomier F, Bousson V, Viala K, Péréon Y, Magot A, Cauquil C, Bouhour F, Vial C, Bedat-Millet AL, Taithe F, Bresch S, Siri A, Kubis N, Lozeron P. Prospective study of the additional benefit of plexus magnetic resonance imaging in the diagnosis of chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2019; 27:181-187. [PMID: 31348848 DOI: 10.1111/ene.14053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Hypertrophy/signal hyperintensity and/or gadolinium enhancement of plexus structures on magnetic resonance imaging (MRI) are observed in two-thirds of cases of typical chronic inflammatory demyelinating polyneuropathy (CIDP). The objective of our study was to determine the additional benefit of plexus MRI in patients referred to tertiary centers with baseline clinical and electrophysiological characteristics suggestive of typical or atypical CIDP. METHODS A total of 28 consecutive patients with initial suspicion of CIDP were recruited in nine centers and followed for 2 years. Plexus MRI data from the initial assessment were reviewed centrally. Physicians blinded to the plexus MRI findings established the final diagnosis (CIDP or neuropathy of another cause). The proportion of patients with abnormal MRI was analyzed in each group. RESULTS Chronic inflammatory demyelinating polyneuropathy was confirmed in 14 patients (50%), as were sensorimotor CIDP (n = 6), chronic immune sensory polyradiculoneuropathy (n = 2), motor CIDP (n = 1) and multifocal acquired demyelinating sensory and motor neuropathy (n = 5). A total of 37 plexus MRIs were performed (17 brachial, 19 lumbosacral and 8 in both localizations). MRI was abnormal in 5/37 patients (14%), all of whom were subsequently diagnosed with CIDP [5/14(36%)], after an atypical baseline presentation. With plexus MRI results masked, non-invasive procedures confirmed the diagnosis of CIDP in all but one patient [1/14 (7%)]. Knowledge of the abnormal MRI findings in the latter could have prevented nerve biopsy being performed. CONCLUSION Systematic plexus MRI in patients with initially suspected CIDP provides little additional benefit in confirming the diagnosis of CIDP.
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Affiliation(s)
- F Jomier
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière, Paris, France
| | - V Bousson
- Service de Radiologie Ostéoarticulaire, AP-HP, Hôpital Lariboisière, Paris, France
| | - K Viala
- Département de Neurophysiologie Clinique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Y Péréon
- Centre de Référence Maladies Neuromusculaires, CHU Nantes, Nantes, France.,Université de Nantes, Nantes, France
| | - A Magot
- Centre de Référence Maladies Neuromusculaires, CHU Nantes, Nantes, France
| | - C Cauquil
- Service de Neurologie, CHU Bicêtre, Le Kremlin-Bicêtre, France.,Centre National de Référence pour la Neuropathie Amyloïde Familiale, CHU Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - F Bouhour
- Service de Neurologie, Hospices Civils de Lyon, Lyon, France
| | - C Vial
- Service de Neurologie, Hospices Civils de Lyon, Lyon, France
| | | | - F Taithe
- Service de Neurologie, CHU Gabriel Montpied, Clermont Ferrand, France.,Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - S Bresch
- Service de Neurologie, CHU de Nice, Nice, France
| | - A Siri
- Service de Neurologie, CHRU de Nancy, Nancy, France
| | - N Kubis
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière, Paris, France.,U1148-Laboratory for Vascular and Translational Science, INSERM, Université de Paris, Paris, France
| | - P Lozeron
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière, Paris, France.,U1148-Laboratory for Vascular and Translational Science, INSERM, Université de Paris, Paris, France
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