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MR microneurography and quantitative T2 and DP measurements of the distal tibial nerve in CIDP

Published:March 11, 2019DOI:https://doi.org/10.1016/j.jns.2019.03.001

      Highlights

      • MR microneurography can visualize some of the microscopic components of nerves.
      • CIDP patients show peripheral nerve enlargement distally at the tibial nerves.
      • This results from the net increase of the area of the nerve's fascicles.
      • The epineurial area as well as T2 and PD are not significantly modified.

      Abstract

      Objective

      In this study we investigated the potential of magnetic resonance (MR) micro-neurography to detect morphological and relaxometric changes in distal tibial nerves in patients affected with chronic inflammatory demyelinating polyneuropathy (CIDP), and their associations with clinical and electrophysiological features.

      Materials and methods

      10 subjects affected with CIDP and 10 healthy subjects were examined. Multiple MR parameters, including the number of fascicles (N), fascicles diameter (FD), total fascicles area (FA), epineurium area (EA), total nerve area (NA), fascicles to nerve ratio (FNR) and quantitative T2 and proton density (PD) were investigated on high resolution MR images of the distal tibial nerve. Those parameters were correlated with clinical scores, age of onset, disease duration and electrophysiologic data.

      Results

      Median NA and FA were significantly increased in the CIDP population (median values for NA in cm2 in CIDP: 0.185; controls: 0.135; p: 0.028; for FA in CIDP 0.136; controls 0.094; p: 0.021). There was no correlation between the parameters investigated and clinical or electrophysiologic features.

      Conclusion

      MR microneurography can detect increased total nerve and fascicle area in distal tibial nerves in CIDP and may be useful for diagnosing CIDP.

      Keywords

      Abbreviations:

      MRI (magnetic resonance imaging), CIDP (chronic inflammatory demyelinating polyneuropathy), N (number of fascicles), FD (fascicles diameter), FA (total fascicles area), EA (epineurium area), NA (total nerve area), FNR (fascicles to nerve ratio), PD (proton density), NCS (nerve conduction studies), MRC-APF (Medical Research Council muscle strength score for Ankle Plantar Flexion of the imaged side), MRC-LL (Medical Research Council muscle strength sum score for the Lower Limbs), INCAT-LL (Inflammatory Neuropathy Cause and Treatment score for the Lower Limbs), ISS-LL (INCAT sensory score for the Lower Limbs)
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