title: The modified ultrasound pattern sum score mUPSS as additional diagnostic tool for genetically distinct hereditary neuropathies.
abstract: The objective of this study is to evaluate the nerve ultrasound characteristics in genetically distinct inherited neuropathies, the value of the modified ultrasound pattern sum score (mUPSS) to differentiate between the subtypes and the correlation of ultrasound with nerve conduction studies (NCS), disease duration and severity. All patients underwent a standardized neurological examination, ultrasound, and NCS. In addition, genetic testing was performed. Consequently, mUPSS was applied, which is a sum-score of cross-sectional areas (CSA) at predefined anatomical points in different nerves. 31 patients were included (10xCharcot-Marie-Tooth (CMT)1a, 3xCMT1b, 3xCMTX, 9xCMT2, 6xHNPP [Hereditary neuropathy with liability to pressure palsies]). Generalized, homogeneous nerve enlargement and significantly increased UPS scores emphasized the diagnosis of demyelinating neuropathy, particularly CMT1a and CMT1b. The amount of enlargement did not depend on disease duration, symptom severity, height and weight. In CMTX the nerves were enlarged, as well, however, only in the roots and lower limbs, most prominent in men. In CMT2 no significant enlargement was detectable. In HNPP the CSA values were increased at entrapped sites, and not elsewhere. However, a distinction from CMT1, which also showed enlarged CSA values at entrapment sites, was only possible by calculating the entrapment ratios and entrapment score. The mUPSS allowed distinction between CMT1a (increased UPS scores, entrapment ratios <1.0) and HNPP (low UPS scores, entrapment ratios >1.4), while CMT1b and CMTX showed intermediate UPS types and entrapment ratios <1.0. Although based on few cases, ultrasound revealed consistent and homogeneous nerve alteration in certain inherited neuropathies. The modified UPSS is a quantitative tool, which may provide useful information for diagnosis, differentiation and follow-up evaluation in addition to NCS and molecular testing.
authors.affiliation: Department of Neurology, Tuebingen University Hospital, University Tübingen, Hoppe-Seyler-Strasse 3, 72072, Tübingen, Germany. alexander.grimm@usb.ch.|Department of Neurology, Basel University Hospital, Basel, Switzerland. alexander.grimm@usb.ch.|Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany. alexander.grimm@usb.ch.
authors.forename: Alexander
authors.initials: A
authors.lastname: Grimm
authors.affiliation: Department of Neurology, Basel University Hospital, Basel, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Rasenack
authors.affiliation: Department of Neurology, Basel University Hospital, Basel, Switzerland.
authors.forename: Ioanna M
authors.initials: IM
authors.lastname: Athanasopoulou
authors.affiliation: Department of Neurology, Tuebingen University Hospital, University Tübingen, Hoppe-Seyler-Strasse 3, 72072, Tübingen, Germany.
authors.forename: Nele Maria
authors.initials: NM
authors.lastname: Dammeier
authors.affiliation: Department of Neurology, Tuebingen University Hospital, University Tübingen, Hoppe-Seyler-Strasse 3, 72072, Tübingen, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Lipski
authors.affiliation: Department of Neurology, Tuebingen University Hospital, University Tübingen, Hoppe-Seyler-Strasse 3, 72072, Tübingen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wolking
authors.affiliation: Department of Neurology, Tuebingen University Hospital, University Tübingen, Hoppe-Seyler-Strasse 3, 72072, Tübingen, Germany.
authors.forename: Debora
authors.initials: D
authors.lastname: Vittore
authors.affiliation: Department of Neurology, Basel University Hospital, Basel, Switzerland.
authors.forename: Bernhard F
authors.initials: BF
authors.lastname: Décard
authors.affiliation: Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
authors.forename: Hubertus
authors.initials: H
authors.lastname: Axer
mesh_terms: D019540:Area Under Curve; D002607:Charcot-Marie-Tooth Disease / Q000000981:diagnostic imaging*; D005260:Female; D015417:Hereditary Sensory and Motor Neuropathy / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D012372:ROC Curve; D012720:Severity of Illness Index; D014463:Ultrasonography / Q000379:methods
keywords: Charcot-Marie-Tooth CMT; HNPP; Hereditary neuropathy; Nerve ultrasonography; Polyneuropathy; Ultrasound pattern sum score