title: Ultrasound of the nerves - An appropriate addition to nerve conduction studies to differentiate paraproteinemic neuropathies.
abstract: OBJECTIVE
  To investigate the use of peripheral nerve ultrasound (PNUS) in addition to nerve conduction studies (NCS) in the diagnosis of paraproteinemic neuropathies (PN).
  
  
  METHODS
  PNUS/NCS of predefined peripheral nerves and the 5th/6th cervical roots were performed in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) (+/-paraprotein), patients with anti-MAG neuropathy, and patients with neuropathy and multiple myeloma or monoclonal gammopathy of uncertain significance (MGUS) - summarized as M-protein associated neuropathies (MPAN) and compared to controls (+/-paraprotein).
  
  
  RESULTS
  39 patients and 27 age-matched controls were included. Nerve enlargement was most marked in patients with CIDP, while in anti-MAG neuropathies enlargement was significant in the legs. In MPAN, no nerve enlargement is found regularly. However, in two cases, the diagnostic steps were influenced by the finding of multiple enlarged nerves and finally immunotherapy response was successfully initiated. By the use of the ultrasound pattern sum score (UPSS), differentiation of PN can be simplified.
  
  
  CONCLUSIONS
  Due to the heterogeneous findings in NCS, correct diagnosis of PN, and straightforward therapeutic decisions often may be controversial. Particularly in cases of M-protein related neuropathy, the finding of multiple nerve enlargements facilitates the decision for therapeutic approaches or nerve biopsy. The UPSS enables the distinction of different PN from each other.
  
  
  CONCLUSIONS
  The use of an ultrasound quantification tool in addition to NCS facilitates a differentiation of PN.
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, Basel University Hospital, Basel, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Rasenack
authors.affiliation: Department of Internal Medicine, County Hospital Reutlingen, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Grimm
authors.affiliation: Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
authors.forename: Hubertus
authors.initials: H
authors.lastname: Axer
authors.affiliation: Department of Neurology, Basel University Hospital, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Sinnreich
authors.affiliation: Department of Neurology, Basel University Hospital, Basel, Switzerland.
authors.forename: Bernhard F
authors.initials: BF
authors.lastname: Décard
authors.affiliation: Department of Neurology, Tübingen University Hospital, Tübingen, Germany. Electronic address: alexander.grimm@usb.ch.
authors.forename: Alexander
authors.initials: A
authors.lastname: Grimm
mesh_terms: D000200:Action Potentials / Q000502:physiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018992:Myelin-Associated Glycoprotein / Q000276:immunology; D009431:Neural Conduction / Q000502:physiology*; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D012372:ROC Curve; D014463:Ultrasonography; D055815:Young Adult
chemical_list: C115082:MAG protein, human; D018992:Myelin-Associated Glycoprotein
keywords: Anti-MAG neuropathy; Demyelinating polyneuropathy; Immune-mediated neuropathy; Monoclonal gammopathy of uncertain significance; Nerve ultrasonography; Paraproteinemic neuropathy