title: Diagnostic value of sonography in treatment-naive chronic inflammatory neuropathies.
abstract: OBJECTIVE
  To determine the diagnostic value of high-resolution ultrasound (HRUS) for detection of chronic inflammatory demyelinating polyneuropathy (CIDP), Lewis-Sumner syndrome (LSS), and multifocal motor neuropathy (MMN).
  
  
  METHODS
  Between January 2013 and January 2015, we enrolled 75 consecutive treatment-naive patients with chronic inflammatory neuropathies and 70 disease controls. We performed extensive nerve conduction and standardized HRUS studies bilaterally of large arm and leg nerves and brachial plexus. We determined optimal sonographic cutoff values of nerve size and used receiver operating characteristic analysis and logistic regression models to identify nerve combinations with optimal diagnostic performance.
  
  
  RESULTS
  Enlargement of median nerve at forearm >10 mm2, upper arm >13 mm2, and any trunk of brachial plexus >8 mm2was 99% specific for chronic inflammatory neuropathies. A shortened HRUS protocol for detecting this abnormal nerve enlargement showed high sensitivity (83%-95%), positive predictive value (100%), and negative predictive value (98%) in discriminating CIDP, LSS, and MMN from clinical mimics.
  
  
  CONCLUSIONS
  Sonographic enlargement of proximal median nerve segments in the arms and brachial plexus is a key feature of chronic inflammatory neuropathies, which helps to reliably distinguish them from axonal neuropathies and amyotrophic lateral sclerosis.
  
  
  METHODS
  This study provides Class II evidence that, in absence of clinical features that suggest a hereditary demyelinating neuropathy, sonographic enlargement of proximal median nerve segments and brachial plexus accurately identifies patients with chronic inflammatory neuropathies.
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands. h.s.goedee-2@umcutrecht.nl.
authors.forename: H Stephan
authors.initials: HS
authors.lastname: Goedee
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
authors.forename: W Ludo
authors.initials: WL
authors.lastname: van der Pol
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
authors.forename: Jan-Thies H
authors.initials: JH
authors.lastname: van Asseldonk
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
authors.forename: Hessel
authors.initials: H
authors.lastname: Franssen
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
authors.forename: Nicolette C
authors.initials: NC
authors.lastname: Notermans
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
authors.forename: Alexander J F E
authors.initials: AJ
authors.lastname: Vrancken
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
authors.forename: Michael A
authors.initials: MA
authors.lastname: van Es
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
authors.forename: Stavros
authors.initials: S
authors.lastname: Nikolakopoulos
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
authors.forename: Leo H
authors.initials: LH
authors.lastname: Visser
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (H.S.G., W.L.v.d.P., H.F., N.C.N., A.J.F.E.V., M.A.v.E., L.H.v.d.B.), and Department of Biostatistics, Julius Center for Health Sciences and Primary Care (S.N.), UMC Utrecht; and Department of Neurology and Clinical Neurophysiology (J-T.H.v.A., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
authors.forename: Leonard H
authors.initials: LH
authors.lastname: van den Berg
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001917:Brachial Plexus / Q000503:physiopathology; D016022:Case-Control Studies; D015331:Cohort Studies; D004487:Edema / Q000209:etiology; D004576:Electromyography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014463:Ultrasonography / Q000379:methods*