Nerve Ultrasound: A Reproducible Diagnostic Tool in Peripheral Neuropathy
- Peripheral neuropathies are now being evaluated by the use of diagnostic ultrasound. Standard protocols were used by the authors of this prospective, multicenter study. The cross section of the median, ulnar, fibular, tibial, sural nerves, and brachial plexus were measured in patients with acquired chronic demyelinating or axonal polyneuropathy and in healthy controls. Systematic differences between measurements made by different investigators were small
- Nerve ultrasound appears to be a valid tool for the assessment of peripheral neuropathy by clinicians.
To determine interobserver variability of nerve ultrasound in peripheral neuropathy in a prospective, systematic, multicenter study.
We enrolled 20 patients with an acquired chronic demyelinating or axonal polyneuropathy and 10 healthy controls in 3 different centers. All participants underwent an extensive nerve ultrasound protocol, including cross-sectional area measurements of median, ulnar, fibular, tibial, and sural nerves, and brachial plexus. Real-time image acquisition was performed blind by a local and a visiting investigator (reference). Five patients were investigated using different types of sonographic devices. Intraclass correlation coefficients were calculated, and a random-effects model was fitted to identify factors with significant effect on interobserver variability.
Systematic differences between measurements made by different investigators were small (mean difference 0.11 mm2 [95% confidence interval 0.00-0.23 mm2]). Intraclass correlation coefficients were generally higher in arm nerves (0.48-0.96) than leg nerves (0.46-0.61). The hospital site and sonographic device did not contribute significantly to interobserver variability in the random-effects model.
Interobserver variability of nerve ultrasound in peripheral neuropathy is generally limited, especially in arm nerves. Different devices and a multicenter setting have no effect on interobserver variability. Therefore, nerve ultrasound is a reproducible tool for diagnostics in routine clinical practice and (multicenter) research.
JA Telleman, IJT Herraets, HS Goedee, C Verhamme, S Nikolakopoulos, JH van Asseldonk, WL van der Pol, LH van den Berg, LH Visser. Nerve Ultrasound: A Reproducible Diagnostic Tool in Peripheral Neuropathy. Neurology 2018 Dec 28;[EPub Ahead of Print]