TY - JOUR
T1 - Quantitative assessment of brachial plexus MRI for the diagnosis of chronic inflammatory neuropathies
AU - van Rosmalen, Marieke H J
AU - Goedee, H Stephan
AU - van der Gijp, Anouk
AU - Witkamp, Theo D
AU - van Eijk, Ruben P A
AU - Asselman, Fay-Lynn
AU - van den Berg, Leonard H
AU - Mandija, Stefano
AU - Froeling, Martijn
AU - Hendrikse, Jeroen
AU - van der Pol, W Ludo
N1 - Funding Information:
M.H.J. van Rosmalen, A. van der Gijp, T.D. Witkamp, R.P.A. van Eijk, F. Asselman, S. Mandija and M. Froeling report no competing interests. H.S. Goedee has received research support from the Prinses Beatrix Spierfonds, speaker fee and travel grands from Shire/Takeda. L.H. van den Berg serves on scientific advisory boards for Orion, Orphazyme and Biogen; received an educational grant from Takeda; serves on the editorial board of Amyotrophic Lateral Sclerosis and the Journal of Neurology, Neurosurgery and Psychiatry; and receives research support from the Prinses Beatrix Spierfonds, Netherlands ALS Foundation, The European Community's Health Seventh Framework Programme (Grant agreement no. 259867), The Netherlands Organization for Health Research and Development (Vici Scheme, JPND (SOPHIA, STRENGTH)). J. Hendrikse has received research support from the Netherlands Organization for Scientific Research (NWO) under Grant no. 91712322 and the European Research Council under Grant agreements no. 637024. W.L. van der Pol has received support from the Prinses Beatrix Spierfonds and Stichting Spieren voor Spieren.
Funding Information:
This study is funded by the Prinses Beatrix Spierfonds (W.OR17-21). Acknowledgements
Publisher Copyright:
© 2020, The Author(s).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/3
Y1 - 2021/3
N2 - OBJECTIVE: This study aimed at developing a quantitative approach to assess abnormalities on MRI of the brachial plexus and the cervical roots in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) and to evaluate interrater reliability and its diagnostic value.METHODS: We performed a cross-sectional study in 50 patients with CIDP, 31 with MMN and 42 disease controls. We systematically measured cervical nerve root sizes on MRI bilaterally (C5, C6, C7) in the coronal [diameter (mm)] and sagittal planes [area (mm2)], next to the ganglion (G0) and 1 cm distal from the ganglion (G1). We determined their diagnostic value using a multivariate binary logistic model and ROC analysis. In addition, we evaluated intra- and interrater reliability.RESULTS: Nerve root size was larger in patients with CIDP and MMN compared to controls at all predetermined anatomical sites. We found that nerve root diameters in the coronal plane had optimal reliability (intrarater ICC 0.55-0.87; interrater ICC 0.65-0.90). AUC was 0.78 (95% CI 0.69-0.87) for measurements at G0 and 0.81 (95% CI 0.72-0.91) for measurements at G1. Importantly, our quantitative assessment of brachial plexus MRI identified an additional 10% of patients that showed response to treatment, but were missed by nerve conduction (NCS) and nerve ultrasound studies.CONCLUSION: Our study showed that a quantitative assessment of brachial plexus MRI is reliable. MRI can serve as an important additional diagnostic tool to identify treatment-responsive patients, complementary to NCS and nerve ultrasound.
AB - OBJECTIVE: This study aimed at developing a quantitative approach to assess abnormalities on MRI of the brachial plexus and the cervical roots in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) and to evaluate interrater reliability and its diagnostic value.METHODS: We performed a cross-sectional study in 50 patients with CIDP, 31 with MMN and 42 disease controls. We systematically measured cervical nerve root sizes on MRI bilaterally (C5, C6, C7) in the coronal [diameter (mm)] and sagittal planes [area (mm2)], next to the ganglion (G0) and 1 cm distal from the ganglion (G1). We determined their diagnostic value using a multivariate binary logistic model and ROC analysis. In addition, we evaluated intra- and interrater reliability.RESULTS: Nerve root size was larger in patients with CIDP and MMN compared to controls at all predetermined anatomical sites. We found that nerve root diameters in the coronal plane had optimal reliability (intrarater ICC 0.55-0.87; interrater ICC 0.65-0.90). AUC was 0.78 (95% CI 0.69-0.87) for measurements at G0 and 0.81 (95% CI 0.72-0.91) for measurements at G1. Importantly, our quantitative assessment of brachial plexus MRI identified an additional 10% of patients that showed response to treatment, but were missed by nerve conduction (NCS) and nerve ultrasound studies.CONCLUSION: Our study showed that a quantitative assessment of brachial plexus MRI is reliable. MRI can serve as an important additional diagnostic tool to identify treatment-responsive patients, complementary to NCS and nerve ultrasound.
KW - Brachial plexus
KW - Chronic inflammatory demyelinating polyneuropathy
KW - Diagnostic value
KW - Magnetic resonance imaging
KW - Multifocal motor neuropathy
UR - http://www.scopus.com/inward/record.url?scp=85091357903&partnerID=8YFLogxK
U2 - 10.1007/s00415-020-10232-8
DO - 10.1007/s00415-020-10232-8
M3 - Article
C2 - 32965512
SN - 0340-5354
VL - 268
SP - 978
EP - 988
JO - Journal of Neurology
JF - Journal of Neurology
IS - 3
ER -