Comparison of cross-sectional areas and distal-proximal nerve ratios in amyotrophic lateral sclerosis

Yu-Ichi Noto; Nidhi Garg; Tiffany Li; Hannah C Timmins; Susanna B Park; Kazumoto Shibuya; Nortina Shahrizaila; William Huynh; José M Matamala; Thanuja Dharmadasa; Con Yiannikas; Steve Vucic; Matthew C Kiernan

doi:10.1002/mus.26301

Comparison of cross-sectional areas and distal-proximal nerve ratios in amyotrophic lateral sclerosis

Muscle Nerve. 2018 Dec;58(6):777-783. doi: 10.1002/mus.26301. Epub 2018 Oct 15.

Authors

Yu-Ichi Noto^{1

2}, Nidhi Garg^{1

2}, Tiffany Li^{1

2}, Hannah C Timmins^{1

2}, Susanna B Park^{1

2}, Kazumoto Shibuya^{1

2}, Nortina Shahrizaila^{1

2}, William Huynh^{1

2}, José M Matamala^{1

2}, Thanuja Dharmadasa^{1

2}, Con Yiannikas^{1

2}, Steve Vucic³, Matthew C Kiernan^{1

2}

Affiliations

¹ Brain and Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Camperdown, Sydney, New South Wales, 2040, Australia.
² Royal Prince Alfred Hospital Sydney, Sydney, New South Wales, Australia.
³ Western Clinical School, University of Sydney, Sydney, New South Wales, Australia.

PMID: 30019401
DOI: 10.1002/mus.26301

Abstract

Introduction: This study explored potential diagnostic markers of nerve ultrasound in differentiating amyotrophic lateral sclerosis (ALS) from mimic disorders.

Methods: Ultrasound of the median, ulnar, and tibial nerves was conducted in 53 patients with ALS, 32 patients with ALS-mimic disorders, and 30 controls. Nerve cross-sectional area (CSA) and distal-proximal ratios were calculated.

Results: The median nerve CSA in the upper arm was decreased (7.9 ± 1.3 mm² vs. 9.0 ± 1.4 mm² , P < 0.05), and the median nerve wrist-upper arm ratio was increased in ALS patients compared with controls (1.3 ± 0.4 vs. 1.1 ± 0.2; P < 0.01). In differentiating ALS from mimic presentations, assessment of median nerve CSA in the upper arm and comparison of a median and ulnar nerve CSA distal-proximal ratio provide diagnostic potential.

Discussion: Assessment of nerve CSA combined with calculation of nerve CSA distal-proximal ratio provides a useful marker to aid in the diagnosis of ALS. Muscle Nerve 58:777-783, 2018.

Keywords: amyotrophic lateral sclerosis; multifocal motor neuropathy; peripheral nerve; peripheral nerve hyperexcitability syndrome; ultrasound.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Amyotrophic Lateral Sclerosis / diagnostic imaging*
Amyotrophic Lateral Sclerosis / pathology*
Electromyography
Female
Forearm / innervation
Humans
Male
Median Nerve / diagnostic imaging*
Middle Aged
Neural Conduction / physiology
ROC Curve
Severity of Illness Index
Spinal Nerves / diagnostic imaging*
Statistics, Nonparametric
Ultrasonography
Wrist / innervation