Neuromuscular Ultrasonography: Quantifying Muscle and Nerve Measurements

Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC 27157-1078, USA.
Physical Medicine and Rehabilitation Clinics of North America (Impact Factor: 0.93). 02/2012; 23(1):133-48, xii. DOI: 10.1016/j.pmr.2011.11.009
Source: PubMed


Neuromuscular ultrasonography can be used both descriptively and quantitatively in the evaluation of patients with neuromuscular disorders. This article reviews the quantitative use of this technology, particularly measurements of the size and echogenicity of nerve and muscle, as a tool for assessing the severity, progression, and response of these tissues to therapeutic interventions. Neuromuscular ultrasonography has several features, including portability and noninvasiveness, that make it an attractive research tool for advancing the diagnosis and treatment of neuromuscular disorders.

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Available from: Michael S Cartwright, May 28, 2015
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    • "In recent years, muscle ultrasonography (MUS) has become a promising tool for diagnosing neuromuscular disorders (Pillen et al., 2008; Boon et al., 2012; Mayans et al., 2012; Grimm et al., 2013). "
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    ABSTRACT: Objective We aimed to determine the utility of muscle ultrasonography (MUS) in addition to electromyography (EMG) in the diagnosis of amyotrophic lateral sclerosis (ALS). Methods In all, 60 patients with ALS and 20 with other neuromuscular disorders underwent MUS and EMG. In addition, 30 healthy controls underwent only MUS. Occurrence of fasciculations and fibrillations was evaluated. Ultrasonic echogenicity was graded semiquantitatively. Results The incidence of fasciculations was significantly higher in patients undergoing MUS than in those undergoing EMG (p < 0.05), even in muscles of full strength (p < 0.001). However, EMG was more sensitive in detecting fibrillations (p < 0.05). MUS had an overall higher sensitivity in detecting spontaneous activity in the tongue (p < 0.05). Patients with ALS showed significantly increased muscle echo intensity (EI) compared to patients who were initially suspected as having ALS and normal controls (p < 0.05), irrespective of the clinical or electrophysiological status. Conclusion Our results showed that the sensitivity and specificity of MUS in diagnosing ALS was almost equivalent to those of EMG, using the Awaji criteria. Combination of MUS and EMG enhances the diagnostic accuracy compared to EMG alone (p < 0.05). Significance The combination of EMG and MUS can be used to evaluate the lower motor neuron affection by reducing the use of the often painful and uncomfortable EMG examinations but without decreasing the diagnostic sensitivity and specificity.
    Clinical Neurophysiology 08/2014; 126(4). DOI:10.1016/j.clinph.2014.06.052 · 3.10 Impact Factor
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    • "Die bei Myositiden wesentlichen Erfahrungen beruhen vor allem auf Untersuchungen an Kindern [18], es gibt aber auch Berichte bei Erwachsenen [7] [14]. "
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    ABSTRACT: Zusammenfassung Bereits in den 1980er und 1990er Jahren wurden erste vielversprechende Ergebnisse in der Ultraschalluntersuchung der Muskulatur berichtet. Sonografisch läßt sich die Muskelstruktur bzgl. Echogenität beurteilen, es lassen sich Faszikulationen und mit neueren hochauflösenden Sonden auch Fibrillationen detektieren und es lassen sich Atrophieparameter der Muskulatur erheben. Durch die zunehmende Entwicklung der Kernspintomographie geriet die Sonographie hier jedoch deutlich in den Hintergrund und fristete einen Dämmerschlaf für fast 15 Jahre. In letzter Zeit haben jedoch Verbesserungen der Ultraschalldiagnostik durch Breitbandschallköpfe mit variabler Frequenzierung sowie hochauflösende Sonden mit hoher Frequenz und somit erhöh-ter Auflösungsfähigkeit neue Perspektiven ergeben. Es ist nun nicht nur möglich, die Ultrastruktur des Muskels und des ihn umgebenden Gewebes feiner darzustellen, sondern durch automatisierte Grauwertanalysemethoden ist auch eine exaktere Berechnung der Echogenitätsveränderungen mög-lich. Hier bieten sich in der Diagnostik neuromuskulärer Erkrankungen enorme Optionen. In dieser Zusammenschau sollen die Methode, die Untersuchungsabläufe und relevante Befunde der Myoso-nographie vorgestellt und diskutiert werden.
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    • "Results of this first pilot study suggest a promising role for bedside ultrasound as an additive non-invasive procedure for detecting changes in muscle architecture in patients with either septic shock or severe sepsis. Several studies have demonstrated that muscle ultrasound is able to reliably detect pathological changes [15-18] such as muscle atrophy, fatty infiltration, and intramuscular fibrosis [28,29]. The combination of static and dynamic images in B-mode and M-mode [30,31] enables the detection of spontaneous muscle activity, so that muscle fasciculations can be visualized with higher sensitivity by ultrasound compared with EMG measurements [14,24,31]. "
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    ABSTRACT: Muscle ultrasound is emerging as a promising tool in the diagnosis of neuromuscular diseases. The current observational study evaluates the usefulness of muscle ultrasound in patients with severe sepsis for assessment of critical illness polyneuropathy and myopathy (CINM) in the intensive care unit. 28 patients with either septic shock or severe sepsis underwent clinical neurological examinations, muscle ultrasound, and nerve conduction studies on days 4 and 14 after onset of sepsis. 26 healthy controls of comparable age underwent clinical neurological evaluation and muscle ultrasound only. 26 of the 28 patients exhibited classic electrophysiological characteristics of CINM, and all showed typical clinical signs. Ultrasonic echogenicity of muscles was graded semiquantitatively and fasciculations were evaluated in muscles of proximal and distal arms and legs. 75% of patients showed a mean echotexture greater than 1.5, which was the maximal value found in the control group. A significant difference in mean muscle echotexture between patients and controls was found at day 4 and day 14 (both p < 0.001). In addition, from day 4 to day 14, the mean grades of muscle echotexture increased in the patient group, although the values did not reach significance levels (p = 0.085). Controls revealed the lowest number of fasciculations. In the patients group, fasciculations were detected in more muscular regions (lower and upper arm and leg) in comparison to controls (p = 0.08 at day 4 and p = 0.002 at day 14). Muscle ultrasound represents an easily applicable, non-invasive diagnostic tool which adds to neurophysiological testing information regarding morphological changes of muscles early in the course of sepsis. Muscle ultrasound could be useful for screening purposes prior to subjecting patients to more invasive techniques such as electromyography and/or muscle biopsy. German Clinical Trials Register, DRKS-ID: DRKS00000642.
    Critical care (London, England) 10/2013; 17(5):R227. DOI:10.1186/cc13050 · 4.48 Impact Factor
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