The Ultrasound pattern sum score - UPSS. A new method to differentiate acute and subacute neuropathies using ultrasound of the peripheral nerves

Alexander Grimm; Bernhard F Décard; Hubertus Axer; Peter Fuhr

doi:10.1016/j.clinph.2015.01.011

The Ultrasound pattern sum score - UPSS. A new method to differentiate acute and subacute neuropathies using ultrasound of the peripheral nerves

Clin Neurophysiol. 2015 Nov;126(11):2216-25. doi: 10.1016/j.clinph.2015.01.011. Epub 2015 Feb 3.

Authors

Alexander Grimm¹, Bernhard F Décard², Hubertus Axer³, Peter Fuhr²

Affiliations

¹ Department of Neurology, Basel University Hospital, Basel, Switzerland. Electronic address: alexander.grimm@usb.ch.
² Department of Neurology, Basel University Hospital, Basel, Switzerland.
³ Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.

PMID: 25691156
DOI: 10.1016/j.clinph.2015.01.011

Abstract

Objective: Ultrasound differentiation of neuropathies is a great challenge. We, therefore, suggest a standardized score to operationalize differentiation between several acute and subacute onset neuropathies.

Method: We retrospectively analyzed the ultrasound data of 61 patients with acute or subacute neuropathies, e.g. chronic immune-mediated neuropathies, Guillain-Barré syndrome (GBS), and axonal/vasculitic neuropathies. We compared these data to 28 healthy controls. Based on these results an ultrasound pattern sum score (UPSS) with three sub-scores (UPS-A for the sensorimotor nerves, UPS-B for the cervical roots and the vagal nerve and UPS-C for the sural nerve) was developed. Afterwards, the applicability of the score was prospectively validated in 10 patients with chronic neuropathies and in 14 patients with unknown acute and subacute PNP before performing additional tests.

Results: UPS-A and UPSS were significantly higher in CIDP than in other neuropathies and controls (p<0.001). UPS-B was significantly more often pathologic in GBS than in CIDP and other neuropathies (p<0.001). Using receiver operation characteristics curve analysis boundary values for each score were defined. Positive predictive value (PPV) of these scores for CIDP and GBS was >85%. Vasculitic neuropathies showed an intermediate type of UPSS compared to other axonal neuropathies (p<0.001). In the prospective application the pattern score could be used with good accuracy in several types of neuropathy.

Conclusion: UPS-A and UPSS operationalize to diagnose acute and subacute-onset CIDP and its variants with high sensitivity, specificity, and PPV. An increased UPS-B with normal UPSS and other sub scores may point to the diagnosis of GBS with high PPV and enables the differentiation from CIDP.

Significance: Using the UPSS and its sub-scores gives a new diagnostic power to the method of the peripheral nerve ultrasound.

Keywords: Inflammatory neuropathy; Nerve enlargement; Nerve ultrasound; Polyneuropathy; Ultrasound pattern; Ultrasound score.

Publication types

Validation Study

MeSH terms

Acute Disease
Adult
Aged
Case-Control Studies
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Peripheral Nerves / diagnostic imaging*
Peripheral Nervous System Diseases / classification
Peripheral Nervous System Diseases / diagnosis*
Peripheral Nervous System Diseases / diagnostic imaging*
Polyneuropathies / classification
Polyneuropathies / diagnosis
Polyneuropathies / diagnostic imaging
Prospective Studies
Retrospective Studies
Sensitivity and Specificity
Severity of Illness Index
Ultrasonography / methods*