High-Resolution Ultrasonography of Peripheral Nerves: Measurements on 14 Nerve Segments in 56 Healthy Subjects and Reliability Assessments

Abstract

Purpose: The aim of this study was to assess different aspects of reliability in high-resolution ultrasonography (HRUS) of the peripheral nerves and to establish reference values for the most frequently examined nerve segments.

Materials and Methods: A nerve size parameter, the cross-sectional area (CSA) of the C5, C6 and C7 cervical roots, the median, ulnar, radial, superficial radial, peroneal, tibial, and the sural nerves was measured using HRUS at a total of 14 predefined anatomical sites in two different cohorts of healthy subjects (n = 56), and the inter-rater, intra-rater and inter-equipment reliability of measurements was assessed.

Results: The mean CSA of the 14 nerve segments ranged from 2 to 10 mm². The intra-rater, inter-rater and inter-equipment reliability was high with intraclass correlation coefficients of 0.93, 0.98, and 0.86, respectively. The CSA values showed no consistent correlation with age, height, and body weight, but males had significantly larger values than females for nerve segments on the arm after correcting for age, weight and height in multivariate analysis. CSA values did not differ when two independent cohorts were compared.

Conclusion: Peripheral nerve ultrasonography is a reliable and reproducible diagnostic method in the hands of experienced examiners. Normal values for several upper and lower extremity nerves are provided by our study.

Zusammenfassung

Ziel: Beurteilung verschiedener Aspekte der Reliabilität des hochauflösenden Ultraschalls (HRUS) bei der Untersuchung peripherer Nerven und die Bestimmung von Referenzwerten der Nervenquerschnittsfläche (CSA- cross sectional area) an verschiedenen Nervenabschnitten.

Material und Methoden: Mittels HRUS wurde bei zwei Normalkollektiven an 14 vorher anatomisch definierten Nervenabschnitten die Nervenquerschnittsfläche (CSA) der Rami ventrales C5, C6, C7, des Nervus medianus, N. ulnaris, N. radialis, Ramus superficialis n. radialis, N. peroneus, N. tibialis und N. suralis (n = 56) gemessen und die Inter-rater, Intra-rater und Inter-equipment Reliabilität bestimmt.

Ergebnisse: Die durchschnittliche Nervenquerschnittsfläche (CSA) an den 14 Nervenabschnitten betrug 2 bis 10 mm². Die Korrelationskoeffizienten der Intra-rater, Inter-rater und Inter-equipment Reliabilität waren mit 0,93 versus 0,98 und versus 0,86 hoch. Dabei zeigten die Nervenquerschnittsflächen (CSA) keine konstante Korrelation mit dem Alter, der Körpergröße und dem Körpergewicht. Andererseits ergab eine multivariante Analyse mit Korrektur dieser Faktoren bei Männern signifikant höhere Werte als bei Frauen. Die Nervenquerschnittsflächen (CSA) unterschieden sich nicht signifikant in den beiden Normalkollektiven.

Schlussfolgerung: Der hochauflösende Ultraschall peripherer Nerven ist eine zuverlässige und reproduzierbare Untersuchungsmethode in den Händen erfahrener Untersucher. Normwerte für mehrere Nervenabschnitte an der oberen und unteren Extremität wurden in der vorliegenden Studie bestimmt.

Key words

high-resolution ultrasonography - cross-sectional area - peripheral nerves - normal values - reliability

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