Lower limb nerve ultrasound: A four-way comparison of acquired and inherited axonopathy, inherited neuronopathy and healthy controls

Muscle Nerve. 2024 Dec;70(6):1263-1267. doi: 10.1002/mus.28260. Epub 2024 Sep 19.

Abstract

Introduction/aims: In a recent study, we showed that nerve ultrasound of the upper limbs could distinguish inherited sensory neuronopathy from inherited axonopathy; surprisingly, no differences were found in the lower limb nerves. In this study, we compared lower limb nerve ultrasound measurements in inherited neuronopathy, inherited axonopathy, and acquired axonopathy.

Methods: Tibial and sural nerve ultrasound cross-sectional areas (CSAs) of 34 healthy controls were retrospectively compared with those of three patient groups: 17 with cerebellar ataxia with neuronopathy and vestibular areflexia syndrome (CANVAS), 18 with Charcot-Marie-Tooth type 2 (CMT2), and 18 with acquired length-dependent sensorimotor axonal neuropathy, using ANOVA with post-hoc Tukey honestly significance difference (HSD) (significance level set at p < .05).

Results: The nerve CSAs of CANVAS and CMT2 patients were not significantly different. Both the tibial and the sural nerve CSAs were significantly smaller in CANVAS and CMT2 compared with the acquired axonal neuropathy group. Tibial nerve CSAs of CANVAS and CMT2 were significantly smaller than controls. Tibial and sural nerve CSAs of the acquired axonal neuropathy group were also significantly larger than the controls'.

Discussion: Ultrasound of the lower limb nerves distinguished inherited from acquired axonopathy with the nerve size respectively reduced and increased in these two groups. This has potential implication for the differential diagnosis of these diseases in clinical practice.

Keywords: Charcot‐Marie‐Tooth type 2; axonal neuropathy; cerebellar ataxia Neuronopathy vestibular Areflexia syndrome; neuromuscular ultrasound; neuronopathy.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Axons / pathology
  • Cerebellar Ataxia / diagnostic imaging
  • Cerebellar Ataxia / genetics
  • Charcot-Marie-Tooth Disease* / diagnostic imaging
  • Charcot-Marie-Tooth Disease* / genetics
  • Charcot-Marie-Tooth Disease* / physiopathology
  • Female
  • Humans
  • Lower Extremity / diagnostic imaging
  • Lower Extremity / innervation
  • Male
  • Middle Aged
  • Retrospective Studies
  • Sural Nerve* / diagnostic imaging
  • Tibial Nerve* / diagnostic imaging
  • Tibial Nerve* / physiopathology
  • Ultrasonography*
  • Young Adult