Comparison of Different Ultrasound Protocols in Patients with Inflammatory Polyneuropathies with Practical Insights

Abstract

Objectives: We aimed to compare well-known ultrasound protocols for inflammatory polyneuropathies in a single cohort. Methods: High-resolution ultrasound was performed according to the Bochum ultrasound score (BUS)/neuropathy ultrasound protocol (NUP), ultrasound pattern sum score (UPSS), and EAN/PNS suggested protocol for patients with chronic (CIDP) and acute inflammatory polyneuropathies (AIDP), multifocal motor neuropathies (MMN) and healthy controls. The upper boundaries were adjusted according to our laboratory normative values to all above-mentioned protocols; additionally, another calculation was performed using the peripheral nerve size values officially proposed by EAN/PNS. Results: We enrolled a total of 189 subjects (105 males and 84 females), comprising 40 patients with CIDP, 13 with MMN, 11 with AIDP, and 125 healthy controls. The mean ages were 62.49 years (range 37–84 years) for the CIDP patients; 55.92 years (range 32–71 years) for the MMN patients; 68.09 years (range 51–88 years) for the AIDP patients; and 49.02 years (range 25–80 years) for the healthy controls. Using the EAN/PNS protocol bilaterally, 72.9% of CIDP cases were identified. When the adjusted EAN/PNS protocol was applied, the detection rate rose to 100%, with a sensitivity of 100%. Both the adjusted BUS/NUP and UPSS protocols demonstrated a specificity of 90% in diagnosing CIDP. EAN/PNS protocol detected 69.23% of MMN cases measured unilaterally and had a 100% sensitivity to distinguish MMN, while the UPSS protocol had the highest specificity (96%). In AIDP cases, the adjusted EAN/PNS protocol identified 90.90% of cases through unilateral or bilateral measurements, with sensitivity 91% and specificity 88%. Conclusions: The EAN/PNS protocol was the most valuable in the detection of treatable states, and the BUS/NUP, UPSS protocols were the most valuable in the differentiation of specific inflammatory polyneuropathies.