臨床検査67巻8号

2023年08月発行

今月の特集2 神経・筋疾患の超音波検査

慢性炎症性脱髄性多発根神経炎（CIDP）における超音波検査

著者： 北國圭一¹

所属機関： ¹帝京大学脳神経内科

ページ範囲：P.870 - P.877

Point

●超音波検査の慢性炎症性脱髄性多発根神経炎（CIDP）への臨床応用は著しい発展を遂げており，神経超音波は最新のEAN/PNS（European Academy of Neurology/Peripheral Nerve Society）の診療ガイドラインにも診断補助ツールとして取り入れられている．

●CIDPの神経超音波では末梢神経の遠位〜近位，さらに神経根も含む広範な領域に神経/神経束腫大が認められる．

●CIDPでみられる神経腫大は部位ごとにばらつきがあり，この特徴が他の脱髄性ニューロパチーとの鑑別診断に有用である．

●神経超音波・筋超音波における神経・筋の形態異常がCIDPの病態，治療反応性や予後の推定に役立つ可能性も報告されている．

参考文献

1）Van den Bergh PYK, van Doorn PA, Hadden RDM, et al：European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force-Second revision. J Peripher Nerv Syst　26：242-268，2021

2）Padua L, Granata G, Sabatelli M, et al：Heterogeneity of root and nerve ultrasound pattern in CIDP patients. Clin Neurophysiol　125：160-165，2014

3）Di Pasquale A, Morino S, Loreti S, et al：Peripheral nerve ultrasound changes in CIDP and correlations with nerve conduction velocity. Neurology　84：803-809，2015

4）Padua L, Granata G, Sabatelli M, et al：Heterogeneity of root and nerve ultrasound pattern in CIDP patients. Clin Neurophysiol　125：160-165，2014

5）Härtig F, Ross M, Dammeier NM, et al：Nerve Ultrasound Predicts Treatment Response in Chronic Inflammatory Demyelinating Polyradiculoneuropathy-a Prospective Follow-Up. Neurotherapeutics　15：439-451，2018

6）Fionda L, Di Pasquale A, Morino S, et al：Changes of clinical, neurophysiological and nerve ultrasound characteristics in CIDP over time: a 3-year follow-up. J Neurol　268：3011-3019，2021

7）Sugimoto T, Ochi K, Hosomi N, et al：Ultrasonographic nerve enlargement of the median and ulnar nerves and the cervical nerve roots in patients with demyelinating Charcot-Marie-Tooth disease: distinction from patients with chronic inflammatory demyelinating polyneuropathy. J Neurol　260：2580-2587，2013

8）Grimm A, Vittore D, Schubert V, et al：Ultrasound pattern sum score, homogeneity score and regional nerve enlargement index for differentiation of demyelinating inflammatory and hereditary neuropathies. Clin Neurophysiol　127：2618-2624，2016

9）Padua L, Martinoli C, Pazzaglia C, et al：Intra- and internerve cross-sectional area variability: new ultrasound measures. Muscle Nerve　45：730-733，2012

10）Grimm A, Décard BF, Axer H, et al：The Ultrasound pattern sum score - UPSS. A new method to differentiate acute and subacute neuropathies using ultrasound of the peripheral nerves. Clin Neurophysiol　126：2216-2225，2015

11）Kerasnoudis A, Pitarokoili K, Behrendt V, et al：Bochum ultrasound score versus clinical and electrophysiological parameters in distinguishing acute-onset chronic from acute inflammatory demyelinating polyneuropathy. Muscle Nerve　51：846-852，2015

12）Niu J, Cui L, Liu M：Multiple Sites Ultrasonography of Peripheral Nerves in Differentiating Charcot-Marie-Tooth Type 1A from Chronic Inflammatory Demyelinating Polyradiculoneuropathy. Front Neurol　8：181，2017

13）Fisse AL, Pitarokoili K, Motte J, et al：Nerve echogenicity and intranerve CSA variability in high-resolution nerve ultrasound (HRUS) in chronic inflammatory demyelinating polyneuropathy (CIDP). J Neurol　266：468-475，2019

14）Puma A, Grecu N, Villa L, et al：Ultra-high-frequency ultrasound imaging of sural nerve: A comparative study with nerve biopsy in progressive neuropathies. Muscle Nerve　63：46-51，2021

15）Zaidman CM, Pestronk A：Nerve size in chronic inflammatory demyelinating neuropathy varies with disease activity and therapy response over time: a retrospective ultrasound study. Muscle Nerve　50：733-738，2014

16）Kerasnoudis A, Pitarokoili K, Behrendt V, et al：Correlation of nerve ultrasound, electrophysiological and clinical findings in chronic inflammatory demyelinating polyneuropathy. J Neuroimaging　25：207-216，2015

17）Grimm A, Vittore D, Schubert V, et al：Ultrasound aspects in therapy-naive CIDP compared to long-term treated CIDP. J Neurol　263：1074-1082，2016

18）Merola A, Rosso M, Romagnolo A, et al：Peripheral Nerve Ultrasonography in Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Multifocal Motor Neuropathy: Correlations with Clinical and Neurophysiological Data. Neurol Res Int　2016：9478593，2016

19）Fisse AL, Pitarokoili K, Trampe N, et al：Clinical, Sonographic, and Electrophysiologic Longitudinal Features of Chronic Inflammatory Demyelinating Polyneuropathy. J Neuroimaging　29：223-232，2019

20）Kerasnoudis A, Pitarokoili K, Gold R, et al：Nerve Ultrasound and Electrophysiology for Therapy Monitoring in Chronic Inflammatory Demyelinating Polyneuropathy. J Neuroimaging　25：931-939，2015

21）Granata G, Pazzaglia C, Calandro P, et al：Ultrasound visualization of nerve morphological alteration at the site of conduction block. Muscle Nerve　40：1068-1070，2009

22）Padua L, Paolasso I, Pazzaglia C, et al：High ultrasound variability in chronic immune-mediated neuropathies. Review of the literature and personal observations. Rev Neurol (Paris)　169：984-990，2013

23）Hokkoku K, Coraci D, Gatto DM, et al：Neuralgic amyotrophy with isolated mononeuropathy of the musculocutaneous nerve: a problematic differential diagnosis of cervical radiculopathy. Acta Neurol Belg　123：267-269，2023

24）Hokkoku K, Matsukura K, Uchida Y, et al：Quantitative muscle ultrasound is useful for evaluating secondary axonal degeneration in chronic inflammatory demyelinating polyneuropathy. Brain Behav　7：e00812，2017

25）Fisse AL, Fiegert S, Stoykova Z, et al：Increased muscle echointensity correlates with clinical disability and muscle strength in chronic inflammatory demyelinating polyneuropathy. Eur J Neurol　28：1698-1705，2021

26）Sugimoto T, Ochi K, Hosomi N, et al：Ultrasonographic reference sizes of the median and ulnar nerves and the cervical nerve roots in healthy Japanese adults. Ultrasound Med Biol　39：1560-1570，2013

27）Kerasnoudis A, Pitarokoili K, Behrendt V, et al：Cross sectional area reference values for sonography of peripheral nerves and brachial plexus. Clin Neurophysiol　124：1881-1888，2013