Comparison of cross-sectional areas and distal-proximal nerve ratios in amyotrophic lateral sclerosis

Abstract

Introduction: This study explored potential diagnostic markers of nerve ultrasound in differentiating amyotrophic lateral sclerosis (ALS) from mimic disorders.

Methods: Ultrasound of the median, ulnar, and tibial nerves was conducted in 53 patients with ALS, 32 patients with ALS-mimic disorders, and 30 controls. Nerve cross-sectional area (CSA) and distal-proximal ratios were calculated.

Results: The median nerve CSA in the upper arm was decreased (7.9 ± 1.3 mm² vs. 9.0 ± 1.4 mm² , P < 0.05), and the median nerve wrist-upper arm ratio was increased in ALS patients compared with controls (1.3 ± 0.4 vs. 1.1 ± 0.2; P < 0.01). In differentiating ALS from mimic presentations, assessment of median nerve CSA in the upper arm and comparison of a median and ulnar nerve CSA distal-proximal ratio provide diagnostic potential.

Discussion: Assessment of nerve CSA combined with calculation of nerve CSA distal-proximal ratio provides a useful marker to aid in the diagnosis of ALS. Muscle Nerve 58:777-783, 2018.

Keywords: amyotrophic lateral sclerosis; multifocal motor neuropathy; peripheral nerve; peripheral nerve hyperexcitability syndrome; ultrasound.