Role of Imaging in Chronic Inflammatory Demyelinating Polyneuropathy: A Systematic Review

Abstract

Introduction: Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a treatable immune-mediated neuropathy with a relapsing-remitting course and symmetrical proximal and distal weakness. Diagnosis relies on nerve conduction studies (NCS) to detect demyelination but can be difficult in atypical cases. In such instances, nerve ultrasound (US) and MRI of the brachial and lumbosacral plexuses help improve diagnostic accuracy and guide treatment. This review examines the role of imaging in CIDP, focusing on its contribution to diagnosis, prognosis, and follow-up.

Methods: A total of 183 articles were identified in the PubMed database using the search terms: "CIDP AND imaging," "CIDP AND ULTRASOUND," and "CIDP AND MRI." Based on predefined inclusion criteria, 106 articles were selected for review (63 related to US and 43 to MRI). From each included study, data were extracted on the study population, imaging protocols used, outcome measures applied, and main findings relevant to the review's aim.

Results: The most used ultrasound and MRI protocols, along with their associated outcome measures, are discussed. Furthermore, the roles of each imaging modality in diagnosis, prognosis, and follow-up are analysed.

Conclusion: Although NCS remain the primary instrumental test for the diagnosis of CIDP, US and MRI can be valuable adjuncts in cases with diagnostic uncertainty. Additionally, these imaging modalities may be more useful than NCS in prognostic evaluation, helping in predict treatment response and monitoring subclinical disease activity.

Keywords: CIDP; MRI; ultrasound.

FIGURE 1

Flowchart of the article selection process in this systematic review.