Ultrasound assessment of peripheral nerve size in Guillain-Barré syndrome: A systematic review and Meta-Analysis

Abstract

Purpose: Guillain-Barré Syndrome (GBS) is an autoimmune disorder causing acute inflammatory polyneuropathy, resulting in muscle weakness. Timely diagnosis is critical to prevent complications such as respiratory failure and long-term disability. Ultrasound imaging of peripheral nerves, specifically assessing nerve cross-sectional area (CSA), has been suggested as a diagnostic tool for GBS. This systematic review aims to evaluate the utility of nerve ultrasound in diagnosing and monitoring GBS.

Methods: A systematic review was conducted following PRISMA guidelines, searching databases including PubMed, Scopus, Web of Science, and Cochrane Library up to December 2024. Studies that used ultrasound to assess peripheral nerve size in GBS patients compared to healthy controls or other neuropathy patients were included. Statistical analysis was conducted using Review Manager 5.4 software.

Results: Out of 848 studies, 25 met the inclusion criteria, with 12 included in the meta-analysis. A total of 528 patients with GBS were included. Ultrasound revealed significant increases in the CSA of cervical, peroneal, median, ulnar, and tibial nerves in GBS patients. Specifically, cervical nerve enlargement (MD: 1.45, P = 0.0008) and peroneal nerve enlargement (Mean Difference (MD): 2.09, P < 0.00001) were notable. Subgroup analysis revealed significant enlargement of the ulnar and tibial nerves across different anatomical regions.

Conclusion: Ultrasound imaging of peripheral nerves, particularly changes in CSA, provides valuable diagnostic insight for GBS, may be helpful in early recognition and intervention. Further studies are needed to establish consistent CSA patterns and improve diagnostic accuracy across various GBS subtypes.

Keywords: Autoimmune disorder; Cross-sectional area; Diagnostic imaging; Guillain-Barré syndrome; Nerve size; Ultrasound.