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  • Review Article
  • Published:

New technologies for the assessment of neuropathies

Nature Reviews Neurology volume 13, pages 203–216 (2017)Cite this article

Subjects

Key Points

  • Ultrasonography has an established role in the investigation of nerve entrapment syndromes and ambiguous neurophysiological findings, and an emerging role in the assessment of diffuse polyneuropathies

  • Magnetic resonance neurography has a supportive role in the diagnostic workup of inflammatory neuropathies, can provide additional information in entrapment neuropathies and has an emerging role in diffuse polyneuropathies

  • Skin biopsy is a minimally invasive technique for diagnosing small-fibre neuropathies, can be used to assess large myelinated nerve fibres, and can provide a quantitative assessment of autonomic pathology

  • Confocal corneal microscopy is a noninvasive technique for detecting small-fibre loss in neuropathies, and findings with this technique correlate with those of skin biopsy in small-fibre neuropathies

  • Microneurography is a minimally invasive technique for the investigation of physiological properties and pathological changes in small-nerve fibres

Abstract

Technical advances are rapidly changing the clinical and instrumental approach to peripheral nerve diseases. Magnetic resonance neurography, diffusion tensor imaging and nerve ultrasonography are increasingly entering the diagnostic workup of peripheral neuropathies as tools that complement neurophysiology and enable investigation of proximal structures, such as plexuses and roots. Progress in the design of magnetic resonance scanners and sequences, and the development of high-frequency ultrasound probes mean that high-resolution peripheral nerve imaging is possible, enabling detailed examination of nerve size, morphology and internal fascicular structure that can integrate nerve conduction studies into clinical practice. In the growing field of small-fibre neuropathy, in which traditional nerve conduction studies are of little or no use, skin biopsy has become a reliable tool for diagnosis. Corneal confocal microscopy, nociceptive evoked potentials and microneurography are emerging techniques that are mainly used in clinical research settings, but have increasing relevance to clinical practice. We review these new and emerging techniques and their effects on diagnosis, treatment strategies and prognosis in a variety of peripheral neuropathies, including entrapments, brachial plexopathies, immune and inherited neuropathies, and small-fibre neuropathies. We discuss the most promising research findings and their potential for future application in clinical practice.

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Figure 1: Appearance of nerve compression in carpal tunnel syndrome with ultrasonography.
Figure 2: Ultrasonography to identify cysts that affect peripheral nerves.
Figure 3: 3D magnetic resonance neurography and diffusion tensor imaging in immune-mediated neuropathies.
Figure 4: Representative images of skin biopsy sample sections using different techniques and antibodies that target different structures.

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Authors and Affiliations

  1. Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Neuroradiology Unit, Spedali Civili, Piazza Spedali Civili, Brescia, 1–25123, Italy

    Roberto Gasparotti

  2. Department of Geriatrics, Catholic University, Neurology, Orthopedics and Rehabilitation, Largo Agostino Gemelli 8, Rome, 0630151, Italy

    Luca Padua

  3. Fondazione Don Gnocchi, P.le R. Morandi 6, Milan, 20121, Italy

    Luca Padua

  4. Department of Neurosciences, University of Padova, Via Giustiniani 5, Padova, 35128, Italy

    Chiara Briani

  5. Neuroalgology Unit and Skin Biopsy, Peripheral Neuropathy and Neuropathic Pain Laboratory, IRCCS Foundation “Carlo Besta” Neurological Institute, Via Celoria 11, Milan, 20133, Italy

    Giuseppe Lauria

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  1. Roberto Gasparotti
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  2. Luca Padua
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  4. Giuseppe Lauria
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Contributions

R.G., L.P. and G.L. wrote the article. All authors researched data for the article, made substantial contributions to discussion of the content and reviewed and/or edited the manuscript before submission.

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Correspondence to Roberto Gasparotti.

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Glossary

Fat suppression

Magnetic resonance technique used for suppressing the bright signal of fat and improving the visualization of nerves.

Internal fascicular pattern

Degree of visualization of fascicular bundles as distinct entities, with uniform size and signal intensity in intact nerves.

Reformations

Secondary images obtained from 3D datasets with longitudinal display of the nerve course.

Fractional anisotropy

Common diffusion tensor imaging parameter indicating the directional preference of water diffusion within microscopic tissue structures, with physiologically high values in intact peripheral nerves.

Echotexture

Characteristic pattern or structure of tissue layers as seen during ultrasonography.

Luxation

Displacement of the ulnar nerve beyond the tip of the epicondyle during elbow flexion.

Neurogenic thoracic outlet syndrome

Condition resulting from the dynamic compression of the brachial plexus as it travels from the thoracic outlet to the axilla.

Notalgia

Patchy area of dysaesthesia and altered sensation classically located in the midback skin, but occurring also in other areas of the body.

Ehlers–Danlos syndrome

Condition encompassing various heritable soft connective tissue disorders characterized by joint hypermobility, skin texture abnormalities and visceral and vascular fragility or dysfunctions; six major variants are currently recognized.

Ross syndrome

Rare clinical disorder of unknown cause characterized by the triad of tonic pupil, hyporeflexia and segmental anhidrosis.

Holmes–Adie syndrome

Rare clinical disorder of unknown cause characterized by tonic pupil and hyporeflexia, with normal sweating function.

Stroma

Layer of the cornea located behind the Bowman layer and in front of the Descemet membrane, representing ∼90% of the total corneal thickness and giving the cornea its strength.

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Gasparotti, R., Padua, L., Briani, C. et al. New technologies for the assessment of neuropathies. Nat Rev Neurol 13, 203–216 (2017). https://doi.org/10.1038/nrneurol.2017.31

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