Wieke Haakma

Comparative study of peripheral nerve Mri and ultrasound in multifocal motor neuropathy and amyotrophic lateral sclerosis

Introduction: Differentiating multifocal motor neuropathy (MMN) from amyotrophic lateral sclerosis (ALS) is important, as MMN is a difficult, but treatable disorder. Methods: We studied peripheral nerve imaging techniques in differentiating MMN from ALS by measuring the cross‐sectional area (CSA) of the median and ulnar nerves in the forearms using high resolution ultrasound (HRUS) and MRI. Results: HRUS CSA values of the median nerve in the forearm (P = 0.002) and the ulnar nerve distal to the sulcus (P = 0.009) were significantly enlarged in patients with MMN. There was a positive correlation between CSA as measured with HRUS and MRI (Spearman rho 0.60; P < 0.001). Conclusions: Peripheral nerve imaging is a potentially powerful technique to distinguish MMN from ALS. Muscle Nerve, 2016 Muscle Nerve 54: 1133–1135, 2016

A comparative study of peripheral nerve MRI and ultrasound in MMN and ALS

Introduction: Differentiating multifocal motor neuropathy (MMN) from amyotrophic lateral sclerosis (ALS) is important, as MMN is a difficult, but treatable disorder. Methods: We studied peripheral nerve imaging techniques in differentiating MMN from ALS by measuring the cross‐sectional area (CSA) of the median and ulnar nerves in the forearms using high resolution ultrasound (HRUS) and MRI. Results: HRUS CSA values of the median nerve in the forearm (P = 0.002) and the ulnar nerve distal to the sulcus (P = 0.009) were significantly enlarged in patients with MMN. There was a positive correlation between CSA as measured with HRUS and MRI (Spearman rho 0.60; P < 0.001). Conclusions: Peripheral nerve imaging is a potentially powerful technique to distinguish MMN from ALS. Muscle Nerve, 2016 Muscle Nerve 54: 1133–1135, 2016

Diffusion tensor imaging of peripheral nerves in non-fixed post-mortem subjects

PURPOSE While standard magnetic resonance imaging (MRI) sequences are increasingly employed in post-mortem (PM) examinations, more advanced techniques such as diffusion tensor imaging (DTI) remain unexplored in forensic sciences. Therefore, we studied the temporal stability and reproducibility of DTI and fiber tractography (FT) in non-fixed PM subjects. In addition, we investigated the lumbosacral nerves with PMDTI and compared their tissue characteristics to in vivo findings. METHODS MRI data were acquired on a 1.5T MRI scanner in seven PM subjects, consisting of six non-trauma deaths and one chronic trauma death, and in six living subjects. Inter-scan (within one session) and inter-session (between days) reproducibility of diffusion parameters, fractional anisotropy (FA), and mean diffusivity (MD), were evaluated for the lumbosacral nerves using Bland-Altman and Jones plots. Diffusion parameters in nerves L3-S2 were compared to living subjects using the non-parametric Mann-Whitney U test. RESULTS Reproducibility of diffusion values of inter-scan 95% limits of agreement ranged from -0.058 to 0.062 for FA, and (-0.037 to 0.052)×10(-3)mm(2)/s for MD. For the inter-session this was -0.0423 to 0.0423, and (-0.0442 to 0.0442)×10(-3)mm(2)/s for FA, and MD, respectively. Although PM subjects showed approximately four-fold lower diffusivity values compared to living subjects, FT results were comparable. The chronic trauma case showed disorganization and asymmetry of the nerves. CONCLUSION We demonstrated that DTI was reproducible in characterizing nervous tissue properties and FT in reconstructing the architecture of lumbosacral nerves in PM subjects. We showed differences in diffusion values between PM and in vivo and showed the ability of PMDTI and FT to reconstruct nerve lesions in a chronic trauma case. We expect that PMDTI and FT may become valuable in identification and documentation of PM nerve trauma or pathologies in forensic sciences.

Multicenter reproducibility study of diffusion MRI and fiber tractography of the lumbosacral nerves: DTI of the Lumbosacral Nerves

Diffusion tensor imaging (DTI) has been applied in the lumbar and sacral nerves in vivo, but information about the reproducibility of this method is needed before DTI can be used reliably in clinical practice across centers.

13 Afbeelden van de sacrale plexus bij kinderen met spina bifida

Resultaten De zenuwbanen van de patiënten in de SB-groep waren minder goed te vervolgen dan de zenuwbanen van gezonde volwassenen (gemiddelde lengte resp. 88,0 mm en 111,6 mm). In sommige gevallen waren de zenuwbanen zelfs onvindbaar. Met name op de plek waar de myelomelingocele zich bevond, was het moeilijk aansluiting te vinden op het ruggenmerg (zie figuur 13.1). Zenuwen van SB-patiënten vertoonden in grote mate asymmetrie en desorganisatie, terwijl asymmetrie bij gezonde proefpersonen slechts in geringe mate voorkwam en bij hen een goede organisatie van de zenuwen te zien was.