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Klinische Neurophysiologie 2013; 44(02): 140-144
DOI: 10.1055/s-0033-1345201
Originalia
© Georg Thieme Verlag KG Stuttgart · New York

Muskelultraschall – ein sinnvolles Werkzeug bei der Diagnosestellung der amyotrophen Lateralsklerose

Sonography of Muscles – A Useful Tool in the Diagnosis of Amyotrophic Lateral Sclerosis
A. Grimm
1   Hans Berger Klinik für Neurologie, Universitätsklinikum Jena
2   Thüringer Muskelzentrum
,
T. Prell
1   Hans Berger Klinik für Neurologie, Universitätsklinikum Jena
,
O. W. Witte
1   Hans Berger Klinik für Neurologie, Universitätsklinikum Jena
2   Thüringer Muskelzentrum
,
H. Axer
1   Hans Berger Klinik für Neurologie, Universitätsklinikum Jena
2   Thüringer Muskelzentrum
,
J. Grosskreutz
1   Hans Berger Klinik für Neurologie, Universitätsklinikum Jena
2   Thüringer Muskelzentrum
› Author Affiliations
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Publication History

Publication Date:
20 June 2013 (online)

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Zusammenfassung

Die Modifizierung der El-Escorial Kriterien von 2008 (sog. Awaji-Shima-Kriterien) hat den Stellenwert der Elektrophysiologie in der Diagnosestellung der amyotrophen Lateralsklerose erweitert. Elek­tromyografisch festgestellten Fibrillationen und positiv scharfen Wellen, aber auch Faszikulationen wird bei chronisch neurogen veränderten oder klinisch betroffenen Muskeln ein pathologischer Stellenwert in der Feststellung einer Schädigung des 2. Motoneurons (Abbkürzung MN) zuteil. Neben der elektrophysiologischen Untersuchung erfährt in den letzten Jahren die Muskelultraschalluntersuchung ein vermehrtes Interesse. Die Kombination von statischer und dynamischer Bilddarstellung gibt Möglichkeiten, die sonst kein anderes bildgebendes Verfahren der Muskulatur bietet. Darüber hinaus ist das Verfahren nicht invasiv und bietet die Möglichkeit, zahlreiche und vor allem elektromyografisch schwer zugängliche Muskelgruppen in toto darzustellen. Während die Detektion von Faszikulationen mittels Ultraschall schon längere Zeit sicher möglich ist, ist dank verbesserter Technologie und hochauflösender Ultraschallsonden bis 18 MHz nun auch die Erkennung von Fibrillationen möglich. B-Bild-Darstellungen der Muskulatur mit Messung von Muskelvolumen, Echogenität und Atrophie können darüber hinaus wichtige Informationen in allen Krankheitsstadien bieten. Ergebnisse der letzten Jahre weisen daraufhin, dass der Ultraschall der Muskulatur in Ergänzung zur EMG die Diagnosestellung beschleunigen und die Sensitivität in der Diagnostik erhöhen kann. Der folgende Artikel soll eine Übersicht über die Methode des Muskelultraschalls in der Diagnosestellung der amyotrophen Lateralsklerose liefern.

Abstract

The modification of the El-Escorial criteria of 2008 (so-called Awaji-Shima criteria) has increased the value of electrophysiology in the diagnostics for amyotrophic lateral sclerosis. Fibrillations detected by electromyography and positive sharp waves as well as fasciculations in chronic neurogenically altered or clinically afflicted muscles are considered to be of pathological relevance in the determination of damage to the 2nd motor neurons (abbreviated as MN). Beside electrophysiological examinations, sonographic examinations of muscles have attracted increasing interest in the past years. The combination of static and dynamic imaging provides possibilities that are not available by any other imaging processes of the musculature. Furthermore. the procedure is non-invasive and, above all, makes possible the in toto visualisation of muscle groups that are only difficultly accessible with electromyography. Although the detection of fasciculations by ultrasound has been possible for some time, improved technology and high-resolution ultrasound scanners of up to 18 MHz have now also made the recognition of fibrillations possible. B mode representations of the musculature with measurements of muscle volume, echogenicity and atrophy provide additional important information in all stages of the disease. Recently acquired results have demonstrated that sonography of muscles as supplement to EMG speeds up the diagnosis process and increases the diagnostic sensitivity. The present article is intended to provide an overview of the methods of muscle sonography as used in the diagnostics for amyotrophic lateral sclerosis.

Schlüsselwörter

amyotrophe Lateralsklerose - Ultraschall - Muskel - neuromuskuläre Erkrankung

Key words

amyotrophic lateral sclerosis - ultrasonography - muscles - neuromuscular diseases
 

  • Literatur

  • 1 Hardiman O, van den Berg LH, Kiernan MC. Clinical diagnosis and management of amyotrophic lateral sclerosis. Nat Rev Neurol 2011; 7 : 639-649 DOI: 10.1038/nrneurol.2011.153.
    PubMedGoogle Scholar
  • 2 de Carvalho M, Dengler R, Eisen A. Electrodiagnostic criteria for diagnosis of ALS. Clin Neurophysiol 2008; 119: 497-503 Epub 2007
    CrossrefPubMedGoogle Scholar
  • 3 Boekestein WA, Kleine BU, Hageman G. Sensitivity and specificity of the ‘Awaji’ electrodiagnostic criteria for amyotrophic lateral sclerosis: Retrospective comparison of the Awaji and revised El Escorial criteria for ALS. Amyotroph Lateral Scler 2010; 11: 497-501
    CrossrefPubMedGoogle Scholar
  • 4 Kraemer M, Buerger M, Berlit P. Diagnostic problems and delay of diagnosis in amyotrophic lateral sclerosis. Clin Neurol Neurosurg 2010; 112: 103-105
    CrossrefPubMedGoogle Scholar
  • 5 Dengler R. Dynamic muscle ultrasound conquers another domain of needle EMG, the detection of fibrillations. Clin Neurophysiol 2009; 120: 843-844
    CrossrefPubMedGoogle Scholar
  • 6 Mayans D, Cartwright MS, Walker FO. Neuromuscular ultrasonography: quantifying muscle and nerve measurements. Phys Med Rehabil Clin N Am 2012; 23: 133-148 xii
    CrossrefPubMedGoogle Scholar
  • 7 Pillen S, Arts IMP, Zwarts MJ. Muscle ultrasound in neuromuscular disorders. Muscle Nerve 2008; 37: 679-693
    CrossrefPubMedGoogle Scholar
  • 8 Pillen S, Verrips A, van Alfen N. Quantitative skeletal muscle ultrasound: diagnostic value in childhood neuromuscular disease. Neuromuscul. Disord 2007; 17: 509-516
    CrossrefPubMedGoogle Scholar
  • 9 Walker FO, Cartwright MS, Wiesler ER. Ultrasound of nerve and muscle. Clin Neurophysiol 2004; 115: 495-507
    CrossrefPubMedGoogle Scholar
  • 10 Pillen S, Tak RO, Zwarts MJ et al. Skeletal muscle ultrasound: correlation between fibrous tissue and echo intensity. Ultrasound Med Biol 2009; 35: 443-446
    CrossrefPubMedGoogle Scholar
  • 11 Reimers CD, Ziemann U, Scheel A. Fasciculations: clinical, electromyographic, and ultrasonographic assessment. J Neurol. 1996; 243: 579-584
    CrossrefPubMedGoogle Scholar
  • 12 Arts IM, Overeem S, Pillen S. Muscle ultrasonography to predict survival in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry. 2010
    PubMedGoogle Scholar
  • 13 Arts IMP, Overeem S, Pillen S. Muscle changes in amyotrophic lateral sclerosis: a longitudinal ultrasonography study. Clin Neurophysiol 2011; 122: 623-628
    CrossrefPubMedGoogle Scholar
  • 14 Arts IMP, Pillen S, Schelhaas HJ. Normal values for quantitative muscle ultrasonography in adults. Muscle Nerve 2010; 41: 32-41
    CrossrefPubMedGoogle Scholar
  • 15 Pillen S, van Alfen N. Skeletal muscle ultrasound. Neurol. Res 2011; 33: 1016-1024
    CrossrefPubMedGoogle Scholar
  • 16 Reimers CD, Kellner H. Muscle ultrasound. Muscle Imaging in Health and Disease. New York: Springer; 1996. 13-20
    CrossrefGoogle Scholar
  • 17 Boon AJ, Smith J, Harper CM. Ultrasound applications in electrodiagnosis. PM R 2012; 4: 37-49
    PubMed
  • 18 Pillen S, Scholten RR, Zwarts MJ. Quantitative skeletal muscle ultrasonography in children with suspected neuromuscular disease. Muscle Nerve 2003; 27: 699-705
    CrossrefPubMedGoogle Scholar
  • 19 Lee CD, Song Y, Peltier AC Muscle ultrasound quantifies the rate of reduction of muscle thickness in amyotrophic lateral sclerosis Muscle Nerve 2010; 42: 814-819
    CrossrefPubMed
  • 20 Xu Y, Zheng J, Zhang S. Needle electromyography of the rectus abdominis in patients with amyotrophic lateral sclerosis. Muscle Nerve 2007; 35: 383-385
    CrossrefPubMedGoogle Scholar
  • 21 Misawa S, Noto Y, Shibuya K et al. Ultrasonographic detection of fasciculations markedly increases diagnostic sensitivity of ALS. Neurology 2011; 77: 1532-1537
    CrossrefPubMedGoogle Scholar
  • 22 Mills KR. Detecting fasciculations in amyotrophic lateral sclerosis: duration of observation required. J Neurol Neurosurg Psychiatry 2011; 82: 549 -551
    CrossrefPubMedGoogle Scholar
  • 23 Boekestein WA, Schelhaas HJ, van Dijk JP 1Ultrasonographic detection of fasciculations markedly increases diagnostic sensitivity of ALS Neurology 2012; 78: 370 author reply 370-371
    CrossrefPubMed
  • 24 Arts IMP, Overeem S, Pillen S et al. Muscle ultrasonography: a diagnostic tool for amyotrophic lateral sclerosis. Clin Neurophysiol 2012; 123: 1662-1667
    CrossrefPubMedGoogle Scholar
  • 25 Pillen S, Nienhuis M, van Dijk JP. Muscles alive: ultrasound detects fibrillations. Clin Neurophysiol 2009; 120: 932-936
    CrossrefPubMedGoogle Scholar
  • 26 van Alfen N, Nienhuis M, Zwarts MJ. Detection of fibrillations using muscle ultrasound: diagnostic accuracy and identification of pitfalls. Muscle Nerve 2011; 43: 178-182
    CrossrefPubMedGoogle Scholar
  • 27 van Baalen A, Stephani U. Fibration, fibrillation, and fasciculation: say what you see. Clin Neurophysiol 2007; 118: 1418-1420
    CrossrefPubMedGoogle Scholar
  • 28 Heckmatt JZ, Leeman S, Dubowitz V. Ultrasound imaging in the diagnosis of muscle disease. J Pediatr 1982; 101: 656-660
    CrossrefPubMedGoogle Scholar
  • 29 Pillen S, van Dijk JP, Weijers G. Quantitative gray-scale analysis in skeletal muscle ultrasound: a comparison study of two ultrasound devices. Muscle Nerve 2009; 39: 781-786
    CrossrefPubMedGoogle Scholar
  • 30 Arts IMP, van Rooij FG, Overeem S. Quantitative muscle ultrasonography in amyotrophic lateral sclerosis. Ultrasound Med Biol 2008; 34: 354-361
    CrossrefPubMedGoogle Scholar
  • 31 World Federation of Neurology Research Group on Neuromuscular Diseases Subcommittee on Motor Neuron Disease . Airlie House guidelines. Therapeutic trials in amyotrophic lateral sclerosis. Airlie House “Therapeutic Trials in ALS” Workshop Contributors. J Neurol Sci 1995; 129 (Suppl) 1-10 Review. No abstract available
    CrossrefPubMedGoogle Scholar
  • 32 Carvalho MD, Swash M. Awaji diagnostic algorithm increases sensitivity of El Escorial criteria for ALS diagnosis. Amyotroph Lateral Scler 2009; 10: 53-57 DOI: 10.1080/17482960802521126.
    CrossrefPubMedGoogle Scholar
  • 33 Brooks BR. El Escorial World Federation of Neurology criteria for the diagnosis of amyotrophic lateral sclerosis. Subcommittee on Motor Neuron Diseases/Amyotrophic Lateral Sclerosis of the World Federation of Neurology Research Group on Neuromuscular Diseases and the El Escorial “Clinical limits of amyotrophic lateral sclerosis” workshop contributors. J Neurol Sci 1994; 124 (Suppl) 96-107 No abstract available
    CrossrefPubMedGoogle Scholar