Ultraschall in der Diagnostik von Polyneuropathien

Zusammenfassung

Zur Diagnosestellung von Polyneuropathien (PNP) stehen neben der ausführlichen Anamneseerhebung und der klinisch-neurologischen Untersuchung in erster Linie die Elektroneurografie und Elektromyografie zur Verfügung. Der hochauflösende Nervenultraschall hat als weiteres Diagnostikum bei PNP in den letzten Jahren zunehmend an Bedeutung gewonnen. Diese nicht-invasive und nebenwirkungsfreie Untersuchungstechnik eröffnet zum klinischen Befund und den Ergebnissen der Nervenleitungsstudien eine weitere diagnostische Dimension. Der Nervenultraschall erlaubt die sonomorphologische Beurteilung der peripheren Nerven und ihrer Umgebung und ermöglicht dadurch u. a. die Erkennung von Differenzialdiagnosen. Insbesondere bei negativen oder nicht eindeutigen elektroneurografischen Untersuchungsergebnissen kann der Befund des Nervenultraschalls wertvolle Zusatzinformationen geben. Hinzu kommt, dass mittels Nervenultraschall auch Abschnitte des peripheren Nervensystems untersucht werden können, die die neurografische Diagnostik nicht oder nur eingeschränkt erreichen kann, wie etwa die Nervenplexus und Spinalwurzeln. Wenn nach ausführlicher Diagnostik eine Nervenbiopsie zur Klärung der PNP Ursache notwendig wird, kann der hochauflösende Ultraschall bei der Auswahl einer geeigneten Biopsiestelle sehr hilfreich sein und somit die diagnostische Treffsicherheit erhöhen. Die Datenlage zur diagnostischen Wertigkeit des hochauflösenden Nervenultraschalls bei PNP wird stetig besser, wobei auch die Herausforderungen immer klarer werden, die in den nächsten Jahren angegangen und gelöst werden müssen. Die standardisierte Untersuchung großer, prospektiv rekrutierter, sowie klinisch und elektrophysiologisch gut charakterisierter Patientengruppen unter weitest gehender Ausschaltung möglicher konfundierender Einflussfaktoren wird in den kommenden Jahren entscheidend dazu beitragen, den hochauflösenden Nervenultraschall bei der PNP-Diagnostik weiter zu verankern.

Abstract

The diagnosis of polyneuropathies (PNP) is made by a detailed patient history, a thorough neurological examination, and neurophysiological tests. In recent years, high-resolution nerve ultrasonography has increasingly gained importance as an additional diagnostic tool in PNP. This non-invasive technique with so far no known side effects opens a further diagnostic dimension to the clinical and electrophysiological assessment of patients with neuropathies. By visualizing the peripheral nerves and their surrounding structures, nerve sonography enables sonomorphological assessment that facilitates making differential diagnoses. Particularly in cases where neurophysiological tests give negative or ambiguous results, findings with high-resolution nerve sonography may give valuable additional diagnostic hints. Moreover, parts of the peripheral nervous system that can hardly be reached or are not at all reachable by electrophysiological methods such as the plexus or the spinal roots can easily be visualized and assessed using nerve sonography. If, after extensive diagnostics, a nerve biopsy becomes necessary, high-resolution nerve sonography can be very helpful in finding a suitable area for biopsy and thus increase diagnostic accuracy. Data on the diagnostic value of high-resolution nerve sonography in PNP is constantly improving; in parallel, the challenges that need to be addressed and solved in the coming years become clearer. Standardized examination of large, prospectively recruited, and clinically and electrophysiologically well characterized patient groups together with maximum control of potential influencing factors will substantially help to further anchor high-resolution nerve ultrasonography in the diagnostics of PNP.

Schlüsselwörter

hochauflösender Nervenultraschall - Polyneuropathie - Diagnostik - Bildgebung - Differenzialdiagnostik

Keywords

high-resolution nerve ultrasonography - polyneuropathy - diagnostics - imaging technique - differential diagnosis

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