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Diagnostic ultrasound in neuromuscular disease

Author
Francis O Walker, MD
Section Editor
Jeremy M Shefner, MD, PhD
Deputy Editor
John F Dashe, MD, PhD

INTRODUCTION

Diagnostic studies for suspected neuromuscular diseases have commonly included blood tests, nerve conduction studies, electromyography, and biopsy. Imaging has been limited to intraoperative observations and occasional MRI and CT scans. However, high resolution ultrasound has opened up this field to clinicians, and modestly priced portable instruments are now routinely available that can provide qualitative and quantitative details about nerve and muscle disease.

This topic will review the use of ultrasound for the evaluation of neuromuscular disease. Electrodiagnostic methods for neuromuscular disease are discussed separately. (See "Overview of electromyography" and "Overview of nerve conduction studies".)

TECHNICAL AND HISTORICAL CONSIDERATIONS

Since its first use in the 1950s for medical practice, ultrasound has evolved into a sophisticated imaging modality employed by specialists to diagnose a broad range of clinical disorders. Early instruments depended on single linear echo latencies to measure fetal head width or midline shift in adults with suspected intracranial mass lesions. Current technology, however, provides real-time two-dimensional images that can be reconstructed into three dimensions (3D) and their change over time (4D) [1]. With the advent of inexpensive, portable units of sufficiently high resolution, the use of ultrasound in the evaluation of muscle and nerve disease is becoming commonplace.

The physics of ultrasound is briefly reviewed here as it is pertinent to the study of muscle and nerve and is discussed in greater detail elsewhere. (See "Echocardiography essentials: Physics and instrumentation" and "Basic principles and safety of diagnostic ultrasound in obstetrics and gynecology".)

The fundamental technique of ultrasound involves the insonation of tissue and analysis of the echoes reflected back to the insonating transducer. Reflected ultrasound occurs at interfaces within or between tissues of different acoustic impedance, a measure directly proportional to the speed at which sound travels through them. Bone conducts sound much faster than soft tissue; soft tissue slightly faster than water, but much faster than air. As such, the brightest echoes in the body are seen between bone and soft tissue. The use of coupling gel between skin and transducer minimizes the reflection that would otherwise occur between skin and air.

            

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Literature review current through: Nov 2016. | This topic last updated: Wed Nov 04 00:00:00 GMT+00:00 2015.
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