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神经肌肉病的超声诊断

Author
Francis O Walker, MD
Section Editor
Jeremy M Shefner, MD, PhD
Deputy Editor
John F Dashe, MD, PhD
Translators
崔立刚, 主任医师,教授

引言

对于疑似神经肌肉病的患者，常用的诊断性检查方法包括血液检测、神经传导检查、肌电图(electromyography, EMG)和组织活检。对于神经肌肉疾病，影像学检查限于术中观察，并限于偶尔使用磁共振成像(magnetic resonance imaging, MRI)和计算机断层扫描(computerized tomography, CT)。然而，高分辨率超声已为临床医生打开了这一领域，并且能够提供神经和肌肉疾病的定量和定性细节的便携廉价装置目前也已能常规获取。

本专题将总结超声用于评估神经肌肉疾病。神经肌肉疾病的电诊断检查方法将单独讨论。 (参见“肌电图的概述”和“神经传导检查概述”)

技术和历史考虑

自20世纪50年代首次用于医学实践以来，超声检查已经发展成为了一种先进的成像方法，被临床专家用于诊断各种各样的临床疾病。早期的超声设备根据的是单线性回声的延迟时间来测量胎儿的头部宽度，或是在疑似颅内占位性病变的患者中测量中线位移。然而，当今的超声技术可提供实时的二维图像，并能提供二维图像重建而成的三维图像(3D)，以及三维图像随着时间的改变(4D)[1]。随着价格低廉且有充分高分辨率的便携式超声设备的出现，利用超声来评估肌肉和神经病变正变得越来越普遍。

由于超声的物理学与肌肉和神经的检查相关，故本专题将对其进行简要总结，并将在别处对其进行更详细地讨论。 (参见“超声心动图基础：物理原理与仪器设备”和“妇产科诊断性超声的基本原则和安全性”)

超声成像的基本技术涉及到探头向组织发出超声波，并对反射回超声换能器的回声进行分析。反射的超声发生于具有不同声学阻抗的组织内或组织之间的交界面，而声学阻抗则与声波经组织传播的速度直接成比例。声波在骨骼内的传播速度远远快于软组织；而软组织则稍快于水，但远快于空气。因此，体内最明亮的回声图像见于骨骼和软组织之间。在皮肤与换能器之间使用耦合剂可最大程度减少皮肤与空气之间发生的反射。

            

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-26.
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References
Top
  1. Tonni G, Centini G, Rosignoli L. Prenatal screening for fetal face and clefting in a prospective study on low-risk population: can 3- and 4-dimensional ultrasound enhance visualization and detection rate? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100:420.
  2. Crass JR, van de Vegte GL, Harkavy LA. Tendon echogenicity: ex vivo study. Radiology 1988; 167:499.
  3. Campbell SE, Adler R, Sofka CM. Ultrasound of muscle abnormalities. Ultrasound Q 2005; 21:87.
  4. Lee JC, Healy J. Sonography of lower limb muscle injury. AJR Am J Roentgenol 2004; 182:341.
  5. Walker FO. Neuromuscular ultrasound. Neurol Clin 2004; 22:563.
  6. Walker FO, Donofrio PD, Harpold GJ, Ferrell WG. Sonographic imaging of muscle contraction and fasciculations: a correlation with electromyography. Muscle Nerve 1990; 13:33.
  7. Ward SR, Lieber RL. Density and hydration of fresh and fixed human skeletal muscle. J Biomech 2005; 38:2317.
  8. Hodges PW, Pengel LH, Herbert RD, Gandevia SC. Measurement of muscle contraction with ultrasound imaging. Muscle Nerve 2003; 27:682.
  9. Zaidman CM. Ultrasound of muscular dystrophies, myopathies, and muscle pathology. In: Neuromuscular Ultrasound, 1st ed., Walker FO, Cartwright MS. (Eds), Elsevier, Philadelphia 2011. p.131.
  10. Arts IM, Pillen S, Schelhaas HJ, et al. Normal values for quantitative muscle ultrasonography in adults. Muscle Nerve 2010; 41:32.
  11. Schwennicke A, Bargfrede M, Reimers CD. Clinical, electromyographic, and ultrasonographic assessment of focal neuropathies. J Neuroimaging 1998; 8:136.
  12. Reimers CD, Finkenstaedt M. Muscle imaging in inflammatory myopathies. Curr Opin Rheumatol 1997; 9:475.
  13. Reimers CD, Schlotter B, Eicke BM, Witt TN. Calf enlargement in neuromuscular diseases: a quantitative ultrasound study in 350 patients and review of the literature. J Neurol Sci 1996; 143:46.
  14. Gunreben G, Bogdahn U. Real-time sonography of acute and chronic muscle denervation. Muscle Nerve 1991; 14:654.
  15. Küllmer K, Sievers KW, Reimers CD, et al. Changes of sonographic, magnetic resonance tomographic, electromyographic, and histopathologic findings within a 2-month period of examinations after experimental muscle denervation. Arch Orthop Trauma Surg 1998; 117:228.
  16. Zaidman CM, Connolly AM, Malkus EC, et al. Quantitative ultrasound using backscatter analysis in Duchenne and Becker muscular dystrophy. Neuromuscul Disord 2010; 20:805.
  17. Pillen S, Arts IM, Zwarts MJ. Muscle ultrasound in neuromuscular disorders. Muscle Nerve 2008; 37:679.
  18. Pillen S, Verrips A, van Alfen N, et al. Quantitative skeletal muscle ultrasound: diagnostic value in childhood neuromuscular disease. Neuromuscul Disord 2007; 17:509.
  19. Aydinli N, Baslo B, Calişkan M, et al. Muscle ultrasonography and electromyography correlation for evaluation of floppy infants. Brain Dev 2003; 25:22.
  20. van den Engel-Hoek L, Erasmus CE, Hendriks JC, et al. Oral muscles are progressively affected in Duchenne muscular dystrophy: implications for dysphagia treatment. J Neurol 2013; 260:1295.
  21. Tieleman AA, Vinke A, van Alfen N, et al. Skeletal muscle involvement in myotonic dystrophy type 2. A comparative muscle ultrasound study. Neuromuscul Disord 2012; 22:492.
  22. Arts IM, Overeem S, Pillen S, et al. Muscle ultrasonography to predict survival in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2011; 82:552.
  23. Reimers CD, Fleckenstein JL, Witt TN, et al. Muscular ultrasound in idiopathic inflammatory myopathies of adults. J Neurol Sci 1993; 116:82.
  24. Hamjian JA, Walker FO. Serial neurophysiological studies of intramuscular botulinum-A toxin in humans. Muscle Nerve 1994; 17:1385.
  25. Caress JB, Walker FO. The spectrum of ectopic motor nerve behavior: from fasciculations to neuromyotonia. Neurologist 2002; 8:41.
  26. Misawa S, Noto Y, Shibuya K, et al. Ultrasonographic detection of fasciculations markedly increases diagnostic sensitivity of ALS. Neurology 2011; 77:1532.
  27. Hobson-Webb LD. Neuromuscular ultrasound in polyneuropathies and motor neuron disease. Muscle Nerve 2013; 47:790.
  28. van Alfen N, Nienhuis M, Zwarts MJ, Pillen S. Detection of fibrillations using muscle ultrasound: diagnostic accuracy and identification of pitfalls. Muscle Nerve 2011; 43:178.
  29. van Baalen A, Stephani U. Fibration, fibrillation, and fasciculation: say what you see. Clin Neurophysiol 2007; 118:1418.
  30. Demondion X, Herbinet P, Boutry N, et al. Sonographic mapping of the normal brachial plexus. AJNR Am J Neuroradiol 2003; 24:1303.
  31. Walker FO, Cartwright MS, Wiesler ER, Caress J. Ultrasound of nerve and muscle. Clin Neurophysiol 2004; 115:495.
  32. Silvestri E, Martinoli C, Derchi LE, et al. Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Radiology 1995; 197:291.
  33. Brown BS. How safe is diagnostic ultrasonography? Can Med Assoc J 1984; 131:307.
  34. Hough AD, Moore AP, Jones MP. Peripheral nerve motion measurement with spectral Doppler sonography: a reliability study. J Hand Surg Br 2000; 25:585.
  35. Zaidman CM, Al-Lozi M, Pestronk A. Peripheral nerve size in normals and patients with polyneuropathy: an ultrasound study. Muscle Nerve 2009; 40:960.
  36. Cartwright MS, Walker FO. Neuromuscular ultrasound in common entrapment neuropathies. Muscle Nerve 2013; 48:696.
  37. Suk JI, Sigur CM, Walker FO. Superficial fibular neuropathy: complementary role of ultrasound. Muscle Nerve 2013; 47:778.
  38. Mohammadi A, Ghasemi-Rad M, Mladkova-Suchy N, Ansari S. Correlation between the severity of carpal tunnel syndrome and color Doppler sonography findings. AJR Am J Roentgenol 2012; 198:W181.
  39. Zaidman CM, Seelig MJ, Baker JC, et al. Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology 2013; 80:1634.
  40. Padua L, Aprile I, Pazzaglia C, et al. Contribution of ultrasound in a neurophysiological lab in diagnosing nerve impairment: A one-year systematic assessment. Clin Neurophysiol 2007; 118:1410.
  41. Padua L, Di Pasquale A, Liotta G, et al. Ultrasound as a useful tool in the diagnosis and management of traumatic nerve lesions. Clin Neurophysiol 2013; 124:1237.
  42. Lee CH, Kim TK, Yoon ES, Dhong ES. Correlation of high-resolution ultrasonographic findings with the clinical symptoms and electrodiagnostic data in carpal tunnel syndrome. Ann Plast Surg 2005; 54:20.
  43. Wong SM, Griffith JF, Hui AC, et al. Carpal tunnel syndrome: diagnostic usefulness of sonography. Radiology 2004; 232:93.
  44. Kele H, Verheggen R, Bittermann HJ, Reimers CD. The potential value of ultrasonography in the evaluation of carpal tunnel syndrome. Neurology 2003; 61:389.
  45. Beekman R, Visser LH. Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature. Muscle Nerve 2003; 27:26.
  46. Nakamichi KI, Tachibana S. Enlarged median nerve in idiopathic carpal tunnel syndrome. Muscle Nerve 2000; 23:1713.
  47. Cartwright MS, White DL, Demar S, et al. Median nerve changes following steroid injection for carpal tunnel syndrome. Muscle Nerve 2011; 44:25.
  48. Abicalaf CA, de Barros N, Sernik RA, et al. Ultrasound evaluation of patients with carpal tunnel syndrome before and after endoscopic release of the transverse carpal ligament. Clin Radiol 2007; 62:891.
  49. Lee CH, Kim TK, Yoon ES, Dhong ES. Postoperative morphologic analysis of carpal tunnel syndrome using high-resolution ultrasonography. Ann Plast Surg 2005; 54:143.
  50. Ochoa J, Fowler TJ, Gilliatt RW. Anatomical changes in peripheral nerves compressed by a pneumatic tourniquet. J Anat 1972; 113:433.
  51. Ochoa J, Danta G, Fowler TJ, Gilliatt RW. Nature of the nerve lesion caused by a pneumatic tourniquet. Nature 1971; 233:265.
  52. Lundborg G, Myers R, Powell H. Nerve compression injury and increased endoneurial fluid pressure: a "miniature compartment syndrome". J Neurol Neurosurg Psychiatry 1983; 46:1119.
  53. Mackinnon SE, Dellon AL, Hudson AR, Hunter DA. Chronic human nerve compression--a histological assessment. Neuropathol Appl Neurobiol 1986; 12:547.
  54. Dellon AL, Mackinnon SE. Human ulnar neuropathy at the elbow: clinical, electrical, and morphometric correlations. J Reconstr Microsurg 1988; 4:179.
  55. Aziz W, Firrell JC, Ogden L, Breidenbach WC. Blood flow in a chronic entrapment neuropathy model in the rabbit sciatic nerve. J Reconstr Microsurg 1999; 15:47.
  56. El-Karabaty H, Hetzel A, Galla TJ, et al. The effect of carpal tunnel release on median nerve flattening and nerve conduction. Electromyogr Clin Neurophysiol 2005; 45:223.
  57. Erel E, Dilley A, Greening J, et al. Longitudinal sliding of the median nerve in patients with carpal tunnel syndrome. J Hand Surg Br 2003; 28:439.
  58. Beekman R, Wokke JH, Schoemaker MC, et al. Ulnar neuropathy at the elbow: follow-up and prognostic factors determining outcome. Neurology 2004; 63:1675.
  59. Beekman R, Van Der Plas JP, Uitdehaag BM, et al. Clinical, electrodiagnostic, and sonographic studies in ulnar neuropathy at the elbow. Muscle Nerve 2004; 30:202.
  60. Park GY, Kim JM, Lee SM. The ultrasonographic and electrodiagnostic findings of ulnar neuropathy at the elbow. Arch Phys Med Rehabil 2004; 85:1000.
  61. Caress JB, Becker CE, Cartwright MS, Walker FO. Ultrasound in the diagnosis of ulnar neuropathy at the elbow. J Clin Neuromuscul Dis 2003; 4:161.
  62. Peer S, Harpf C, Willeit J, et al. Sonographic evaluation of primary peripheral nerve repair. J Ultrasound Med 2003; 22:1317.
  63. Bodner G, Harpf C, Gardetto A, et al. Ultrasonography of the accessory nerve: normal and pathologic findings in cadavers and patients with iatrogenic accessory nerve palsy. J Ultrasound Med 2002; 21:1159.
  64. Bodner G, Buchberger W, Schocke M, et al. Radial nerve palsy associated with humeral shaft fracture: evaluation with US--initial experience. Radiology 2001; 219:811.
  65. Hobson-Webb LD, Walker FO. Traumatic neuroma diagnosed by ultrasonography. Arch Neurol 2004; 61:1322.
  66. Kuo YL, Yao WJ, Chiu HY. Role of sonography in the preoperative assessment of neurilemmoma. J Clin Ultrasound 2005; 33:87.
  67. Pedrazzini M, Pogliacomi F, Cusmano F, et al. Bilateral ganglion cyst of the common peroneal nerve. Eur Radiol 2002; 12:2803.
  68. Boedeker CC, Ridder GJ, Schipper J. Paragangliomas of the head and neck: diagnosis and treatment. Fam Cancer 2005; 4:55.
  69. Young NP, Sorenson EJ, Spinner RJ, Daube JR. Clinical and electrodiagnostic correlates of peroneal intraneural ganglia. Neurology 2009; 72:447.
  70. Vijayan J, Chan YC, Therimadasamy A, Wilder-Smith EP. Role of combined B-mode and Doppler sonography in evaluating neurolymphomatosis. Neurology 2015; 85:752.
  71. Heinemeyer O, Reimers CD. Ultrasound of radial, ulnar, median, and sciatic nerves in healthy subjects and patients with hereditary motor and sensory neuropathies. Ultrasound Med Biol 1999; 25:481.
  72. Matsuoka N, Kohriyama T, Ochi K, et al. Detection of cervical nerve root hypertrophy by ultrasonography in chronic inflammatory demyelinating polyradiculoneuropathy. J Neurol Sci 2004; 219:15.
  73. Taniguchi N, Itoh K, Wang Y, et al. Sonographic detection of diffuse peripheral nerve hypertrophy in chronic inflammatory demyelinating polyradiculoneuropathy. J Clin Ultrasound 2000; 28:488.
  74. Beekman R, van den Berg LH, Franssen H, et al. Ultrasonography shows extensive nerve enlargements in multifocal motor neuropathy. Neurology 2005; 65:305.
  75. Cartwright MS, Walker FO, Griffin LP, Caress JB. Peripheral nerve and muscle ultrasound in amyotrophic lateral sclerosis. Muscle Nerve 2011; 44:346.