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A growing body of literature recognises the importance of peripheral nerve ultrasound in neuromuscular disorders. Several attempts have been made to differentiate amyotrophic lateral sclerosis (ALS) from multifocal motor neuropathy (MMN) using peripheral nerve ultrasound. A much-debated question is whether the cross-sectional area (CSA) of peripheral nerve in ALS patients is significantly smaller compared to healthy controls. This study aims to determine the CSA of peripheral nerves in patients with ALS. One hundred and thirty-nine patients with ALS and 75 healthy controls were recruited. Ultrasound of the median, ulnar, and trunks of the brachial plexus and cervical nerve roots was undertaken in ALS patients and controls. Compared to controls, ALS patients had mild reductions of the median nerve, most sites of the ulnar nerve, trunks of the brachial plexus and cervical nerve roots. Another important finding of this study is that the median nerve tends to have a more significant reduction than the ulnar nerve in ALS patients, especially at the proximal. Ultrasound could be sensitive to nerve motor fibre loss in patients with ALS. CSA at the proximal Median nerve may be a promising biomarker in patients with ALS. •Cross-sectional areas (CSA) of peripheral nerve were undertaken in patients with ALS.•Reduction of CSAs was determined at the peripheral nerve in ALS patients compared to healthy controls.•CSA at the proximal Median nerve may be a promising biomarker in patients with ALS.

Nerve growth factor（NGF） plays an important role in promoting neuroregeneration after peripheral nerve injury. However, its effects are limited by its short half-life; it is therefore important to identify an effective mode of administration. High-frequency ultrasound（HFU） is increasingly used in the clinic for high-resolution visualization of tissues, and has been proposed as a method for identifying and evaluating peripheral nerve damage after injury. In addition, HFU is widely used for guiding needle placement when administering drugs to a specific site. We hypothesized that HFU guiding would optimize the neuroprotective effects of NGF on sciatic nerve injury in the rabbit. We performed behavioral, ultrasound, electrophysiological, histological, and immunohistochemical evaluation of HFU-guided NGF injections administered immediately after injury, or 14 days later, and compared this mode of administration with intramuscular NGF injections. Across all assessments, HFU-guided NGF injections gave consistently better outcomes than intramuscular NGF injections administered immediately or 14 days after injury, with immediate treatment also yielding better structural and functional results than when the treatment was delayed by 14 days. Our findings indicate that NGF should be administered as early as possible after peripheral nerve injury, and highlight the striking neuroprotective effects of HFU-guided NGF injections on peripheral nerve injury compared with intramuscular administration.

: Peripheral nerve ultrasound is used to evaluate nerve enlargement in immune-mediated neuropathies; however, assessment can be challenging because the distribution and severity of nerve enlargement vary among patients and are often accompanied by indistinct nerve boundaries and heterogeneous echogenicity. Although deep learning-based segmentation has been reported, most studies have focused on limited regions or single anatomical sites, primarily in compressive neuropathies. This study aimed to evaluate the performance of temporal deep learning-based segmentation for assessing diffuse or focal nerve enlargement in immune-mediated neuropathies using continuous ultrasound scans. : Twenty-five healthy participants and five patients with immune-mediated neuropathy and nerve enlargement were included. Continuous ultrasound scanning from the wrist to below the elbow was performed. A static DeepLabV3+ model and temporal models incorporating convolutional long short-term memory (ConvLSTM) or Temporal Mamba were constructed and compared. : In healthy participants, segmentation performance was comparable across models. In contrast, in patients with nerve enlargement, temporal models demonstrated higher Dice coefficients and reduced frame-to-frame variability. The ConvLSTM-based model showed the highest performance, with mean Dice coefficients ranging from 0.87 to 0.92. : Temporal deep learning showed potential for nerve segmentation in selected cases with nerve enlargement associated with immune-mediated neuropathies. Temporal models achieved improved segmentation performance and reduced frame-to-frame variability in these preliminary cases. This approach may facilitate more consistent quantitative ultrasound evaluation and warrants further validation in larger cohorts.

The common peroneal nerve is one of the most frequent sites of neuropathy around the knee. Owing to its superficial course, it is highly vulnerable to both trauma and mechanical compression. High-frequency ultrasonography enables real-time, dynamic evaluation of the common peroneal nerve along its entire trajectory from the popliteal fossa to the exit from the peroneal tunnel. This article presents a stepwise, structured ultrasound protocol for the assessment of the common peroneal nerve in the peri-knee region. Supported by illustrative images and videos, the protocol is expected to facilitate practical applicability in daily practice and improve diagnostic accuracy. Furthermore, the guiding role of ultrasonography in interventional planning is highlighted.

Background and Objectives: Ultrasound (US) is a non-invasive tool for the in vivo detection of peripheral nerve alterations. Materials and Methods: In this study, we applied nerve US to assist the discrimination between the spectrum of amyotrophic lateral sclerosis (ALS, n = 11), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP, n = 5), and genetically confirmed Charcot–Marie–Tooth disease (CMT, n = 5). All participants and n = 15 controls without neurological diseases underwent high-resolution US of the bilateral tibial nerve. The nerve cross-sectional area (CSA) and nerve microvascular blood flow were compared between the groups and related to cerebrospinal fluid (CSF) measures, clinical symptoms, and nerve conduction studies. The analyses are part of a larger multimodal study on the comparison between US and 7 Tesla (7T) magnetic resonance neurography (MRN). Results: The patients and controls were matched with respect to their demographical data. CMT had the longest disease duration, followed by CIDP and ALS. CSA was related to age, weight, and disease duration. CSA was larger in CMT and CIDP compared to ALS and controls. The blood flow was greatest in CIDP, and higher than in CMT, ALS, and controls. In ALS, greater CSA was correlated with greater CSF total protein and higher albumin quotient. The US measures did not correlate with clinical scores or nerve conduction studies in any of the subgroups. Conclusion: Our results point towards the feasibility of CSA and blood flow to discriminate between ALS, CIDP, and CMT, even in groups of small sample size. In ALS, larger CSA could indicate an inflammatory disease subtype characterized by reduced blood–nerve barrier integrity. Our upcoming analysis will focus on the additive value of 7T MRN in combination with US to disentangle the spectrum between more inflammatory or more degenerative disease variants among the disease groups.

In diabetic patients, controversies still exist about the validity of electrodiagnostic and nerve ultrasound diagnosis for carpal tunnel syndrome (CTS). We analyzed 69 patients with type 2 diabetes. Nerve conduction studies and peripheral nerve ultrasound of the median nerve over the carpal tunnel were performed. CTS symptoms were assessed using the Boston Carpal Tunnel Questionnaire. Polyneuropathy was assessed using the Neuropathy Symptom Score and the Neuropathy Disability Score. Although 19 patients reported predominantly mild CTS symptoms, 37 patients met the electrophysiological diagnosis criteria for CTS, and six patients were classified as severe or extremely severe. The sonographic cross-sectional area (CSA) of the median nerve at the wrist was larger than 12 mm2 in 45 patients (65.2%), and the wrist-to-forearm-ratio was larger than 1.4 in 61 patients (88.4%). Receiver operating characteristic analysis showed that neither the distal motor latency, the median nerve CSA, nor the wrist-to-forearm-ratio could distinguish between patients with and without CTS symptoms. Diagnosis of CTS in diabetic patients should primarily be based upon typical clinical symptoms and signs. Results of electrodiagnostic testing and nerve ultrasound have to be interpreted with caution and additional factors have to be considered especially polyneuropathy, but also body mass index and hyperglycemia.

Objectives: We aimed to compare well-known ultrasound protocols for inflammatory polyneuropathies in a single cohort. Methods: High-resolution ultrasound was performed according to the Bochum ultrasound score (BUS)/neuropathy ultrasound protocol (NUP), ultrasound pattern sum score (UPSS), and EAN/PNS suggested protocol for patients with chronic (CIDP) and acute inflammatory polyneuropathies (AIDP), multifocal motor neuropathies (MMN) and healthy controls. The upper boundaries were adjusted according to our laboratory normative values to all above-mentioned protocols; additionally, another calculation was performed using the peripheral nerve size values officially proposed by EAN/PNS. Results: We enrolled a total of 189 subjects (105 males and 84 females), comprising 40 patients with CIDP, 13 with MMN, 11 with AIDP, and 125 healthy controls. The mean ages were 62.49 years (range 37–84 years) for the CIDP patients; 55.92 years (range 32–71 years) for the MMN patients; 68.09 years (range 51–88 years) for the AIDP patients; and 49.02 years (range 25–80 years) for the healthy controls. Using the EAN/PNS protocol bilaterally, 72.9% of CIDP cases were identified. When the adjusted EAN/PNS protocol was applied, the detection rate rose to 100%, with a sensitivity of 100%. Both the adjusted BUS/NUP and UPSS protocols demonstrated a specificity of 90% in diagnosing CIDP. EAN/PNS protocol detected 69.23% of MMN cases measured unilaterally and had a 100% sensitivity to distinguish MMN, while the UPSS protocol had the highest specificity (96%). In AIDP cases, the adjusted EAN/PNS protocol identified 90.90% of cases through unilateral or bilateral measurements, with sensitivity 91% and specificity 88%. Conclusions: The EAN/PNS protocol was the most valuable in the detection of treatable states, and the BUS/NUP, UPSS protocols were the most valuable in the differentiation of specific inflammatory polyneuropathies.

Objectives: We aimed to provide data of nerve sizes and echogenicity reference values of the Lithuanian population. Methods: High-resolution ultrasound was bilaterally performed according to the Ultrasound Pattern Sum Score and Neuropathy ultrasound protocols for healthy Lithuanian adults. Cross-sectional area (CSA) measurement and echogenicity were used as the main parameters for investigation. Echogenicity was evaluated using ImageJ, and nerves were categorized in classes according to echogenicity. Results: Of 125 subjects enrolled, 63 were males (mean age 47.57 years, range 25–78 years) and 62 were females (mean age 50.50 years, range 25–80 years). Reference values of nerve sizes and values of echogenicity as a fraction of black in percentage of cervical roots, upper and middle trunks of the brachial plexus and the following nerves: vagal, median, ulnar, radial, superficial radial, tibial, fibular, and sural in standard regions were established. Mild to moderate correlations were found between nerves CSA, echogenicity values and anthropometric measurements with the differences according to sex. Inter-rater (ICC 0.93; 95% CI 0.92–0.94) and intra-rater (ICC 0.94; 95% CI 0.93–0.95) reliability was excellent. Conclusions: Reference values of nerve size and echogenicity of Lithuanians were presented for the first time as a novel such kind of publication from the Baltic countries.

Background and Objectives: Diagnostic ultrasound of the vagus nerve has been used to examine different polyneuropathies, and it has been suggested to be useful as a marker of autonomic dysfunction in diabetic patients. Materials and Methods: We analyzed the cross-sectional area (CSA) of the right vagus nerve of 111 patients with type 2 diabetes in comparison to 104 healthy adults and 41 patients with CIDP (chronic inflammatory demyelinating polyneuropathy). In the diabetes group, sympathetic skin response (SSR) was measured as an indicator for autonomic neuropathy. Carotid intima–media thickness (CIMT) was measured as a surrogate for atherosclerosis. Clinical symptoms of polyneuropathy were assessed using the Neuropathy Symptom Score and the Neuropathy Disability Score. Results: In total, 61.3% of the diabetes patients had clinical signs of polyneuropathy; 23.4% had no SSR at the feet as an indicator of autonomic neuropathy. Mean vagus nerve CSA did not differ in patients with and without diabetic polyneuropathy or in diabetic patients with and without SSR at the feet. No significant correlation was found between vagus nerve CSA and CIMT or SSR parameters in diabetic patients. Mean CSA of the right vagus nerve was slightly larger in diabetic patients (p = 0.028) and in patients with CIDP (p = 0.015) than in healthy controls. Conclusions: Effect sizes and mean differences were rather small so that a reliable diagnosis cannot be performed based on the vagus nerve measurement of a single person alone. Vagus nerve CSA seems not suitable as an indicator of autonomic dysfunction or cardiovascular risk in diabetic patients.

The demand for refined anaesthetic protocols in ovine experimental surgery has increased due to ethical considerations and the need to improve perioperative stability. This study evaluated the analgesic efficacy of ultrasound-guided combined sciatic and saphenous nerve blocks using two different local anaesthetics in Hair Canarian Sheep undergoing invasive orthopaedic hindlimb surgery. Fifteen clinically healthy sheep were randomly assigned to one of three groups: lidocaine (2%), bupivacaine (0.5%), or control (general anaesthesia alone). Intraoperative physiological parameters, including heart rate, respiratory rate, and arterial blood pressure, were recorded, and postoperative pain was assessed using a modified Melbourne Pain Scale. Sheep receiving locoregional anaesthesia showed significantly lower postoperative pain scores compared with control animals. Intraoperatively, a significant difference between groups was observed only for respiratory rate, with lower values in the bupivacaine group. The bupivacaine group exhibited lower and more stable respiratory rates, with a trend towards lower heart rates during surgery, as well as consistently lower pain scores during the early postoperative period. Lidocaine provided limited intraoperative and postoperative effects compared with the control group. Respiratory rate appeared to be more closely associated with pain scores than other physiological parameters. In conclusion, ultrasound-guided sciatic and saphenous nerve blocks were associated with improved perioperative analgesia in sheep undergoing orthopaedic surgery. The use of bupivacaine was associated with lower respiratory rates intraoperatively and reduced postoperative pain scores, suggesting a potential benefit in perioperative analgesia.