Intra- and Inter-Observer Variability in Sonographic Measurement of the Cervical Nerve Roots of Healthy Volunteers

Year 2021, Volume: 3 Issue: 1, 10 - 15, 23.01.2021

Enes Gürün , İsmail Akdulum

https://doi.org/10.37990/medr.847549

Abstract

Aim: The aim of our study is to determine the normal values of mean cervical (C) nerve root diameter in millimeters (mm) in healthy volunteers and to show its relationship to age, gender, height, weight, body mass index (BMI), and the dominant hand.
Material and Method: Two observers measured the mean nerve root diameter of the bilateral C5, C6, and C7 nerve of all volunteers. Before the procedure, the age, sex, height, weight, BMI, and the dominant hand of all the participants were noted. Two measurements were taken by each of the two observers without one knowing about the other’s noted values. The intraclass correlation coefficient (ICC) test was used to analyze intra-and inter-observer reliability.
Results: There was no statistically significant relationship between gender and dominant hand, and mean nerve root diameter. Moreover, when we compared the mean nerve root diameter for the nerves in the right and left sides of each participant, no significant statistical differences were identified. The mean diameter of the C6 nerve root was higher than that of C7, which was higher than that of C5 on both sides (p < 0.001). The ICC values for intra- and inter-observer were good or excellent for all diameter measurements (ICC > 0.8).
Conclusions: The normal range of cervical nerve root diameters should be determined to distinguish pathological conditions. In our study, the measurement of mean nerve root diameters of C5, C6, and C7 nerves is highly reproducible with excellent intra-observer and inter-observer agreement. Therefore, the measurement of nerve root diameter can be confidently performed in daily clinical practice.

Keywords

Brachial plexus, , cervical nerve root, , ultrasonography, , diameters, , healthy volunteers

References

• 1. Orebaugh SL, Williams BA. Brachial plexus anatomy: normal and variant. ScientificWorldJournal. 2009;9:300-12.
• 2. Leinberry CF, Wehbe MA. Brachial plexus anatomy. Hand Clin. 2004;20(1):1-5.
• 3. Apan A, Baydar S, Yilmaz S, Uz A, Tekdemir I, Guney S, et al. Surface landmarks of brachial plexus: ultrasound and magnetic resonance imaging for supraclavicular approach with anatomical correlation. Eur J Ultrasound. 2001;13(3):191-6.
• 4. Yang WT, Chui PT, Metreweli C. Anatomy of the normal brachial plexus revealed by sonography and the role of sonographic guidance in anesthesia of the brachial plexus. AJR Am J Roentgenol. 1998;171(6):1631-6.
• 5. Orman G, Ozben S, Huseyinoglu N, Duymus M, Orman KG. Ultrasound elastographic evaluation in the diagnosis of carpal tunnel syndrome: initial findings. Ultrasound Med Biol. 2013;39(7):1184-9.
• 6. Lapegue F, Faruch-Bilfeld M, Demondion X, Apredoaei C, Bayol MA, Artico H, et al. Ultrasonography of the brachial plexus, normal appearance and practical applications. Diagn Interv Imaging. 2014;95(3):259-75.
• 7. Vargas MI, Viallon M, Nguyen D, Beaulieu JY, Delavelle J, Becker M. New approaches in imaging of the brachial plexus. Eur J Radiol. 2010;74(2):403-10.
• 8. Khadilkar SV, Khade SS. Brachial plexopathy. Ann Indian Acad Neurol. 2013;16(1):12-8.
• 9. Caldana WCI, Kodaira SK, Cavalcanti CFA, Rodrigues MB, Saito OC, Buchpiguel CA. Value of ultrasound in the anatomical evaluation of the brachial plexus: correlation with magnetic resonance imaging. Radiol Bras. 2018;51(6):358-65.
• 10. Zaidman CM, Seelig MJ, Baker JC, Mackinnon SE, Pestronk A. Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology. 2013;80(18):1634-40.
• 11. Pham M, Baumer T, Bendszus M. Peripheral nerves and plexus: imaging by MR-neurography and high-resolution ultrasound. Curr Opin Neurol. 2014;27(4):370-9.
• 12. Goedee HS, Jongbloed BA, van Asseldonk JH, Hendrikse J, Vrancken A, Franssen H, et al. A comparative study of brachial plexus sonography and magnetic resonance imaging in chronic inflammatory demyelinating neuropathy and multifocal motor neuropathy. Eur J Neurol. 2017;24(10):1307-13.
• 13. Sugimoto T, Ochi K, Hosomi N, Mukai T, Ueno H, Takahashi T, et al. Ultrasonographic reference sizes of the median and ulnar nerves and the cervical nerve roots in healthy Japanese adults. Ultrasound Med Biol. 2013;39(9):1560-70.
• 14. Drake-Perez M, Pelayo-Negro AL, Sanchez-de la Torre JR, Berciano J, Gallardo E. Ultrasonography of cervical nerve roots: cross-sectional reference values according to age. Neurol Sci. 2020:1-9.
• 15. Nodera H, Takamatsu N, Shimatani Y, Mori A, Sato K, Oda M, et al. Thinning of cervical nerve roots and peripheral nerves in ALS as measured by sonography. Clinical Neurophysiology. 2014;125(9):1906-11.
• 16. Boehm J, Scheidl E, Bereczki D, Schelle T, Aranyi Z. High-resolution ultrasonography of peripheral nerves: measurements on 14 nerve segments in 56 healthy subjects and reliability assessments. Ultraschall Med. 2014;35(5):459-67.
• 17. Takeuchi M, Wakao N, Kamiya M, Osuka K, Matsuo N, Terasawa T, et al. Morphological distinction of cervical nerve roots associated with motor function in 219 healthy volunteers: a multicenter prospective study. Spine (Phila Pa 1976). 2014;39(16):E944-9.
• 18. Matsuoka N, Kohriyama T, Ochi K, Nishitani M, Sueda Y, Mimori Y, et al. Detection of cervical nerve root hypertrophy by ultrasonography in chronic inflammatory demyelinating polyradiculoneuropathy. J Neurol Sci. 2004;219(1-2):15-21.