Neuromuscular ultrasound standardized scanning techniques and protocols: Expert panel recommendations

Tawfik EA 1 , Cartwright MS 2 , van Alfen N 3 , Axer H 4 , Boon AJ 5 , Crump N 6 Show all authors , Grimm A 7 , Hobson-Webb LD 8 , Kerasnoudis A 9 , Mandeville R 10 , Preston DC 11 , Sakamuri S 12 , Shahrizaila N 13 , Shin S 14 , Shook SJ 15 , Wilder-Smith E 16 , Walker FO 2

Affiliations 

  • 1 Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
  • 2 Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  • 3 Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
  • 4 Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
  • 5 Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
  • 6 Department of Neurology, Austin Health and University of Melbourne, Heidelberg, Australia
  • 7 Department of Neurology, University Hospital Tuebingen, Tuebingen, Germany
  • 8 Department of Neurology, Neuromuscular Division, Duke University School of Medicine, Durham, North Carolina, USA
  • 9 Department of Neurology, St Josef Hospital, Ruhr University, Bochum, Germany
  • 10 Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  • 11 Neurological Institute, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
  • 12 Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
  • 13 Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 14 Department of Neurology, Mount Sinai School of Medicine, New York, New York, USA
  • 15 Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
  • 16 Department of Neurology, Kantonsspital, Lucerne, Switzerland
Muscle Nerve, 2023 Oct;68(4):375-379.
PMID: 37074101 DOI: 10.1002/mus.27830

Abstract

Neuromuscular ultrasound has become an integral part of the diagnostic workup of neuromuscular disorders at many centers. Despite its growing utility, uniform standard scanning techniques do not currently exist. Scanning approaches for similar diseases vary in the literature creating heterogeneity in the studies as reported in several meta-analysis. Moreover, neuromuscular ultrasound experts including the group in this study have different views with regards to technical aspects, scanning protocols, and the parameters that should be assessed. Establishing standardized neuromuscular scanning protocols is essential for the development of the subspeciality to ensure uniform clinical and research practices. Therefore, we aimed to recommend consensus-based standardized scanning techniques and protocols for common neuromuscular disorders using the Delphi approach. A panel of 17 experts participated in the study, which consisted of three consecutive electronic surveys. The first survey included voting on six scanning protocols addressing the general scanning technique and five common categories of suspected neuromuscular disorders. The subsequent surveys focused on refining the protocols and voting on new steps, rephrased statements, or areas of non-agreement. A high degree of consensus was achieved on the general neuromuscular ultrasound scanning technique and the scanning protocols for focal mononeuropathies, brachial plexopathies, polyneuropathies, amyotophic lateral sclerosis, and muscle diseases. In this study, a group of neuromuscular ultrasound experts developed six consensus-based neuromuscular ultrasound scanning protocols that may serve as references for clinicians and researchers. The standardized protocols could also aid in achieving high-quality uniform neuromuscular ultrasound practices.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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