Differential diagnosis of neuromuscular diseases (ND) using ultrasonography

Aims: To use ultrasound has become a well established practice. However, the value of this method is a matter of dispute. The results presented below are to show what can currently be achieved by this gentle diagnostic procedure.

Methods: Patient muscles were scanned transversally at midarm and midthigh while supine as well as midcalf while prone. Direct comparison to healthy controls of identical age, sex and constitution has been employed for identification. A high- end equipment, 7–15MHz tranducers and strictly constant physical parameters have been used. The results have been stored both digitally and by S-VHS videotape. A total of 1150 suspected or confirmed patients (age 2 days to 84 y.) including 26 different ND have been prospectively examined together with 350 controls.

Results: Typical texture abnormalities of the skeletal muscle pathology has been successfully evaluated and differentiated into following categories: Duchenne-, Becker- limbgirdle-, facioscapulohumeral, congenital and myotonic dystrophies, further rare disorders like congenital structurs anomalies, metabolic myopathies and spinal muscular atrophies as well as inflammatory diseases. Dys- and atrophic lesions can be clearly distinguished.

Conclusion: In our hands sceletal muscle ultrasound was able to differentiate 26 different disease entities due to typical texture profiles. In addition it is highly relevant to evaluate the pattern of affection and to assess the progression to permit differential diagnosis of ND. Furthermore, to optimize histological diagnosis muscle biopsy should be guided by ultrasound navigation.