Stellenwert der hochauflösenden Sonografie bei der Diagnostik peripherer Nervenerkrankungen

Zusammenfassung

Der hochauflösende Ultraschall (HRUS) ermöglicht den Nachweis struktureller Veränderungen der peripheren Nerven bei einer Reihe von pathologischen Prozessen und erhöht als komplementäre Methode zur Elektrophysiologie die diagnostische Treffsicherheit. Bei Nervenkompressionssyndromen kann neben der Kompressionsstelle die genaue Ursache der Kompression identifiziert werden. Darüber hinaus gelingt die Darstellung operationsrelevanter anatomischer Varianten. Außerdem lässt sich in der Mehrzahl der Fälle die Ätiologie eines postoperativen Rezidivs ermitteln. Hochgradige Nervenverletzungen, die immer einer chirurgischen Therapie bedürfen, können mit dem HRUS sehr frühzeitig erkannt werden. Außerdem ermöglicht die Sonografie eine genaue Aussage über Lokalisation, Ausmaß und Ursache einer traumatischen Nervenläsion. Auch benigne und maligne periphere Nervenscheidentumore sowie andere Raumforderungen mesenchymalen Ursprungs im Nerven sind mittels HRUS mit einer hohen Sensitivität nachweisbar. Die Rolle bei der Diagnostik von Polyneuropathien ist bisher nicht ausreichend evaluiert. Ultraschallgestützte Nervenblockaden erhöhen die Trefferquote und helfen gleichzeitig Komplikationen (z. B. ungewollte Gefäßpunktionen) zu vermeiden.

Abstract

High-resolution ultrasound (HRUS) is a new tool in the diagnosis of disorders of the peripheral nerves that allows the detection of structural changes in the majority of the cases hence increasing the diagnostic accuracy and provides important additional information to electro­diagnostic testing, clinical exam and anamnesis survey. In nerve compression syndromes HRUS can show the exact site of the compression and it’s precise aetiology. Moreover different anatomic variations that may influence the surgical procedure and causes of surgery failure are also detectable. In case of a severe traumatic nerve lesion, that always requires surgical repair, HRUS enables an accurate diagnosis at an early stage. Furthermore, HRUS provides exact information about site, extent und aetiology of a nerve injury. In addition, HRUS helps to diagnose benign and malignant tumours of the peripheral nerve sheath and other mesenchymal space occupying lesions within a peripheral nerve with a high sensitivity. It’s role in the diagnosis of polyneuropathies has not been sufficiently evaluated yet. Ultrasound-guided peripheral nerve blocks may help to reduce the number of complications (e. g., risk for incidental vascular punctures) and the incidence of block failure.

Schlüsselwörter

hochauflösender Ultraschall - Nervenkompressions­syndrom - traumatische Nervenläsion - Nervenscheidentumore - ultraschallgestützte ­Nervenblockaden

Keywords

high-resolution ultrasound - nerve compression ­syndrome - traumatic nerve injury - tumour of the peripheral nerve sheath - ultrasound-guided nerve blocks

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