There are no current biomarkers in CIDP, with diagnosis and treatment monitoring largely based on clinical parameters. High frequency ultrasound of peripheral nerves can reflect pathophysiological changes in CIDP, as well as changes with treatment, in a quick, non-invasive, and painless manner. This project aims to further the identification of useful diagnostic, prognostic and treatment-related biomarkers utilizing parameters found on neuromuscular ultrasound (NMUS).

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We conducted a standardized clinical and ultrasonographic assessment of patients with CIDP at both Wake Forest Baptist Medical Center, NC (October to November 2017) and Austin Health, Melbourne, Australia (July 2018 to current). Our protocol focused on bilateral whole length assessment of the median and ulnar nerves, with unilateral assessment of radial, tibial, fibular and sural nerves. Correlation of clinical (disease duration, current clinical state, treatment history), electrodiagnostic (from most recent test) and ultrasound findings (in particular nerve size as measured by cross sectional area) was undertaken. 25 patients were studied at WFBMC neurodiagnostic laboratory, with data collection continuing at Austin Health.

Of the 25 patients studied at WFBMC, all had abnormalities on ultrasound (as determined by focal nerve enlargement determined by increased cross sectional area), with 23 of 25 subjects having >=4 enlarged segments. All patients had at least one abnormality in either median or ulnar nerve, with no additional diagnostic information from other nerves tested. We analyzed our data in line with previously published diagnostic scores and protocols, and these findings will also be presented and discussed for typical vs atypical CIDP subtypes, as well correlation with clinical findings. Early data from the Australian cohort studied will also be presented.

This cross-sectional study of NMUS in patients with CIDP suggests assessment of bilateral median and ulnar nerves from wrist to axilla may be adequate in providing diagnostic information.