General discussion 139 8 Figure 8.1 Proposal of revision of diagnostic criteria for CIDP Clinical suspicion of CIDP Ultrasound available? Perform ultrasound1 Perform NCS3 Yes No No other diagnosis based on additional laboratory findings2 Start of treatment Definite CIDP Perform NCS3 tDefinite, probable or possible Inconclusive Definite CIDP Monitor disease course Definite Definite CIDP Probable Possible Inconclusive Probable CIDP ≥ 2 supportive criteria4 Possible CIDP Perform MRI of brachial plexus5 Start of treatment Definite CIDP Monitor disease course tConsider alternative diagnosis ≥ 1 supportive criterion4 T+ t+ TT+ Tt+ ≥ 1 supportive criterion4 No other diagnosis based on additional laboratory findings2 This flow chart summarizes results from recent diagnostic nerve ultrasound and MRI studies on diagnosis of CIDP and integrates them in the current diagnostic criteria of the EFNS/PNS.19 In the blue rectangle the position of MRI of the brachial plexus based on our study in chapter 4 of this thesis. 1 Examination of the median nerve in the forearms (> 10 mm2), upper arms (> 13 mm2) and C5 nerve root (> 8 mm2). Abnormal when ≥ 1 measurement site is enlarged. 2 Additional laboratory examination consists of determination of protein in cerebrospinal fluid and exclusion of other (metabolic) causes of neuropathy (e.g. diabetes, hypothyroidism, liver or renal insufficiency, vitamin deficiencies). 3 Results of NCS should be interpreted according to the electrodiagnostic criteria of the EFNS/PNS guideline.19 4 Supportive criteria of CIDP can be found in Table 8.1. MRI should be quantitatively assessed. 5 Results of MRI examination should be quantitatively assessed and interpreted using the risk chart in chapter 4, Figure 4.3. Abbreviations: CIDP = chronic inflammatory demyelinating polyneuropathy; NCS = nerve conduction studies; MRI = magnetic resonance imaging; T+ = positive result of test; T- = negative result of test; t+ = good treatment response; t- = no treatment response.
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