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Peripheral Nerve Cross-Sectional Area in Healthy Thai Children: Reference Values for Clinical Neuromuscular
Tanitnun Paprad1,2, Jakkrit Amornvit3,4, Chernkhuan Stonsaovapak5
1Division of Neurology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Insights
This study establishes normative nerve cross-sectional area (CSA) values for healthy Thai children, crucial for diagnosing pediatric peripheral neuropathies. These reference values correlate with anthropometric data and aid clinical decisions.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Clinical Electrophysiology
Background:
- Nerve cross-sectional area (CSA) ultrasonography aids peripheral neuropathy diagnosis.
- Limited normative CSA reference values exist for children, especially in Southeast Asia.
Purpose of the Study:
- To establish normative nerve CSA reference values in healthy Thai children.
- To investigate correlations between nerve CSA and anthropometric factors.
- To assess the reliability of CSA measurements in pediatric populations.
Main Methods:
- 164 healthy Thai children (1-18 years) underwent ultrasonographic nerve CSA measurements.
- CSA was assessed in 10 peripheral nerves and 3 cervical roots (C5-C7) across 34 sites.
- Correlations with weight, height, age, and reliability were analyzed.
Main Results:
- Normative CSA values were established for all measured nerves and sites.
- Nerve CSA showed moderate-to-strong correlations with age, weight, and height (r=0.36-0.78).
- Tibial, sciatic, and median nerves exhibited the strongest correlations; intra/interobserver reliability was good-to-excellent.
Conclusions:
- Nerve CSA in Thai children is influenced by age, weight, height, and anatomical location.
- These normative values provide a crucial reference for pediatric neurophysiological practice.
- The findings support the use of nerve CSA ultrasonography for diagnosing pediatric peripheral neuropathies.
Introduction:
Ultrasonography of the nerve cross-sectional area (CSA) is increasingly used to support the diagnosis of peripheral neuropathies. However, normative CSA reference values in children, particularly in Southeast Asian populations, are limited.
Methods:
Ultrasonographic nerve CSA measurements were conducted in 164 healthy Thai children aged 1 to 18 years at King Chulalongkorn Memorial Hospital, Thailand. Participants were classified into six age groups. CSA was measured in 10 peripheral nerves at 34 anatomical sites and bilateral cervical roots (C5-C7), and the median CSAs were calculated. Correlations between CSA and body weight, height, and age were calculated using Spearman and Pearson correlation coefficients. Intraobserver and interobserver reliability were evaluated in a subset of participants using intraclass correlation coefficients.
Results:
Normative CSA values were established for all examined nerves and sites. Most nerves demonstrated proximal-to-distal tapering in CSA, with the median nerve exhibiting a unique pattern of larger CSA at the wrist and mid-upper arm. C7 root was the largest cervical root measured (median CSA up to 7.0 mm 2 in older adolescents). CSA demonstrated moderate-to-strong correlations with anthropometric variables, including weight, height, and age ( r = 0.36-0.78). The tibial, sciatic, and median nerves showed the strongest correlations (all P < 0.001). Intraobserver and interobserver reliability were good-to-excellent across the selected nerves.
Conclusions:
Nerve CSA is influenced by age, weight, height, and location in this Southeast Asian population. These normative reference values may serve as a reference for distinguishing normal from pathological findings and aid clinical decision making in pediatric neurophysiological practice.
