Role of combined B-mode and Doppler sonography in evaluating neurolymphomatosis

Objective: To highlight the potential usefulness of nerve ultrasonography to identify lymphomatous peripheral nerve infiltration in patients with lymphoma. Methods: We performed electrodiagnostic studies and nerve ultrasonography in 3 patients with lymphoma presenting with focal peripheral neuropathy. Results: In all 3 patients, electrodiagnostic studies proved focal involvement of the peripheral nerves. Ultrasonography showed nerve thickening at sites of electrodiagnostic abnormality. All enlarged nerves showed increased blood flow within the area of nerve thickening. Abnormal sonographic studies prompted focused imaging and histologic studies, which confirmed the diagnosis of neurolymphomatosis. Conclusions: Nerve ultrasonography should be considered when evaluating focal neuropathic symptoms in patients with lymphoma. Demonstration of neural enlargement and increased blood flow in symptomatic and electrophysiologically abnormal nerves suggests a diagnosis of neurolymphomatosis, probably reflecting infiltration and neovascularization. Further sonographic studies on the detection and quantification of nerve abnormality in neurolymphomatosis will be of additional value. Classification of evidence: This study provides Class IV evidence that for patients with lymphoma and focal neuropathies, nerve ultrasound aids in identifying those with lymphomatous peripheral nerve infiltration on biopsy.