Objective: We investigated whether a structured ultrasound protocol integrating fascicular morphometry, fractal image analysis, and AI-assisted classification can stratify neuropathic versus myogenic contributors to motor decline.

Background: Motor dysfunction frequently results from overlapping mechanisms involving peripheral neuropathy, muscle pathology, or myofascial dysfunction. Conventional diagnostic pathways rely on sequential investigations such as electromyography (EMG) and MRI, which may delay etiological clarification. Point-of-care neuromuscular ultrasound (POCUS-NMUS) enables simultaneous bedside evaluation of nerves and muscles [1-3].

Method: Twelve patients presenting with motor dysfunction were examined using high-frequency ultrasound during initial clinical evaluation. Peripheral nerves and muscles were assessed using a structured POCUS protocol. Nerve assessment followed a fascicle-based morphometric method (Bubnov method [1]) including fascicle diameter, fascicular asymmetry, and nerve cross-sectional area. Muscle evaluation included dynamic functional testing and identification of focal trigger-point regions [2,3]. Fractal texture analysis of ultrasound images was performed using algorithms as in [4] to calculate fractal dimension (FD) and lacunarity as markers of tissue structural complexity. An AI-assisted pipeline integrated morphometric and fractal features to classify patterns of neuromuscular involvement.

Results: POCUS identified distinct imaging phenotypes. Neuropathic cases (including suspected autoimmune neuropathy resembling Guillain–Barré pattern, diabetic neuropathy, and post-chemotherapy neuropathy) demonstrated fascicular enlargement and heterogeneous nerve architecture, with elevated FD values reflecting increased microstructural complexity. In contrast, muscle-dominant pathology (post-injury myofascial syndrome, spasticity, rheumatic disease, and postural imbalance with trigger points) demonstrated localized regions of increased FD within muscle texture, altered contractile response during dynamic testing, and relative preservation of nerve fascicular architecture.

Conclusion: A bedside POCUS neuromuscular ultrasound protocol integrating fascicular morphometry and fractal biomarkers enables early stratification of neuropathic and myogenic mechanisms underlying motor dysfunction.

References: 1. Bubnov RV. Ultrasonography diagnosis of peripheral neuropathy. The initial experience. Ultrasound Med Biol. 2011; 37(8): S144–S145.
2. Bubnov R. Ultrasonography for local muscle spasticity management. Mov Disord 2012, 27(Suppl 1):336.
3. Bubnov R, Kalika L. Ultrasound Assessment of Collagen Content in Contracted and Non-contracted Muscle Areas: A Comparative Study. Mov Disord. 2024; 39 (suppl 1):S703.
4. Bubnov R, Spivak M. Fractal analysis of muscle ultrasound imaging to evaluate muscle health and spasticity. Mov Disord. 2020; 35 (suppl 1): S58.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/point-of-care-neuromuscular-ultrasound-with-fractal-biomarkers-for-stratification-of-neuropathic-and-myogenic-drivers-of-motor-decline/