Musculoskeletal Ultrasound and MRI in the Evaluation of Chemotherapy-Induced Peripheral Neuropathy: A Review

30 January 2026 : Review article

Yuxia Zuo^{BCE 1}, Xingchao Xu^{BC 2}, Cai Wu^{E 2}, Xue Cui^{CE 2}, Xiangqi Li^{A 2*}

DOI: 10.12659/MSM.951283

Med Sci Monit 2026; 32:e951283

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Introduction Pathogenesis of Chemotherapy-Induced Neuropathy MSUS Technical Principles and Equipment Selection Characteristic MSUS Manifestations of CIPN Quantitative Assessment Parameters of MSUS Advantages and Limitations of MSUS Core Technical Principles of MRI (DTI/DKI) The Correlation Between MRI Features, CIPN Pathology, and Clinical Scales Quantitative Assessment Parameters of MRI Limitations and Reproducibility Challenges of MRI Standardized Protocol for Peripheral Nervous System Examination Future Directions Conclusions References

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Table 1 Analysis of direct and indirect sonographic features of chemotherapy-induced peripheral neuropathy (CIPN).

Direct ultrasonic signs	Indirect ultrasonic signs
Alterations in Nerve Continuity, Complete Rupture: Disruption of nerve fascicle echogenicity with retracted ends/traumatic neuroma formation.Partial Tear: Localized architectural disorganization accompanied by hematoma	Peripheral Tissue Abnormalities, Compressive Lesions: Ganglion cysts (anechoic cystic structures), osteophytic deformities.Subsequent Changes: Edema (hypoechoic areas), fibrosis (hyperechoic enhancement)
Neuromorphological Alterations, Pathological thickening (eg, cross-sectional area [CSA] of the median nerve >10–15 mm in carpal tunnel syndrome). Chronic atrophy (thinning with hyperechoic fibrotic changes)	Muscle Denervation Changes, Acute phase: Muscle fascicle edema (hypoechoic and loss of fascicular architecture).Chronic phase: Atrophy with fatty infiltration (hyperechoic appearance and thickening of perimysial septa)
Microstructural Changes in Nerve Fascicles, Acute phase:Loss of fascicular demarcation and heterogeneous echotexture. Chronic phase: Structural disintegration with fibrosis (disruption of the normal “honeycomb” or “cable-like” architecture)	Dynamic Functional Impairments Abnormal nerve gliding (eg, gliding distance <3 mm in carpal tunnel syndrome), Compression-induced deformation (morphological changes at the site of constriction during dynamic observation)
CIPN – chemotherapy-induced peripheral neuropathy; CSA – cross-sectional area.

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