Contribution of ultrasound in the assessment of patients with suspect idiopathic pudendal nerve disease Alberto Tagliafico a,⇑ , Bianca Bignotti b , Maribel Miguel Perez c , Lizia Reni d , Gerd Bodner e , Carlo Martinoli b a Institute of Anatomy, Department of Experimental Medicine, University of Genoa, Via de Toni 14, 16132 Genoa, Italy b Radiology Department, DISSAL, Università di Genova, Largo Rosanna Benzi 8, 16138 Genoa, Italy c Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapy, Faculty of Medicine (C Bellvitge), University of Barcelona, Barcelona, Spain d Neurology Department, AOU San Martino-IST, Largo Rosanna Benzi 8, 16138 Genoa, Italy e Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Austria See Editorial, pages 1079–1080 article info Article history: Available online 7 December 2013 Keywords: Pudendal nerve Ultrasound Anatomy Perineal nerves Pathology Entrapment Magnetic resonance imaging highlights  Diagnosis of pudendal neuralgia is difficult and classical diagnostic criteria are not sufficient for all clinical situations.  High-resolution ultrasound (US) is able to evaluate normal and pathological pudendal nerves.  In patients with suspected idiopathic pudendal nerve disease, ultrasound allowed the identification of morphological alterations to the nerve in 80% of cases. abstract Objective: To assess if Ultrasound (US) is contributive in patients suspected of having idiopathic pudendal neuralgia. Methods: Between July 2012 and April 2013, 10 consecutive female patients with suspected idiopathic pudendal neuralgia (mean age: 47 ± 14 years; mean BMI: 24 ± 3) were included. Two radiologists blinded to the clinical and neurophysiological data performed pudendal nerve evaluation with broadband linear array transducers (12–7 MHZ, and 17–5 MHZ). MRI was added to confirm US data. A third independent clinician, who did not perform electrodiagnosis and US, reviewed the data and scored US as ‘‘contribu- tive’’ or ‘‘non-contributive’’: if US confirmed the clinical and neurophysiological diagnosis or if US findings were not useful. Results: Ultrasound identified alterations to the pudendal nerve in 7/10 of cases (70%). In seven cases US revealed the presence of a diffusely or focally enlarged pudendal nerve confirmed by MRI. In these cases neurophysiological findings were suspicious for pudendal neuralgia in 5/7 cases, whereas in 2/7 cases they were inconclusive. Conclusion: High-resolution ultrasound (US) may demonstrate alterations to the pudendal nerve in patients with pudendal neuralgia. Significance: US is useful in patients with suspected idiopathic pudendal nerve disease. Ó 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved. 1. Introduction In the presence of typical perineal pain, the diagnosis of puden- dal neuralgia is possible if defined criteria are present. These criteria are known among clinicians as ‘‘Nantes Criteria’’ and are divided into four diagnostic domains (essential, complementary, 1388-2457/$36.00 Ó 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.clinph.2013.10.053 ⇑ Corresponding author. Address: Department of Experimental Medicine, DIMES, Università di Genova, Via de Toni 14, 16132 Genoa, Italy. Tel.: +39 3479745122; fax: +39 0103537885. E-mail address: albertotagliafico@gmail.com (A. Tagliafico). Clinical Neurophysiology 125 (2014) 1278–1284 Contents lists available at ScienceDirect Clinical Neurophysiology journal homepage: www.elsevier.com/locate/clinph