Wu Hung-Ta H, Schweitzer Mark E, Culp Randall W
Department of Radiology, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan.
J Comput Assist Tomogr. 2004 Nov-Dec;28(6):860-4. doi: 10.1097/00004728-200411000-00024.
In nonoperated patients, the MR diagnosis of carpal tunnel syndrome (CTS) is difficult. In the postoperative patient this difficulty is compounded. Consequently, we sought to evaluate for potential MR signs of postoperative CTS.
At 1.5 T, 41 wrists in 37 patients with previous CTS release were evaluated by two observers for 1) flexor retinacular regrowth; 2) median nerve: a) high T2 signal, b) proximal enlargement, c) fibrous fixation, d) neuroma, and e) entrapment; 3) flexor tenosynovitis; 4) mass, bursitis, accessory muscle, distal belly progression, or excessive deep fat; 5) hamate fracture; and 6) volar nerve migration. Electromyography (EMG), operative findings, and clinical follow-up were used to determine the presence of recurrent CTS.
Fifteen of 41 wrists had recurrent CTS. Retinacular regrowth was seen in 4/15 (27%) with and 7/26 (27%) without recurrent CTS (P=0.7). Excessive fat was seen in 1/15 (7%) with and 2/26 (8%) without CTS (P=0.19). No patient had incomplete resection of flexor retinaculum, scarring, neuroma of nerve, or tendon laceration; bursitis, accessory or distal muscle progression of muscle belly, or hamate fracture. Nerve edema with high T2 signal was seen in 4/15 (27%) with and 3/26 (12%) without CTS (P=0.16); proximal enlargement was seen in 6/15 (40%) with CTS and 2/26 (8%) without CTS (P=0.007). Also, 1 patient with recurrent disease demonstrated a mass and 1 other patient without CTS had nerve entrapment. Tenosynovitis was seen in 9/15 (60%) with and 9/26 (35%) without recurrent CTS (P=0.02). Counterintuitively, the nerve was more palmar with recurrent CTS than without (mean 6.9/8.9 mm).
Only proximal enlargement, tenosynovitis, and the rare mass may help to diagnose recurrent CTS by MR. However, there appears to be a subgroup of patients with recurrent neuropathy related to an excessively superficial median nerve.
在未经手术的患者中，腕管综合征（CTS）的磁共振（MR）诊断较为困难。对于术后患者，这种困难更加复杂。因此，我们试图评估术后CTS的潜在MR征象。
在1.5T条件下，由两名观察者对37例既往有CTS松解术的患者的41只手腕进行评估，观察内容包括：1）屈肌支持带再生；2）正中神经：a）T2高信号，b）近端增粗，c）纤维固定，d）神经瘤，e）卡压；3）屈肌腱鞘炎；4）肿块、滑囊炎、副肌、肌腹远端进展或深部脂肪过多；5）钩骨骨折；6）掌侧神经移位。采用肌电图（EMG）、手术所见及临床随访来确定复发性CTS的存在。
41只手腕中有15只存在复发性CTS。在有复发性CTS的15例患者中有4例（27%）以及无复发性CTS的26例患者中有7例（27%）可见支持带再生（P = 0.7）。有CTS的15例患者中有1例（7%）以及无CTS的26例患者中有2例（8%）可见脂肪过多（P = 0.19）。没有患者存在屈肌支持带切除不完全、瘢痕形成、神经瘤或肌腱撕裂；没有出现滑囊炎、副肌或肌腹远端进展或钩骨骨折。有复发性CTS的15例患者中有4例（27%）以及无CTS的26例患者中有3例（12%）可见T2高信号的神经水肿（P = 0.16）；有CTS的15例患者中有6例（40%）以及无CTS的26例患者中有2例（8%）可见近端增粗（P = 0.007）。此外，1例复发性疾病患者显示有肿块，另1例无CTS的患者存在神经卡压。有复发性CTS的15例患者中有9例（60%）以及无复发性CTS的26例患者中有9例（35%）可见腱鞘炎（P = 0.02）。与直觉相反，复发性CTS患者的神经比无CTS患者的神经更偏向掌侧（平均6.9/8.9mm）。
只有近端增粗、腱鞘炎以及罕见的肿块可能有助于通过MR诊断复发性CTS。然而，似乎有一小部分复发性神经病变患者与正中神经过度表浅有关。
