Klauser Andrea S, Halpern Ethan J, De Zordo Tobias, Feuchtner Gudrun M, Arora Rohit, Gruber Johann, Martinoli Carlo, Löscher Wolfgang N
Department of Diagnostic Radiology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Radiology. 2009 Jan;250(1):171-7. doi: 10.1148/radiol.2501080397. Epub 2008 Nov 26.
To improve accuracy in the diagnosis of carpal tunnel syndrome (CTS) by comparing cross-sectional area (CSA) measurements of the median nerve obtained at the level of the carpal tunnel (CSAc) with those obtained more proximally (CSAp), at the level of the pronator quadratus muscle.
The study protocol was approved by the institutional review board, and all subjects gave written informed consent. One hundred wrists of 68 consecutive patients with CTS (16 men, 52 women; mean age, 57.9 years; range, 25-85 years) and 93 wrists of 58 healthy volunteers (16 male, 42 female; mean age, 55.1 years; range, 17-85 years) were examined with ultrasonography (US). Electrodiagnostic test results confirmed the diagnosis of CTS in all 68 patients. The US examiner was blinded to these test results. The CSA of the median nerve was measured at the carpal tunnel and proximal levels, and the difference between CSAc and CSAp (Delta CSA) was calculated for each wrist.
The mean CSAc in healthy volunteers (9.0 mm(2)) was smaller than that in patients (16.8 mm(2), P < .01). The mean Delta CSA was smaller in asymptomatic wrists (0.25 mm(2)) than in CTS-affected wrists (7.4 mm(2), P < .01). Receiver operating characteristic analysis revealed a diagnostic advantage to using the Delta CSA rather than the CSAc (P = .036). Use of a Delta CSA threshold of 2 mm(2) yielded the greatest sensitivity (99%) and specificity (100%) for the diagnosis of CTS.
Receiver operating characteristic analysis revealed improved accuracy in the diagnosis of CTS determined with the Delta CSA compared with the accuracy of the diagnosis determined with the CSAc.
通过比较腕管水平（CSAc）和更近端、旋前方肌水平（CSAp）获得的正中神经横截面积（CSA）测量值，提高腕管综合征（CTS）诊断的准确性。
研究方案经机构审查委员会批准，所有受试者均签署书面知情同意书。对68例连续的CTS患者（16例男性，52例女性；平均年龄57.9岁；范围25 - 85岁）的100只手腕和58名健康志愿者（16例男性，42例女性；平均年龄55.1岁；范围17 - 85岁）的93只手腕进行超声（US）检查。电诊断测试结果证实所有68例患者均为CTS。超声检查者对这些测试结果不知情。在腕管和近端水平测量正中神经的CSA，并计算每只手腕的CSAc与CSAp之间的差值（ΔCSA）。
健康志愿者的平均CSAc（9.0 mm²）小于患者的平均CSAc（16.8 mm²，P <.01）。无症状手腕的平均ΔCSA（0.25 mm²）小于CTS受累手腕的平均ΔCSA（7.4 mm²，P <.01）。受试者操作特征分析显示，使用ΔCSA比使用CSAc具有诊断优势（P =.036）。使用2 mm²的ΔCSA阈值对CTS诊断具有最高的敏感性（99%）和特异性（100%）。
受试者操作特征分析显示，与使用CSAc诊断CTS的准确性相比，使用ΔCSA诊断CTS的准确性有所提高。
