School of Allied Medical Professions, The Ohio State University, College of Medicine, Columbus, OH 43210, USA.
J Ultrasound Med. 2012 May;31(5):729-36. doi: 10.7863/jum.2012.31.5.729.
The purpose of this study was to document and analyze intraneural vascular flow within the median nerve using power and spectral Doppler sonography and to determine the relationship of this vascular flow with diagnosis of carpal tunnel syndrome based on electrodiagnostic testing.
Power and spectral Doppler sonograms in the median nerve were prospectively collected in 47 symptomatic and 44 asymptomatic subjects. Doppler studies were conducted with a 12-MHz linear transducer. Strict inclusion criteria were established for postexamination assessment of waveforms; routine quality assurance was completed; electrodiagnostic tests were conducted on the same day as sonographic measurements; and the skin temperature was controlled. Included waveforms were categorized by location and averaged by individual for comparative analysis to electrodiagnostic testing.
A total of 416 waveforms were collected, and 245 were retained for statistical analysis based on strict inclusion criteria. The mean spectral peak velocity among all waveforms was 4.42 (SD, 2.15) cm/s. At the level of the pisiform, the most consistent data point, mean peak systole, was 3.75 cm/s in symptomatic patients versus 4.26 cm/s in asymptomatic controls. Statistical trending showed an initial increase in the mean spectral peak velocity in symptomatic but diagnostically negative cases, with decreasing velocity as diagnostic categories progressed from mild to severe.
An inverse relationship may exist between intraneural vascular flow in the median nerve and an increasing severity of carpal tunnel syndrome based on nerve conduction results. Randomized controlled trials are needed to determine whether spectral Doppler sonography can provide an additive benefit for diagnosing the severity of carpal tunnel syndrome.
本研究旨在使用功率和谱多普勒超声记录和分析正中神经内的神经内血管血流，并确定这种血管血流与基于电诊断测试的腕管综合征诊断的关系。
在 47 例有症状和 44 例无症状的受试者中前瞻性地收集正中神经的功率和谱多普勒超声图。多普勒研究使用 12MHz 线性换能器进行。为了进行检查后评估，建立了严格的纳入标准；完成了常规质量保证；在超声测量的同一天进行电诊断测试；并控制皮肤温度。纳入的波形按位置分类，并按个体平均进行比较分析，以与电诊断测试进行比较。
共采集了 416 个波形，根据严格的纳入标准，保留了 245 个进行统计分析。所有波形的平均频谱峰值速度为 4.42（SD，2.15）cm/s。在豌豆骨水平，最一致的数据点，即有症状患者的平均收缩期峰值为 3.75cm/s，无症状对照组为 4.26cm/s。统计趋势显示，在有症状但诊断为阴性的病例中，平均频谱峰值速度最初增加，随着诊断类别从轻度到重度的进展，速度逐渐降低。
根据神经传导结果，正中神经内神经内血管血流与腕管综合征严重程度的增加之间可能存在反比关系。需要进行随机对照试验来确定频谱多普勒超声是否可以为诊断腕管综合征的严重程度提供附加益处。
