Department of Rheumatology and Immunology, Medical University Graz, , Graz, Austria.
Ann Rheum Dis. 2013 Dec;72(12):1934-9. doi: 10.1136/annrheumdis-2012-202328. Epub 2012 Dec 4.
To compare ultrasound measurement of median nerve cross-sectional area (CSA) at different anatomical landmarks and to assess the value of power Doppler signals within the median nerve for diagnosis of carpal tunnel syndrome (CTS).
A prospective study of 135 consecutive patients with suspected CTS undergoing two visits within 3 months. A final diagnosis of CTS was established by clinical and electrophysiological findings. CSA was sonographically measured at five different levels at forearm and wrist; and CSA wrist to forearm ratios or differences were calculated. Intraneural power Doppler signals were semiquantitatively graded. Diagnostic values of different ultrasound methods were compared by receiver operating characteristic curves using SPSS.
CTS was diagnosed in 111 (45.5%) wrists; 84 (34.4%) had no CTS and 49 (20.1%) were possible CTS cases. Diagnostic values were comparable for all sonographic methods to determine median nerve swelling, with area under the curves ranging from 0.75 to 0.85. Thresholds of 9.8 and 13.8 mm(2) for the largest CSA of the median nerve yielded a sensitivity of 92% and a specificity of 92%. A power Doppler score of 2 or greater had a specificity of 90% for the diagnosis of CTS. Sonographic median nerve volumetry revealed a good reliability with an intraclass correlation coefficient of 0.90 (95% CI 0.79 to 0.95).
Sonographic assessment of median nerve swelling and vascularity allows for a reliable diagnosis of CTS. Determination of CSA at its maximal shape offers an easily reproducible tool for CTS classification in daily clinical practice.
比较不同解剖标志下正中神经横截面积（CSA）的超声测量，并评估正中神经内功率多普勒信号对腕管综合征（CTS）的诊断价值。
对 135 例连续疑似 CTS 患者进行前瞻性研究，这些患者在 3 个月内进行了两次就诊。通过临床和电生理发现最终确立 CTS 的诊断。在腕部和前臂的五个不同水平上进行超声 CSA 测量，并计算 CSA 腕部与前臂的比值或差值。对神经内功率多普勒信号进行半定量分级。使用 SPSS 通过接收者操作特征曲线比较不同超声方法的诊断价值。
111 个（45.5%）腕部诊断为 CTS；84 个（34.4%）无 CTS，49 个（20.1%）为可能 CTS 病例。所有超声方法确定正中神经肿胀的诊断价值相当，曲线下面积范围为 0.75 至 0.85。正中神经最大 CSA 的阈值为 9.8 和 13.8mm(2)时，灵敏度为 92%，特异性为 92%。功率多普勒评分≥2 对 CTS 的诊断具有 90%的特异性。超声正中神经容积测量具有良好的可靠性，组内相关系数为 0.90（95%CI 0.79 至 0.95）。
正中神经肿胀和血管性超声评估可可靠诊断 CTS。确定 CSA 的最大形态提供了一种在日常临床实践中对 CTS 进行分类的简单可重复工具。
