Ooi Chin Chin, Wong Siew Kune, Tan Agnes B H, Chin Andrew Y H, Abu Bakar Rafidah, Goh Shy Yunn, Mohan P Chandra, Yap Robert T J, Png Meng Ai
Department of Diagnostic Radiology, Singapore General Hospital, Block 2, level 1, Outram Road, 169608, Singapore, Singapore,
Skeletal Radiol. 2014 Oct;43(10):1387-94. doi: 10.1007/s00256-014-1929-z. Epub 2014 Jun 12.
The aim of this work was to evaluate the diagnostic performance of grey-scale, color Doppler, and dynamic ultrasound (US) for diagnosing carpal tunnel syndrome (CTS) using the medical diagnostic test called nerve conduction study (NCS) as the reference standard, and to correlate the increase in median nerve (MN) cross-sectional area (CSA) with severity of CTS. Fifty-one patients (95 wrists) with clinical symptoms of idiopathic CTS were recruited. The CSA and flattening ratio of the MN were measured at the distal radio-ulnar joint, pisiform, and hamate levels; bowing of the flexor retinaculum was determined at the hamate level. The hypervascularity of the MN was evaluated. The transverse sliding of the MN was observed dynamically and recorded as being either normal or restricted/absent. Another 15 healthy volunteers (30 wrists) were recruited as controls. Interoperator reliability was established for all criteria. CTS was confirmed in 75 wrists (75/95: 79%; 14 minimal, 21 mild, 23 moderate, 17 severe). CSA at the pisiform level was found to be the most reliable and accurate grey-scale criterion to diagnose CTS (optimum threshold: 9.8 mm(2)). There was a good correlation between the severity of NCS and CSA (r = 0.78, p < 0.001). The sensitivity and specificity of color-Doppler and dynamic US in detecting CTS was 69, 95, 58, and 86%, respectively. Combination of these subjective criteria with CSA increases the sensitivity to 98.3%. US measurement of CSA provides additional information about the severity of MN involvement. Color-Doppler and dynamic US are useful supporting criteria that may expand the utility of US as a screening tool for CTS.
这项研究的目的是，以神经传导研究（NCS）这项医学诊断测试作为参考标准，评估灰阶、彩色多普勒和动态超声（US）诊断腕管综合征（CTS）的诊断性能，并将正中神经（MN）横截面积（CSA）的增加与CTS的严重程度相关联。招募了51例有特发性CTS临床症状的患者（95只手腕）。在桡尺远侧关节、豌豆骨和钩骨水平测量MN的CSA和平坦率；在钩骨水平确定屈肌支持带的弓形。评估MN的血管增多情况。动态观察MN的横向滑动，并记录为正常或受限/无滑动。另外招募了15名健康志愿者（30只手腕）作为对照。建立了所有标准的操作者间可靠性。75只手腕确诊为CTS（75/95：79%；14例轻度，21例中度，23例重度，17例极重度）。发现豌豆骨水平的CSA是诊断CTS最可靠、最准确的灰阶标准（最佳阈值：9.8 mm²）。NCS的严重程度与CSA之间存在良好的相关性（r = 0.78，p < 0.001）。彩色多普勒和动态US检测CTS的敏感性和特异性分别为69%、95%、58%和86%。这些主观标准与CSA相结合可将敏感性提高到98.3%。US测量CSA可提供有关MN受累严重程度的额外信息。彩色多普勒和动态US是有用的辅助标准，可能会扩大US作为CTS筛查工具的效用。
