Fu Tengfei, Cao Manlin, Liu Fang, Zhu Jiaan, Ye Dongmei, Feng Xianxuan, Xu Yiming, Wang Gang, Bai Yuehong
Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
PLoS One. 2015 Jan 24;10(1):e0116777. doi: 10.1371/journal.pone.0116777. eCollection 2015.
To evaluate the diagnostic value of the Inlet-to-outlet median nerve area ratio (IOR) in patients with clinically and electrophysiologically confirmed carpal tunnel syndrome (CTS).
Forty-six wrists in 46 consecutive patients with clinical and electrodiagnostic evidence of CTS and forty-four wrists in 44 healthy volunteers were examined with ultrasonography. The cross-sectional area (CSA) of the median nerve was measured at the carpal tunnel inlet (the level of scaphoid-pisiform) and outlet (the level of the hook of the hamate), and the IOR was calculated for each wrist. Ultrasonography and electrodiagnostic tests were performed under blinded conditions. Electrodiagnostic testing combined with clinical symptoms were considered to be the gold standard test. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic value between the inlet CSA and IOR.
The study population included 16 men and 30 women (mean age, 45.3 years; range, 18-83 years). The control population included 18 men and 26 women (mean age, 50.4 years; range, 18-79 years). The mean inlet CSA was 8.7 mm2 in healthy controls and 14.6mm2 in CTS group (P<0.001). The mean IOR in healthy volunteers (1.0) was smaller than that in patients (1.6, P<0.001). Receiver operating characteristic analysis revealed a diagnostic advantage to using the IOR rather than the inlet CSA (P<0.01). An IOR cutoff value of ≥ 1.3 would yield 93% specificity and 91% sensitivity in the diagnosis of CTS.
The IOR of median nerve area promises to be an effective means in the diagnosis of CTS. A large-scale, randomized controlled trial is required to determine how and when this parameter will be used.
评估入口至出口正中神经面积比（IOR）在临床及电生理确诊的腕管综合征（CTS）患者中的诊断价值。
对46例临床及电诊断证实为CTS的连续患者的46只手腕和44例健康志愿者的44只手腕进行超声检查。在腕管入口（舟状骨 - 豌豆骨水平）和出口（钩骨钩水平）测量正中神经的横截面积（CSA），并计算每只手腕的IOR。超声检查和电诊断测试在盲法条件下进行。电诊断测试结合临床症状被视为金标准测试。采用受试者操作特征（ROC）曲线评估入口CSA和IOR之间的诊断价值。
研究人群包括16名男性和30名女性（平均年龄45.3岁；范围18 - 83岁）。对照人群包括18名男性和26名女性（平均年龄50.4岁；范围18 - 79岁）。健康对照组的平均入口CSA为8.7mm²，CTS组为14.6mm²（P < 0.001）。健康志愿者的平均IOR（1.0）小于患者的平均IOR（1.6，P < 0.001）。受试者操作特征分析显示，使用IOR比入口CSA具有诊断优势（P < 0.01）。IOR临界值≥1.3在CTS诊断中具有93%的特异性和91%的敏感性。
正中神经面积的IOR有望成为CTS诊断的有效手段。需要进行大规模随机对照试验来确定如何以及何时使用该参数。
