Abrishamchi Fatemeh, Zaki Bagher, Basiri Keyvan, Ghasemi Majid, Mohaghegh Mohammadreza
Department of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
J Res Med Sci. 2014 Dec;19(12):1113-7.
Electrophysiologic (EDX) study is the most valuable method in grading the severity of carpal tunnel syndrome (CTS), but it is invasive and painful. We evaluated the efficacy of ultrasound for this purpose.
Eighty-one wrists of 52 consecutive patients with clinical evidences of CTS, confirmed and graded by EDX as mild, moderate, and severe, were examined by ultrasonography. Cross-sectional area (CSA) of the median nerve was measured at the distal wrist (CSA-D), and proximal forearm (CSA-P), and wrist-to-forearm ratio (WFR) was calculated for each hand.
The mean CSA-D was 0.12 cm(2) ± 0.03, 0.15 cm(2) ± 0.03 and 0.19 cm(2) ± 0.06 and the mean WFR was 2.77 ± 1.14, 3.07 ± 1.07 and 4.07 ± 1.61 in mild, moderate and severe groups respectively. WFR showed significant differences between the severe and none severe CTS groups (P < 0.001), but there was no significant difference between mild and moderate CTS groups (P < 0.381). CSA-D showed a significant difference between all groups (P < 0.0001). In the Receiver Operating Characteristic curve analysis, the optimal cut-off value of the CSA-D and WFR for detecting severe CTS were 0.15 (area under the curve 0.784, 95% confidence interval (CI): 0.662-0.898, P < 0.001, sensitivity of 68.2% and specificity of 70.9%) and 3 (area under the curve 0.714, 95% CI: 0.585-0.84, P = 0.001, sensitivity of 68.2% and specificity of 64.8%) respectively. All values were superior in CSA-D.
Ultrasonography, can be complementary but not conclusive to the classification of CTS severities. CSA-D and WFR both increased in proportion to CTS severity, but neither parameter exhibited excellent performance in grading the severities.
电生理（EDX）检查是评估腕管综合征（CTS）严重程度最有价值的方法，但它具有侵入性且会引起疼痛。我们评估了超声在此方面的有效性。
对52例连续患有CTS临床证据的患者的81只手腕进行了超声检查，这些患者经EDX确诊并分为轻度、中度和重度。在手腕远端（CSA-D）和前臂近端（CSA-P）测量正中神经的横截面积（CSA），并计算每只手的腕部与前臂比值（WFR）。
轻度、中度和重度组的平均CSA-D分别为0.12 cm²±0.03、0.15 cm²±0.03和0.19 cm²±0.06，平均WFR分别为2.77±1.14、3.07±1.07和4.07±1.61。重度与非重度CTS组之间的WFR有显著差异（P<0.001），但轻度与中度CTS组之间无显著差异（P<0.381）。所有组之间的CSA-D均有显著差异（P<0.0001）。在受试者工作特征曲线分析中，检测重度CTS时CSA-D和WFR的最佳截断值分别为0.15（曲线下面积0.784，95%置信区间（CI）：0.662-0.898，P<0.001，灵敏度68.2%，特异性70.9%）和3（曲线下面积0.714，95%CI：0.585-0.84，P = 0.001，灵敏度68.2%，特异性64.8%）。所有值中CSA-D更优。
超声检查可作为CTS严重程度分类的补充方法，但不能作为定论。CSA-D和WFR均随CTS严重程度增加，但在分级方面均未表现出优异的性能。
