Paluch Ł, Noszczyk B H, Walecki J, Osiak K, Kiciński M, Pietruski P
Department of Radiology, Gruca Orthopedic and Trauma Teaching Hospital, Medical Centre of Postgraduate Education, Otwock, Poland.
Department of Plastic Surgery, Prof. W. Orlowski Memorial Hospital, Medical Centre of Postgraduate Education, Czerniakowska 231 Street, 00-416 Warsaw, Poland.
J Plast Reconstr Aesthet Surg. 2018 Nov;71(11):1593-1599. doi: 10.1016/j.bjps.2018.08.018. Epub 2018 Sep 4.
An interesting alternative to traditional diagnostic techniques of the upper extremity nerve entrapments might be an ultrasound elastography that has started to gain attention in recent research. The aim of this preliminary study was to verify whether a quantitative analysis of the ulnar nerve stiffness by shear-wave elastography can be used to diagnose ulnar tunnel syndrome (UTS), an ulnar nerve neuropathy at Guyon's canal. The study included 46 patients (39 women) and 39 healthy controls (34 women). All diagnoses in patients and controls were confirmed with nerve conduction studies. Measurements of nerve stiffness were taken at three levels: Guyon's canal (G), distal forearm (DF), and mid forearm (MF). Additionally, the ulnar nerve cross-sectional area at the canal's level was determined by ultrasonography. Patients with UTS presented with significantly greater nerve stiffness than the controls (mean, 99.41 kPa vs. 49.08 kPa, P < 0.001). No significant intergroup differences were found in the nerve elasticity at DF and MF levels (P < 0.836 and P < 0.881, respectively). An ulnar nerve stiffness value of 80 kPa and G:DF and G:MF ratios equal to 1.5 provided 100% sensitivity, specificity, and positive and negative predictive values in the detection of the syndrome. The mean nerve cross-sectional area in the Guyon's canal was significantly greater in patients than in the controls (4.63 mm, range, 2-7 mm vs. 3.23 mm, range, 2-5 mm, P < 0.001). In conclusion, we believe that shear-wave elastography has the potential to become a useful adjunct diagnostic test for UTS.
上肢神经卡压传统诊断技术的一种有趣替代方法可能是超声弹性成像，该技术在最近的研究中已开始受到关注。这项初步研究的目的是验证通过剪切波弹性成像对尺神经硬度进行定量分析是否可用于诊断尺管综合征（UTS），即一种发生在Guyon管的尺神经病变。该研究纳入了46例患者（39名女性）和39名健康对照者（34名女性）。患者和对照者的所有诊断均通过神经传导研究得以证实。在三个水平测量神经硬度：Guyon管（G）、前臂远端（DF）和前臂中部（MF）。此外，通过超声检查确定管水平处的尺神经横截面积。UTS患者的神经硬度明显高于对照组（平均99.41kPa对49.08kPa，P<0.001）。在DF和MF水平，两组间神经弹性无显著差异（分别为P<0.836和P<0.881）。尺神经硬度值为80kPa且G:DF和G:MF比值等于1.5时，在该综合征检测中提供了100%的敏感性、特异性、阳性和阴性预测值。患者Guyon管内的平均神经横截面积显著大于对照组（4.63mm，范围2 - 7mm对3.23mm，范围2 - 5mm，P<0.001）。总之，我们认为剪切波弹性成像有潜力成为UTS的一种有用辅助诊断测试。
