Neurophysiology Unit, Iatropolis Medical Group, Athens, Halandri 15231, Greece; Second Department of Neurology, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Chaidari 12462, Athens, Greece.
Second Department of Neurology, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Chaidari 12462, Athens, Greece; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.
Clin Neurophysiol. 2019 Mar;130(3):321-330. doi: 10.1016/j.clinph.2018.12.005. Epub 2018 Dec 31.
To assess the effect of age on the accuracy of high-resolution ultrasound (HRUS) in the diagnosis and grading of carpal tunnel syndrome (CTS).
Patients with symptoms and signs of CTS (N = 527 wrists) were evaluated using electrodiagnostic studies (EDx) for CTS diagnosis and grading. Median nerve cross-sectional areas at carpal tunnel inlet (CSA) and at forearm level were measured by HRUS and the ratio of these values was calculated (WFR). Healthy controls underwent identical testing (N = 122 wrists). HRUS accuracy was assessed against the EDx standard by Receiver Operator Characteristic (ROC) curve analysis.
In patients >65 y with moderate and severe CTS, disease-related increases in CSA and WFR were negatively correlated with increasing age. Subjects were grouped by age into younger (<65 y) and older (≥65 y). The c-statistics for CSA and WFR respectively were: For CTS diagnosis, younger group: 0.94 and 0.96 (excellent); older group: 0.85 and 0.86 (satisfactory). For CTS grading, younger group: differentiating mild CTS from controls: 0.90 and 0.92 (excellent); mild from moderate: 0.79 and 0.74 (satisfactory); moderate from severe: 0.82 and 0.78 (satisfactory). For CTS grading, older group: differentiating mild CTS from controls: 0.83 and 0.83 (satisfactory); mild from moderate: 0.53 and 0.61 (poor); moderate from severe: 0.65 and 0.53 (poor).
For subjects aged <65 y, HRUS accuracy is excellent in CTS diagnosis and satisfactory in grading. For older subjects, accuracy is satisfactory in diagnosis but not in grading.
HRUS for CTS has diagnostic limitations selectively in older individuals.
评估年龄对高频超声（HRUS）诊断和分级腕管综合征（CTS）的准确性的影响。
对有 CTS 症状和体征的患者（N=527 个腕关节）进行电诊断研究（EDx）以进行 CTS 诊断和分级。通过 HRUS 测量正中神经在腕管入口（CSA）和前臂水平的横截面积（CSA），并计算这些值的比值（WFR）。健康对照者接受相同的测试（N=122 个腕关节）。通过接收者操作特征（ROC）曲线分析，将 HRUS 准确性与 EDx 标准进行比较。
在年龄＞65 岁的中重度 CTS 患者中，CSA 和 WFR 的疾病相关增加与年龄的增加呈负相关。将受试者按年龄分为年轻组（＜65 岁）和老年组（≥65 岁）。CSA 和 WFR 的 C 统计量分别为：对于 CTS 诊断，年轻组：0.94 和 0.96（优秀）；老年组：0.85 和 0.86（满意）。对于 CTS 分级，年轻组：将轻度 CTS 与对照组区分开来：0.90 和 0.92（优秀）；轻度与中度：0.79 和 0.74（满意）；中度与重度：0.82 和 0.78（满意）。对于 CTS 分级，老年组：将轻度 CTS 与对照组区分开来：0.83 和 0.83（满意）；轻度与中度：0.53 和 0.61（差）；中度与重度：0.65 和 0.53（差）。
对于年龄＜65 岁的受试者，HRUS 在 CTS 诊断中的准确性非常高，在分级中的准确性也令人满意。对于年龄较大的受试者，诊断的准确性是满意的，但分级的准确性则不然。
HRUS 对 CTS 的诊断具有选择性限制，仅在年龄较大的个体中。
