Savage Nathan J, McKell John S
Department of Physical Therapy, Winston-Salem State University, Winston-Salem, North Carolina, USA.
Department of Physical Therapy, McKell Therapy Group, LLC, Provo, Utah, USA.
J Ultrasound Med. 2024 Sep;43(9):1683-1694. doi: 10.1002/jum.16491. Epub 2024 May 30.
Evaluate diagnostic accuracy of median nerve cross-sectional area (CSA) to determine severity versus presence of carpal tunnel syndrome (CTS) across existing electrodiagnostic-based (EDX) classification systems in patients with type 2 diabetes or bifid anatomy.
Retrospective analysis of cross-sectional patient data. Receiver operating characteristic analysis used to determine median nerve CSA cutoff values and associated diagnostic likelihood ratios for all consolidated and binary EDX-based classifications of CTS in patients with type 2 diabetes or bifid anatomy. Determine shifts in diagnostic probability based on established cutoff values and associated likelihood ratios. Distal CSA measured at or near carpal tunnel inlet, proximal CSA at level of pronator quadratus muscle, and delta CSA by subtracting proximal from distal.
Binary categorizations of CTS were statistically superior to consolidated categorizations of CTS severity in patients with type 2 diabetes or bifid anatomy. Binary categorizations established reasonably consistent median nerve CSA cutoff values across all EDX-based classifications examined resulting in the following for distal CSA or delta CSA: ≤10 or ≤4 mm to rule out and ≥11 or ≥5 mm to rule in CTS, respectively. These cutoff values resulted in small shifts in diagnostic probability in patients with type 2 diabetes and small to conclusive shifts in diagnostic probability in patients with bifid anatomy.
Binary categorizations to rule out or rule in CTS based on the proposed cutoff values provide the most meaningful information about shifts in diagnostic probability across all EDX-based classifications examined. The use of median nerve CSA to categorize severity of CTS is not recommended in patients with type 2 diabetes or bifid anatomy.
评估正中神经横截面积（CSA）在2型糖尿病患者或二分解剖结构患者中，根据现有的基于电诊断（EDX）的分类系统来确定腕管综合征（CTS）严重程度与存在情况的诊断准确性。
对横断面患者数据进行回顾性分析。采用受试者工作特征分析来确定2型糖尿病患者或二分解剖结构患者中CTS所有综合及二元EDX分类的正中神经CSA临界值及相关诊断似然比。根据既定临界值及相关似然比确定诊断概率的变化。在腕管入口处或其附近测量远端CSA，在旋前方肌水平测量近端CSA，并通过远端减去近端计算差值CSA。
在2型糖尿病患者或二分解剖结构患者中，CTS的二元分类在统计学上优于CTS严重程度的综合分类。二元分类在所有检查的基于EDX的分类中建立了合理一致的正中神经CSA临界值，对于远端CSA或差值CSA分别为：≤10或≤4毫米以排除CTS，≥11或≥5毫米以诊断CTS。这些临界值导致2型糖尿病患者的诊断概率有小的变化，二分解剖结构患者的诊断概率有小到确定性的变化。
基于提议的临界值排除或诊断CTS的二元分类提供了关于所有检查的基于EDX的分类中诊断概率变化的最有意义信息。不建议在2型糖尿病患者或二分解剖结构患者中使用正中神经CSA对CTS严重程度进行分类。
