Zou Qijiu, Guo Xiaoli, Ni Xuejun, Chen Xiaoyang, Xu Cheng, Yin Yifei, Huang Chen
Department of Ultrasound, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China.
Department of Radiology, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China.
Br J Radiol. 2025 Jan 1;98(1165):58-67. doi: 10.1093/bjr/tqae189.
Carpal tunnel syndrome (CTS) is a prevalent neuropathy where accurate diagnosis is crucial for effective treatment planning. This study introduces a novel approach for CTS grading using ultrasound, specifically through the analysis of the cross-sectional area (CSA) and shear wave elastography (SWE) of the median nerve in various wrist positions.
Our research involved subjects from outpatient clinics, diagnosed with CTS through nerve conduction studies (NCS), and a control group of healthy individuals. High-frequency ultrasound and SWE measurements were conducted in 3 wrist positions: straight, 45° extension, and 45° flexion.
The key findings revealed significant differences in median nerve CSA and SWE values between the CTS and control groups across all wrist positions, with notable variances in SWE values correlating with wrist positioning. SWE demonstrated enhanced sensitivity and specificity in distinguishing between mild, moderate, and severe CTS, especially at 45° wrist flexion. In contrast, CSA measurements were limited in differentiating between the varying severity stages of CTS.
The study concludes that SWE, particularly at 45° wrist flexion, provides a more precise diagnostic benchmark for CTS severity grading than CSA. This advancement in non-invasive diagnostic methodology not only aids in accurate CTS grading but also has significant implications in formulating tailored treatment strategies, potentially reducing the reliance on more invasive diagnostic methods like NCS.
This study marks a significant advancement in the ultrasound diagnosis of CTS. It particularly highlights the importance of applying SWE technology across various wrist joint angles, offering a new diagnostic benchmark. This discovery provides data support and additional insights for achieving an early consensus on ultrasound-based grading diagnosis of CTS.
腕管综合征（CTS）是一种常见的神经病变，准确诊断对于有效治疗方案的制定至关重要。本研究引入了一种使用超声对CTS进行分级的新方法，具体是通过分析正中神经在不同腕部位置的横截面积（CSA）和剪切波弹性成像（SWE）。
我们的研究纳入了来自门诊诊所、经神经传导研究（NCS）诊断为CTS的受试者以及一组健康个体作为对照组。在3个腕部位置进行高频超声和SWE测量：伸直、45°伸展和45°屈曲。
关键发现显示，在所有腕部位置，CTS组和对照组之间正中神经CSA和SWE值存在显著差异，SWE值的显著差异与腕部位置相关。SWE在区分轻度、中度和重度CTS方面表现出更高的敏感性和特异性，尤其是在腕部45°屈曲时。相比之下，CSA测量在区分CTS不同严重程度阶段方面存在局限性。
该研究得出结论，SWE，尤其是在腕部45°屈曲时，比CSA为CTS严重程度分级提供了更精确的诊断基准。这种非侵入性诊断方法的进步不仅有助于准确的CTS分级，而且在制定个性化治疗策略方面具有重要意义，可能减少对如NCS等更具侵入性诊断方法的依赖。
本研究标志着CTS超声诊断的重大进展。它特别强调了在不同腕关节角度应用SWE技术的重要性，提供了一个新的诊断基准。这一发现为在基于超声的CTS分级诊断上达成早期共识提供了数据支持和更多见解。
