ObjectivesUltrasound is widely used in diagnosing carpal tunnel syndrome (CTS). However, the limitations of ultrasound in CTS detection are the lack of objective measures in the detection of nerve abnormality and the operator‐dependent nature of ultrasound imaging. Therefore, in this study, we developed and proposed externally validated artificial intelligence (AI) models based on deep‐radiomics features.MethodsWe have used 416 median nerves from 2 countries (Iran and Colombia) for the development (112 entrapped and 112 normal nerves from Iran) and validation (26 entrapped and 26 normal nerves from Iran, and 70 entrapped and 70 normal nerves from Columbia) of our models. Ultrasound images were fed to the SqueezNet architecture to extract deep‐radiomics features. Then a ReliefF method was used to select the clinically significant features. The selected deep‐radiomics features were fed to 9 common machine‐learning algorithms to choose the best‐performing classifier. The 2 best‐performing AI models were then externally validated.ResultsOur developed model achieved an area under the receiver operating characteristic (ROC) curve (AUC) of 0.910 (88.46% sensitivity, 88.46% specificity) and 0.908 (84.62% sensitivity, 88.46% specificity) with support vector machine and stochastic gradient descent (SGD), respectively using the internal validation dataset. Furthermore, both models consistently performed well in the external validation dataset, and achieved an AUC of 0.890 (85.71% sensitivity, 82.86% specificity) and 0.890 (84.29% sensitivity and 82.86% specificity), with SVM and SGD models, respectively.ConclusionOur proposed AI models fed with deep‐radiomics features performed consistently with internal and external datasets. This justifies that our proposed system can be employed for clinical use in hospitals and polyclinics.
Background: Ultrasonography is a diagnostic resource that serves as a complement in the evaluation of patients with carpal tunnel syndrome. The correlation of ultrasonography findings with nerve conduction studies can serve to classify new phenotypes and to evaluate therapeutic responses. Objectives: To determine the diagnostic sensitivity of ultrasound, the correlation between the cross-sectional area against the motor and sensitive latencies, and the capacity to differentiate the mild, moderate and severe degrees of the electrophysiological classification of carpal tunnel syndrome. Methods: A cross-sectional study with prospective data collection was carried out. An ultrasonography system with a 15 MHz transducer was used. Nerve conduction studies of the median nerve were performed with conventional techniques. Data from the most symptomatic hand were used. Determination of the correlations of nerve diameter with motor and sensitive latencies of the median nerve was performed in four age groups: 40 (n=11), 40-54 (n=47), 55-70 (n=42) y >70 (n=27). Results : A total of 127 patients were evaluated (average age = 58.2 years: minimum = 26; maximum = 85; SD = 13.4); female patients 109 (85.8%). According to the electrophysiological classification, mild = 40 (31.5%) were found; moderate = 60 (47.2%); and severe = 27 (21.3%).Significant differences in the area of the median nerve were found between the electrophysiological types (mild, moderate and severe; p = 0.000). The diagnostic sensitivity of ultrasonography differed for each age group. The capacity for ultrasonography to classify the degrees of electrophysiological severity was different for each age group. Conclusions: There is a well-defined and significant correlation between nerve conduction studies and median nerve diameter in patients with Carpal Tunnel Syndrome. However, the exclusive use of the ultrasonographic measurement of the cross sectional area would not be enough to confirm or rule out an entrapment of the median nerve through the carpal tunnel, nor to predict in every case their electrophysiological severity.
Introduction: Pompe disease is characterized by the deficiency of the acid alfa glucosidase enzyme, which leads to a glycogen accumulation mainly in cardiac and skeletal muscles. Its onset may be early or late; the late form is more difficult to handle given the variety of presentations. Enzyme replacement therapy has shown to improve gross motor function and lung function in patients.Case description: Female patient who presented chronic quadriparesis. She was diagnosed with Pompe disease, which required enzyme replacement therapy that helped improve the symptoms, which was evident with the performance of rapid functional evaluation tests.Discussion: Enzyme replacement therapy in Pompe disease modifies the natural history of the disease. A brief review of the literature about the functional tests that can be used to assess a patient with this disorder is presented.Conclusion: The 10-meter walk test, one-leg stance test, cervical flexion in supine position, five times sit to stand test, and coin rotation task are useful for clinical evaluation in patients with Pompe disease receiving enzyme replacement therapy.
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