Correlation between Ultrasonography Findings and Electrodiagnostic Severity in Carpal Tunnel Syndrome: 3D Ultrasonography

Abstract

Background and PurposeTo determine the correlation between the cross-sectional area (CSA) of the median nerve measured at the wrist using three-dimensional (3D) ultrasonography (US) and the electrophysiological severity of carpal tunnel syndrome (CTS).MethodsWe prospectively examined 102 wrists of 51 patients with clinical CTS, which were classified into 3 groups according to the electrodiagnostic (EDX) findings. Median nerve CSAs were measured using 3D US at the carpal tunnel inlet and at the level of maximal swelling.ResultsTen wrists were negative for CTS. Of the 92 CTS-positive wrists, 23, 30, and 39 were classified as having mild, moderate, and severe CTS, respectively. The median nerve CSA differed significantly between the severe- and moderate-CTS groups (p=0.0007 at the carpal tunnel inlet and p<0.0001 at the maximal swelling site). There was a correlation between median nerve CSA and EDX parameters among those wrists with severe and mild CTS (p<0.0001 at both sites).ConclusionsThe median nerve CSA as measured by 3D US could provide additional information about the severity of CTS, as indicated by the strong correlation with standard EDX findings.

The significance of muscle echo intensity on ultrasound for focal neuropathy: The median- to ulnar-innervated muscle echo intensity ratio in carpal tunnel syndrome

“…Recent technologic advances in high-resolution ultrasound (US) have broadened its application to neuromuscular disorders (Buchberger et al, 1992;Koenig et al, 2009;Kwon et al, 2014;Tawfik et al, 2015). Compared to MRI, US is a less expensive and more readily available imaging modality.…”

Evaluation Of freehand high‐resolution 3‐dimensional ultrasound of the median nerve

“…For the purpose of testing examiner experience on CSA assessment, the MN was examined with 3DUS over a distance of 20 cm, which covers almost the entire forearm and is more than 3 times the distance examined in the study by Girtler and colleagues . In contrast to all previous studies, we used freehand 3DUS, which makes ultrasound scanning similar to a conventional 2DUS examination and would also allow scanning of more complex anatomical regions like the ulnar nerve at the flexed elbow or nerves in the lower extremities. Nerve evaluation and measurement of CSA at randomly assigned measuring points within the virtual 3D volume was possible offline in 93.2% and 91.2% of the images, respectively.…”

“…Therefore, subsequent studies should focus on the potential benefit of 3DUS in combination with electrophysiology in different diseases of the peripheral nervous system such as entrapment syndromes or the heterogeneous groups of both immune‐related and hereditary neuropathies, including follow‐up examinations. Pyun and colleagues have already demonstrated that 3DUS can be used for examination of CTS …”

“…Moreover, 3DUS would also allow an exact perpendicular alignment of all spatial planes to the nerve's course which, in turn, may allow an even more accurate measurement of CSA. Recently, 3DUS of upper extremity peripheral nerves in healthy subjects and in patients with CTS was shown to be feasible . However, those studies lacked comparison with 2DUS, which lowers their significance and additional benefit.…”

Ultrasonography in evaluating the character of lesions of the median nerve in carpal tunnel syndrome

“…Корреляция УС-и ЭНМГ-показателей проводится с целью выявления чувствительности и специфичности ме-тода УСИ в диагностике и степени тяжести клинических проявлений СЗК [17,18]. Однако в данных исследованиях не проводится оценка характера поражения нерва.…”