Diagnosis of Carpal Tunnel Syndrome using Shear Wave Elastography and High-frequency Ultrasound Imaging

Nam, Kibo; Peterson, Shawn M.; Wessner, Corinne E.; Machado, Priscilla; Forsberg, Flemming

doi:10.1016/j.acra.2020.08.011

“…In addition to the advantages of safety and noninvasiveness, short detection time, and low cost, high-frequency ultrasound can be used to assess parameters such as the size, blood flow, and mobility of the cross-sectional area of the median nerve [ 9 ]. In addition, high-frequency ultrasound can also provide anatomical variations and morphological changes of the median nerve, which helps to identify the factors causing carpal tunnel syndrome [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Wrist Dorsiflexion/Palmar Flexion on Median Nerve Deviation and Cross-Sectional Area in Patients with Carpal Tunnel Syndrome

Xu

¹

,

Ma

²

,

Zhang

³

et al. 2023

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Objective. To evaluate the effect of wrist dorsiflexion/palmar flexion on median nerve excursion and cross-sectional area in patients with carpal tunnel syndrome. Methods. From November 2019 to December 2021, 85 patients (110 affected wrists) who presented to our department and were diagnosed with carpal tunnel syndrome were collected and classified by severity as mild to moderate. Twenty-five healthy controls were selected during the same period, with a total of 50 healthy wrists. All patients and healthy volunteers underwent high-frequency ultrasonography to measure the vertical deviation between the median nerve and the transverse carpal ligament during wrist dorsiflexion/palmar flexion and the changes in the cross-sectional area of the median nerve in the pisiform plane. All patients with carpal tunnel syndrome underwent neurophysiological testing to measure median nerve sensory conduction velocity, sensory latency time, and sensorimotor point fluctuation amplitude. Results. The mean age of the patients was 50 ± 8 years, the proportion of males was 18%, and the disease course was 2.3 ± 1.2 years. In terms of severity grading, 38 patients (34.5%) had mild carpal tunnel syndrome, 30 patients (27.3%) had moderate carpal tunnel syndrome, and 42 patients (38.2%) had severe carpal tunnel syndrome. Compared with the control group, the distance between the proximal median nerve and the transverse carpal ligament, the distance between the distal median nerve and the transverse carpal ligament, and the cross-sectional area were decreased in the carpal tunnel syndrome group compared with those during wrist dorsiflexion, and the differences were statistically significant ( P < 0.05 ). Compared with the control group, there were significant differences in the vertical distance and cross-sectional area between the median nerve and the transverse carpal ligament at the proximal and distal ends in the mild, moderate, and severe groups ( P < 0.05 ). The proximal vertical distance of the median nerve was positively correlated with sensory latency ( P < 0.05 ) and negatively correlated with sensory conduction velocity ( P < 0.05 ). The vertical distance of the distal end of the median nerve was also significantly positively correlated with sensory latency ( P < 0.05 ) and significantly negatively correlated with sensory conduction velocity ( P < 0.05 ). Conclusion. Wrist dorsiflexion/palmar flexion can affect median nerve deviation and cross-sectional area in patients with carpal tunnel syndrome. High-frequency ultrasound is helpful to detect such an effect and can also help determine the severity of carpal tunnel syndrome, which is worthy of clinical promotion.

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“…The potential clinical value of this advanced technology and how it could significantly change clinical management were illustrated in several researches. [ 14 , 22 ] To gain clarity, in this study, we will perform a systematic review to summarize high-quality studies and to provide evidence on the evidence-based medical support for clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Superb microvascular imaging for detecting carpal tunnel syndrome compared with power Doppler ultrasonography

Zhang

¹

,

Zhu²,

Lin

³

et al. 2021

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Background: Sonography enhances diagnostic accuracy by the detection of the epineural or intraneuronal blood flow. [ 1 – 4 ] Power Doppler ultrasonography (PDUS) in carpal tunnel syndrome (CTS) has been previously studied and shown to be valid and reliable for grading the intraneural flow. [ 3 , 4 ] However, superb microvascular imaging (SMI) represents a new era in diagnostic sonography, and this new technology enables accurate visualization of vascular structures with intensive clutter suppression to provide flow signals for large to small vessels, and it presents these data at high frame rates. [ 5 – 7 ] Studies suggested that SMI is more sensitive in demonstrating blood flow in the diagnosis of CTS compared with PDUS. [ 7 ] In order to gain clarity, a meta-analysis to systematically review and synthesize relevant data on the evaluating intraneural blood flow of the median nerve (MN) using SMI and PDUS was undertaken. Methods: We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the December 31, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata 14.0 software will be used for data analysis. Results: This systematic review will investigate whether superb microvascular imaging is more sensitive to display the blood flow in the MN with CTS than PDUS. Conclusion: Its findings will provide strong evidence for the feasibility of superb microvascular imaging on the detection of the neovascularization of the MN with CTS. Systematic review registration: INPLASY202110018.

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“…Blood flow images were obtained using colour Doppler imaging (CDI) and PDI as well as using colour-coded and monochrome SMI (cSMI and mSMI). 21 29 The imaging settings for each technique such as colour map, gain, postprocessing filter, focus, and frequency were kept the same for all subjects.…”

Section: Methodsmentioning

confidence: 99%

Ultrasound quantitative assessment of ventral finger microvasculopathy in systemic sclerosis with Raynaud’s phenomena: a comparative study

Nam

¹

,

Mendoza

²

,

Wessner

³

et al. 2023

Self Cite

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ObjectiveTo assess the finger vascularity of systemic sclerosis patients with Raynaud’s phenomenon (RP-SSc) using various ultrasound techniques.MethodsAll fingers (except thumbs) of 18 RP-SSc patients and 18 controls were imaged at room temperature using four ultrasound vascular imaging techniques. The percent vascular area was quantified by counting blood flow pixels in a 25 mm2square centred at the nail fold for the dorsal side and in 25 mm2and 100 mm2square from the fingertip for the ventral side. The mean vascular intensity was calculated from the corresponding areas for dorsal and ventral sides.ResultsThe percent vascular areas and mean vascular intensities in RP-SSc were significantly lower than those in controls for both dorsal and ventral sides (p<0.01). The mean vascular intensities showed slightly higher area under the curve (AUC) than the percent vascular areas (0.53–0.91 vs 0.53–0.90) regardless of imaging technique and assessment side. For each imaging technique, the ventral side vascularity showed a higher AUC (0.74–0.91) compared with the dorsal side (0.53–0.81). Moreover, ventral side abnormalities were associated with a history of digital ulcers.ConclusionsUltrasound demonstrated potential to quantify finger vascularity of RP-SSc. The ventral side of the fingers showed a higher accuracy in detecting RP-SSc than the dorsal side.

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Diagnosis of Carpal Tunnel Syndrome using Shear Wave Elastography and High-frequency Ultrasound Imaging

Cited by 24 publications

References 38 publications

Effect of Wrist Dorsiflexion/Palmar Flexion on Median Nerve Deviation and Cross-Sectional Area in Patients with Carpal Tunnel Syndrome

Effect of Wrist Dorsiflexion/Palmar Flexion on Median Nerve Deviation and Cross-Sectional Area in Patients with Carpal Tunnel Syndrome

Superb microvascular imaging for detecting carpal tunnel syndrome compared with power Doppler ultrasonography

Ultrasound quantitative assessment of ventral finger microvasculopathy in systemic sclerosis with Raynaud’s phenomena: a comparative study

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