Evaluation of the Transverse Carpal Ligament in Carpal Tunnel Syndrome by Shear Wave Elastography: A Non-Invasive Approach of Diagnosis and Management

Abstract

ObjectivesThe goal of this work is to determine the clinical value of the transverse carpal ligament (TCL) in carpal tunnel syndrome (CTS) for guiding subsequent treatment.MethodsThis study analyzed patients who underwent median nerve (MN) ultrasound (US) examination of the wrist from April 2020 to April 2021. The cross-sectional area and anteroposterior diameter of the MN, as well as the TCL thickness and stiffness, were measured from images. The intra-group and intra-patient subgroup differences were compared using a t-test and a rank test. We also utilized receiver operating characteristic (ROC) curves to diagnose CTS and evaluate the severity.ResultsThe final cohort consisted of 120 wrists (bilateral) from 60 samples, evenly balanced across the patient and control groups according to their CTS diagnosis. In the unilateral positive patient subgroup, the MN and TCL of the positive hand were significantly thicker and stiffer than the negative counterparts (both, p < 0.05). The values from the right were also thicker and stiffer than the left (both, p < 0.05) in patients with bilateral CTS. The MN and TCL of the patient group were also significantly thicker and stiffer than those of the control group (both, p < 0.001). For diagnosing CTS, the area under the curve (AUC) of TCL thickness and stiffness at the distal carpal tunnel (DCT) ranged between 0.925 and 0.967. For evaluating CTS severity, we found that the optimal TCL stiffness is sufficient for diagnosing mild and non-mild patient cases (AUC: Emean = 0.757, Emax = 0.779).ConclusionsShear wave elastography is therefore an effective method for CTS diagnosis and management.

Sonoelastography: A powerful technique in musculoskeletal imaging

“…Similar greater sensitivity of sonoelastography versus grayscale US for early stages of tendinopathy have been reported in the Achilles, quadriceps, biceps, supraspinatus, and other tendons 9,14–17 . Sonoelastography has also been applied to osteoarthritic cartilage, the transverse ligament in carpal tunnel syndrome, myopathies, ligaments, rheumatoid synovitis, methotrexate hepatotoxicity (important in rheumatology), meniscal disease, trigger finger, and musculoskeletal tumors with similar changes in elasticity of the relevant tissue with variable sensitivity and specificity for pathology versus alternative imaging methods 14–25 …”

“…The low cost, convenience, noninvasive nature, lack of ionizing radiation, direct relevance to palpable anatomy, point‐of‐care applicability, and increasing number of applications indicate that US will only increase in use in musculoskeletal medicine 1–4 . Sonoelastography is another powerful method available to observe the musculoskeletal system, and appears particularly valuable in detecting early tendinopathies, areas of myopathy suitable for biopsy, pursuing complaints of localized musculoskeletal pain, analyzing soft tissue masses, and research applications in musculoskeletal medicine 14–25 . Shear wave elastography in particular permits rapid quantitative assessments of musculoskeletal structures and will be particularly valuable at the beside, in research studies and clinical trials, and in monitoring disease presence, progression, and response to therapy, especially in muscle and tendon disease.…”

“…9,[14][15][16][17] Sonoelastography has also been applied to osteoarthritic cartilage, the transverse ligament in carpal tunnel syndrome, myopathies, ligaments, rheumatoid synovitis, methotrexate hepatotoxicity (important in rheumatology), meniscal disease, trigger finger, and musculoskeletal tumors with similar changes in elasticity of the relevant tissue with variable sensitivity and specificity for pathology versus alternative imaging methods. [14][15][16][17][18][19][20][21][22][23][24][25] US is increasingly becoming an extension of the physical examination in musculoskeletal medicine. 1 The low cost, convenience, noninvasive nature, lack of ionizing radiation, direct relevance to palpable anatomy, point-of-care applicability, and increasing number of applications indicate that US will only increase in use in musculoskeletal medicine.…”

“…[1][2][3][4] Sonoelastography is another powerful method available to observe the musculoskeletal system, and appears particularly valuable in detecting early tendinopathies, areas of myopathy suitable for biopsy, pursuing complaints of localized musculoskeletal pain, analyzing soft tissue masses, and research applications in musculoskeletal medicine. [14][15][16][17][18][19][20][21][22][23][24][25] Shear wave elastography in particular permits rapid quantitative assessments of musculoskeletal structures and will be particularly valuable at the beside, in research studies and clinical trials, and in monitoring disease presence, progression, and response to therapy, especially in muscle and tendon disease. It is anticipated that sonoelastography will increase in specificity, sensitivity, depth of imaging, and applications as the technology of this US method becomes increasingly sophisticated.…”

Machine learning and magnetic resonance imaging: Differentiating benign from malignant osseous tumors

“…Radiomics is an image analysis method that can be used to identify and measure characteristics in an image that are challenging or time‐consuming to accomplish manually or difficult to be reproducibility be defined by an observer 13–15 . Radiomics have been used extensively in diagnostic oncology, brain volumetric analysis, and cardiac imaging, and recently has been expanded to evaluation of the musculoskeletal system 15,16 .…”