The value of power and pulsed Doppler in the diagnosis of CTS: Is a solution in sight

Systematic Review of the Use of Power Doppler Ultrasound in the Imaging of Peripheral Nerve Compression Neuropathy

“…Some studies examined the ability of power Doppler ultrasound to classify disease severity. 7,8,11,13,22,[26][27][28]33,34,36,38 Multivariate and linear regression analyses of diagnostic factors were performed in a few studies. 31,32,36 Some researchers looked at accuracy in detecting prognosis of treatment and patient satisfaction.…”

“…Others used computer software to quantitatively evaluate the area of vascular flow 34 or pixel intensity, 26,37 although a few investigators either counted power Doppler signals, 8,32,36 or used the presence or absence of visible signal as a binary metric. 13,21,[29][30][31][32]36,[38][39][40] One study only counted intraneural power Doppler signals visualized before signals in other structures, particularly the flexor tendons. 24…”

“…The rest were cross-sectional studies, and only a few were multicenter. 38,40 Population Studies evaluated a total of 2220 extremities in 1751 patients diagnosed with or suspected of having compression neuropathy of the median (2048 in 1582 patients) or ulnar nerve 13,39,40 (172 in 169 patients). Typical inclusion criteria were adult patients with suspected or confirmed diagnosis of idiopathic carpal tunnel syndrome or cubital tunnel syndrome.…”

“…24,[29][30][31] Comparator Clinical diagnosis was the reference standard in nine studies, 16,24,27,[31][32][33][38][39][40] and electrophysiologic diagnosis was the reference standard in the rest. Almost all studies compared power Doppler ultrasound with at least one other form of ultrasound, whereas some compared it to electrodiagnostic studies, 7,8,11,13,[20][21][22][23][25][26][27][29][30][31][32][33][34][35][36][37][38][39] magnetic resonance imaging, 25 patient-reported outcomes, 7,20,23,35 or other measures. 51e Intervention All included studies used power Doppler ultrasound either alone or in combination with other diagnostic methods.…”

“…51e Intervention All included studies used power Doppler ultrasound either alone or in combination with other diagnostic methods. Most studies used both grayscale and power Doppler ultrasound, whereas some used multiple ultrasonography settings to detect flow, including color Doppler, spectral Doppler, and superb microvascular imaging, either to confirm power Doppler signals 8,11,13,26,29,30,32,33,36,38 or compare ultrasonography techniques. 22,27,37 The majority of studies used electrodiagnostic studies for confirmation of diagnosis, stratification of patients by disease severity, or comparison with ultrasonographic results.…”