Which Ultrasound Parameter Is More Accurate in the Diagnosis of Carpal Tunnel Syndrome

Çiloğlu, Osman; Görgülü, Feride Fatma

doi:10.1097/phm.0000000000001464

Cited by 6 publications

(9 citation statements)

References 10 publications

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“…The diagnostic tests evaluated and their weighted mean sensitivity and specificity are outlined in Tables 2 and 3. 16-128 Although studies utilizing “clinical diagnosis” as a reference standard were treated as a unified subset, many studies 16-128 were found to utilize different definitions of clinical diagnosis. An outline of the utilized definitions for “clinical diagnosis” is presented in Supplemental Digital Content 1.…”

Section: Resultsmentioning

confidence: 99%

The Impact of Reference Standard on Diagnostic Testing Characteristics for Carpal Tunnel Syndrome: A Systematic Review

Bennett

Sears

2023

Plastic and Reconstructive Surgery - Global Open

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Background: Lack of a reliable reference standard for carpal tunnel syndrome (CTS) diagnosis could impact the diagnostic test characteristics. This systematic review sought to evaluate differences in the accuracy of CTS diagnostic modalities based on the reference standard used. Methods: A systematic review was performed following PRISMA guidelines to investigate diagnostic modalities used in CTS. A literature search of Embase, PubMed, and Cochrane Reviews was conducted for the years of 2010–2021 for primary data, and 113 studies met final inclusion criteria. Studies were stratified based on the reference standard utilized and diagnostic modality assessed, and the weighted means of the sensitivities and specificities were calculated. Results: Thirty-five studies used clinical diagnosis alone as a reference standard, and 78 studies used electrodiagnostic study (EDS). The specificity for MRI and ultrasound (US) were substantially lower when EDS was used as the reference standard. MRI was the test most affected by the reference standard used, showing increased sensitivity when using EDS as the reference compared to clinical diagnosis (77.1% versus 60.9%) and decreased specificity (87.6% versus 99.2%). Regardless of the reference standard used, all tests had anticipated false-positive and/or false-negative rates of at least 10%. Conclusions: Testing characteristics vary greatly based on the choice of reference standard, with the sensitivity of MRI most affected. Regardless of reference standard used, EDS, US, and MRI each had false-positive and/or false-negative rates too great to be appropriate for use as a screening examination.

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Section: Resultsmentioning

confidence: 99%

The Impact of Reference Standard on Diagnostic Testing Characteristics for Carpal Tunnel Syndrome: A Systematic Review

Bennett

Sears

2023

Plastic and Reconstructive Surgery - Global Open

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“…However, those studies with a positive correlation with EDX severity noted that the ability of ultrasound to differentiate between the moderate and severe groups was poor 17,24 . A recent study by Ciloglu et al found that CSA was able to differentiate between the mild/moderate and severe groups of the Padua EDX protocol using a cutoff of 15 cm 2 ; however, they had a fairly low sample size of only 36 wrists 15 . In our study, ∆CSA had poor concordance with both CSI severity categories and Bland severity grading.…”

Section: Discussionmentioning

confidence: 98%

“…Roll and colleagues concluded that the lack of standardized methodology has made it difficult to determine the diagnostic utility of ultrasound in CTS evaluation 13 . Additionally, the current literature is conflicting on whether ultrasound parameters can be used to determine CTS severity grading, 12,14‐17 which limits utility of ultrasound diagnostics because severity grading may be used to predict surgical outcome and guide treatment 6,7,18,19 . This indicates that further studies are necessary to characterize the diagnostic accuracy of the ultrasound measurements.…”

Section: Introductionmentioning

confidence: 99%

Assessing Diagnostic and Severity Grading Accuracy of Ultrasound Measurements for Carpal Tunnel Syndrome Compared to Electrodiagnostics

Chen

Olson

Lee

et al. 2021

PM&R

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Background The combined sensory index (CSI) is the most sensitive electrodiagnostic criteria for carpal tunnel syndrome (CTS), and the CSI and Bland criteria have been shown to predict surgical treatment outcomes. The proposed ultrasound measurements have not been assessed against the CSI for diagnostic accuracy and grading of CTS severity. Objective To investigate the use of ultrasound evaluations for both diagnosis and assessment of severity grading of CTS in comparison to electrodiagnostic assessment. Design All patients underwent an electrodiagnostic evaluation using the CSI and Bland severity grading. Each patient underwent an ultrasound evaluation including cross‐sectional area (CSA), the change in CSA from the forearm to the tunnel (∆CSA), and the wrist‐forearm ratio (WFR). These measurements were assessed for diagnostic and severity grading accuracy using the CSI as the gold standard. Setting Tertiary academic center. Participants All patients referred for electrodiagnostic evaluation for CTS were eligible for the study. Only those with idiopathic CTS were included and those with prior CTS treatment were also excluded. Ninety‐five patients were included in the study. Interventions Not applicable. Main Outcome Measures The primary study outcome measure was concordance between CSI diagnosis and severity categories and the ultrasound measurements. Both outcomes were also assessed using Bland criteria. Results Optimal cut‐points for diagnosis of CTS were found to be CSA ≥12 mm2, ∆CSA ≥4 mm2, WFR ≥1.4. Using these cut‐points, C‐statistics comparing diagnosis of CTS using ultrasound measurements versus using the CSI ranged from 0.893‐0.966. When looking at CSI severity grading compared to ∆CSA, however, the C‐statistics were 0.640‐0.661 with substantial overlap between severity groups. Conclusions Although ultrasound measurements had high diagnostic accuracy for CTS based on the CSI criteria, ultrasound measurements were unable to adequately distinguish between CSI severity groups among patients with CTS.

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“…[9][10][11] These reference values have been based on either healthy control subjects (i.e., normal values), providing the 95% confidence interval of a nerve CSA for a given population, or on diagnostic studies in patients and controls using a receiver operating curve analysis for optimal sensitivity and specificity in specific disorders (i.e., disease specific cut-offs), such as carpal tunnel syndrome (CTS). 12,13 Normal values provide a sensitive means of detecting nerve pathology, but they are nonspecific, whereas disease-specific cut-offs have a known, deliberately chosen, specificity. However, diseasespecific reference values are only validated for use in patients having (only) that particular disease from which the values were derived.…”

Section: Various Sets Of Reference Values Have Been Published For Manymentioning

confidence: 99%

“…Various sets of reference values have been published for many nerves in different populations to help detect the presence of possible abnormalities 9–11 . These reference values have been based on either healthy control subjects (i.e., normal values), providing the 95% confidence interval of a nerve CSA for a given population, or on diagnostic studies in patients and controls using a receiver operating curve analysis for optimal sensitivity and specificity in specific disorders (i.e., disease specific cut‐offs), such as carpal tunnel syndrome (CTS) 12,13 . Normal values provide a sensitive means of detecting nerve pathology, but they are nonspecific, whereas disease‐specific cut‐offs have a known, deliberately chosen, specificity.…”

mentioning

confidence: 99%

The use and misuse of sonographic reference values in neuromuscular disease

Goedee

Alfen

2023

Muscle and Nerve

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Which Ultrasound Parameter Is More Accurate in the Diagnosis of Carpal Tunnel Syndrome

Cited by 6 publications

References 10 publications

The Impact of Reference Standard on Diagnostic Testing Characteristics for Carpal Tunnel Syndrome: A Systematic Review

The Impact of Reference Standard on Diagnostic Testing Characteristics for Carpal Tunnel Syndrome: A Systematic Review

Assessing Diagnostic and Severity Grading Accuracy of Ultrasound Measurements for Carpal Tunnel Syndrome Compared to Electrodiagnostics

The use and misuse of sonographic reference values in neuromuscular disease

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