IntroductionCarpal tunnel syndrome (CTS) is a common compression neuropathy of the median nerve in the wrist. Early diagnosis of CTS is essential for selecting treatment options and assessing prognosis. The current diagnosis of CTS is based on the patient's clinical symptoms, signs, and an electromyography (EMG) test. However, they have some limitations. Recently, ultrasound has been adopted as an adjunct diagnostic tool for electromyography (EMG). Ultrasound is a non-invasive and cost-effective technique. It provides a dynamic display of morphological changes in the median nerve and an assessment of CTS etiology such as tenosynovitis, mass compression, and tendon disease. This study aimed to investigate the value of conventional ultrasound and real-time shear wave elastography (SWE) in evaluation of median neuropathy in patients with carpal tunnel syndrome (CTS) before and after surgery.MethodsFirst, the Boston Carpal Tunnel Questionnaire (BCTQ) was administered to patients with CTS. All subjects were measured at three levels: the distal 1/3 of the forearm, the carpal tunnel inlet, and the distal carpal tunnel using conventional ultrasound and SWE. Median nerve parameters were examined in patients with CTS 1 week after surgery.ResultsThe cross-sectional area (CSA) and stiffness of the median nerve at the carpal tunnel inlet and distal carpal tunnel were significantly higher in patients with CTS than in healthy controls (p < 0.001). The CSA and stiffness of the median nerve at the carpal tunnel inlet were statistically significantly significantly between pre- and postoperative patients with CTS (p < 0.001). The CSA and stiffness of the nerve in patients with CTS had a positive correlation with electrophysiology severity.Conclusions and discussionConventional ultrasound and elastography are valuable in the diagnosis of CTS and are useful in the clinical assessment of patient's nerve recovery after operation.

Background To develop a nomogram model combining gray-scale ultrasound and virtual touch tissue imaging quantification (VTIQ) characteristics to predict axillary lymph node metastasis (ALNM) in ultrasound (US)-diagnosed N0 breast cancer patients. Methods A total of 567 patients enrolled in this study from April 2017 to May 2022, including 395 patients in the primary cohort and 172 patients in the external validation cohort. These are patients who are undergoing upfront surgery (no neoadjuvant treatment). Their preoperative gray-scale ultrasound images and VTIQ parameters were collected and used to develop a nomogram with internal and external validation for the prediction of occult ALNM. Results Three gray-scale ultrasound characteristics (age, margin, and distance from the nipple) and one VTIQ parameter (Emax) were identified as independent risk factors in univariate and multivariate analyses. The nomogram showed an area under the curves of 0.843 and 0.869 in the training and external validation cohorts, respectively, indicating good calibration. Conclusions The nomogram model can predict occult ALNM with relatively high accuracy. It is expected to be a non-invasive, easy, quick, and affordable supplement to traditional axillary ultrasound (AUS), which can help to determine appropriate axillary treatment for US-diagnosed N0 breast cancer patients.