Correlation Between the Severity of Carpal Tunnel Syndrome and Color Doppler Sonography Findings

Mohammadi, Afshin; Ghasemi-Rad, Mohammad; Mladkova-Suchy, Nikol; Ansari, Sanam

doi:10.2214/ajr.11.7012

Cited by 63 publications

(59 citation statements)

References 18 publications

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“…To compensate, perineural veins may dilate and cause hyperemia and hypervascularization, which could be detected by NMUS [35]. We found hypervascularization in the median nerve in 16 patients and in the peroneal nerve in 7 patients.…”

Section: Discussionmentioning

confidence: 73%

Diagnostic accuracy of quantitative neuromuscular ultrasound for the diagnosis of intensive care unit-acquired weakness: a cross-sectional observational study

Witteveen

Sommers

Wieske

et al. 2017

Ann. Intensive Care

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BackgroundNeuromuscular ultrasound is a noninvasive investigation, which can be easily performed at the bedside on the ICU. A reduction in muscle thickness and increase in echo intensity over time have been described in ICU patients, but the relation to ICU-acquired weakness (ICU-AW) is unknown. We hypothesized that quantitative assessment of muscle and nerve parameters with ultrasound can differentiate between patients with and without ICU-AW. The aim of this cross-sectional study was to investigate the diagnostic accuracy of neuromuscular ultrasound for diagnosing ICU-AW.MethodsNewly admitted ICU patients, mechanically ventilated for at least 48 h, were included. As soon as patients were awake and attentive, an ultrasound was made of four muscles and two nerves (index test) and ICU-AW was evaluated using muscle strength testing (reference standard; ICU-AW defined as mean Medical Research Council score <4). Diagnostic accuracy of muscle thickness, echo intensity and homogeneity (echo intensity standard deviation) as well as nerve cross-sectional area, thickness and vascularization were evaluated with the area under the curve of the receiver operating characteristic curve (ROC–AUC). We also evaluated diagnostic accuracy of z-scores of muscle thickness, echo intensity and echo intensity standard deviation.ResultsSeventy-one patients were evaluated of whom 41 had ICU-AW. Ultrasound was done at a median of 7 days after admission in patients without ICU-AW and 9 days in patients with ICU-AW. Diagnostic accuracy of all muscle and nerve parameters was low. ROC–AUC ranged from 51.3 to 68.0% for muscle parameters and from 51.0 to 66.7% for nerve parameters.ConclusionNeuromuscular ultrasound does not discriminate between patients with and without ICU-AW at the time the patient awakens and is therefore not able to reliably diagnose ICU-AW in ICU patients relatively early in the disease course.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0263-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 73%

Diagnostic accuracy of quantitative neuromuscular ultrasound for the diagnosis of intensive care unit-acquired weakness: a cross-sectional observational study

Witteveen

Sommers

Wieske

et al. 2017

Ann. Intensive Care

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“…A significant correlation between nerve cross-sectional area and all conventional measures of CTS severity, including clinical scales, hand function, and neurophysiological classification, has been found [43] in some but not all studies. Of interest, a recent study reported that hypervascularity, detected by ultrasound, correlated with the severity of nerve damage, assessed by neurophysiology [36, 37]. …”

Section: Compressive Neuropathymentioning

confidence: 99%

Ultrasonography of Peripheral Nerves

Suk

Walker

Cartwright

2013

Curr Neurol Neurosci Rep

108

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Over the last decade, neuromuscular ultrasound has emerged as a useful tool for the diagnosis of peripheral nerve disorders. This article reviews sonographic findings of normal nerves including key quantitative ultrasound measurements that are helpful in the evaluation of focal and possibly generalized peripheral neuropathies. It also discusses several recent papers outlining the evidence base for the use of this technology, as well as new findings in compressive, traumatic, and generalized neuropathies. Ultrasound is well suited for use in electrodiagnostic laboratories where physicians, experienced in both the clinical evaluation of patients and the application of hands-on technology, can integrate findings from the patient’s history, physical examination, electrophysiological studies, and imaging for diagnosis and management.

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“…10 Normal and pathologic reference values for the cross-sectional area of the median nerve have been suggested, with the upper limit of normal generally approximating 9 mm 2 at the carpal tunnel. 15–18 …”

mentioning

confidence: 99%

Reliability Assessment of Various Sonographic Techniques for Evaluating Carpal Tunnel Syndrome

Junck

Escobedo

Lipa

et al. 2015

J of Ultrasound Medicine

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Objectives The aim of this study was to determine the intra- and inter-rater reliability of sonographic measurements of the median nerve cross-sectional area in individuals with carpal tunnel syndrome and healthy control participants. Methods The median nerve cross-sectional area was evaluated by sonography in 18 participants with carpal tunnel syndrome (18 upper extremities) and 9 control participants (18 upper extremities) at 2 visits 1 week apart. Two examiners, both blinded to the presence or absence of carpal tunnel syndrome, captured independent sonograms of the median nerve at the levels of the carpal tunnel inlet, pronator quadratus, and mid-forearm. The cross-sectional area was later measured by each examiner independently. Each also traced images that were captured by the other examiner. Results Both the intra- and inter-rater reliability rates were highest for images taken at the carpal tunnel inlet (radiologist, r = 0.86; sonographer, r = 0.87; inter-rater, r = 0.95; all P < .0001), whereas they was lowest for the pronator quadratus (r = 0.49, 0.29, and 0.72, respectively; all P < .0001). At the mid-forearm, the intra-rater reliability was lower for both the radiologist and sonographer, whereas the inter-rater reliability was relatively high (r = 0.54, 0.55, and 0.81; all P < .0001). Tracing of captured images by different examiners showed high concordance for the median cross-sectional area at the carpal tunnel inlet (r = 0.96–0.98; P < .0001). Conclusions The highest intra- and inter-rater reliability was found at the carpal tunnel inlet. The results also demonstrate that tracing of the median nerve cross-sectional area from captured images by different examiners does not contribute significantly to measurement variability.

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Correlation Between the Severity of Carpal Tunnel Syndrome and Color Doppler Sonography Findings

Abstract: Our study suggests that the severity of CTS strongly correlates with color Doppler sonography findings, and this technique may represent a reliable complementary tool in CTS examination.

Cited by 63 publications

References 18 publications

Diagnostic accuracy of quantitative neuromuscular ultrasound for the diagnosis of intensive care unit-acquired weakness: a cross-sectional observational study

Diagnostic accuracy of quantitative neuromuscular ultrasound for the diagnosis of intensive care unit-acquired weakness: a cross-sectional observational study

Ultrasonography of Peripheral Nerves

Reliability Assessment of Various Sonographic Techniques for Evaluating Carpal Tunnel Syndrome

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