The Diagnostic and Grading Value of Diffusion Tensor Imaging in Patients with Carpal Tunnel Syndrome

Bulut, Hacı Taner; Yıldırım, Adem; Ekmekçi, Burcu; Günbey, Hediye Pınar

doi:10.1016/j.acra.2014.02.009

Cited by 26 publications

(36 citation statements)

References 31 publications

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“…Ayrıca venül içi kan akışı da bozularak median sinir içindeki akson transportunda bozulmaya ve sonuçta median sinirde hasara neden olur (2,8). KTS olarak anılan bu klinik tablo, en sık görülen tuzak nöropatisidir (1)(2)(3)(4)(5)(6)(7)(8). KTS'nin en sık nedenleri arasında hipotroidizm, romatoid artrit, diabetes mellitus, amiloidoz gibi sistemik hastalıklar, kas ve tendonların anomalileri gibi konjenital varyasyonlar, travma, tümör, osteoartrit vb.…”

Section: Discussionunclassified

“…Klinik olarak KTS düşünülen ancak ENMG ile tanı konulmasında zorlanılan hastalarda tanıyı doğrulamada görüntü-leme yöntemlerinden (US, manyetik rezonans görüntüleme vb.) faydalanılabilmektedir (6)(7)(8). US, düşük maliyet ve kısa inceleme zamanı, radyasyon içermemesi, kolay ulaşılabilir olması, girişim-sel olmaması ve ucuz olması gibi avantajları yanında kullanıcıya bağımlı olması en önemli dezavantajıdır (2,10).…”

Section: Discussionunclassified

“…Bu çalışmalar, KTS tanısında median sinirin ve komşu diğer yapıların anatomik olarak incelenmesine olanak sağlayan ultrasonografinin (US) yararını ortaya koymuştur (1)(2)(3)(4)(5). US'nin yanısıra manyetik rezonans görüntüleme (MRG), KTS'de median sinire ait patolojik değişimleri göstermede alternatif tanı yöntemi olarak kullanılabilmektedir (6)(7)(8). US'nin MRG'ye göre ucuz, girişimsel olmayan ve kolay ulaşılabilir ve uygulanabilir olması gibi avantajları bulunmaktadır.…”

Section: Introductionunclassified

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Role of ultrasonography in patients with mild and moderate carpal tunnel syndrome

Bulut¹,

Yıldırım²

2017

Eur J Ther

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ÖZAmaç: Bu çalışmanın amacı hafif ve orta düzeyde karpal tünel sendromu (KTS) olan hastaların tanısında ultrasonografik olarak ölçümü yapılabilen median sinir kesit alanı (MSKA, mm 2 ) parametresinin tanısal değerini elektrofizyolojik parametreler ile karşılaş-tırarak ortaya koymaktı. Yöntemler: Çalışmaya en az bir el bileğinde KTS tanısı almış 25 hasta ile KTS tanısı olmayan 23 sağlıklı gönüllüye ait toplam 72 el bileği dahil edildi. Çalışmaya dahil edilen tüm katılımcıların median ve ulnar sinir motor ve duyusal sinir ileti çalışmaları ile ultrasonografi (US) ile MSKA değerleri kaydedildi. Hasta ve kontrol gruplarının elektrofizyolojik ve ultrasonografik verileri karşılaştırıldı, MSKA ile median sinirin duyusal ve motor ileti hız ve latansları arasındaki korelasyon araştırıldı. Ayrıca MSKA ile KTS tanısı koyabilmek için gereken kestirim değeri için Receiver operating characteristic (ROC) eğri analizi yapıldı. Bulgular: Hasta ve kontrol gurubu arasında MSKA, median sinir duyusal ileti hızı (DİH) ve motor distal latansı (MDL) değerleri arasında istatistiksel olarak anlamlı fark bulundu. Çok hafif KTS olan Evre 1 hastalar ile kontrol gurubunun MSKA ortalama değerleri arasındaki fark istatistiksel olarak anlamlı idi. MSKA ile DİH arasında orta düzeyde ve negatif yönde anlamlı düzeyde korelasyon saptanırken; MSKA ile MDL arasında düşük düzeyde ve pozitif yönde anlamlı korelasyon saptandı. Ayrıca MSKA değerleri ile evreler arasında da orta düzeyde ve pozitif yönde anlamlı korelasyon mevcut idi. ROC analizinde elde edilen 10,25 mm 2 kestirim değeri %80 sensitivite ve %76 spesifisite ile hasta ile sağlıklı kontrol gurupları arasında ayrım yapılmasına imkân verdi. Sonuç: US ile ölçümü yapılan MSKA parametresinin yüksek sensitivite ve spesifite değerleri ile hafif ve orta evre karpal tünel sendromu tanısında elektromiyografi ile beraber tanı aracı olarak kullanılabileceği kanısındayız. Anahtar kelimeler: Karpal tünel sendromu, ultrasonografi, elektromiyografi ABSTRACT Objective: This study aimed to determine the diagnostic value of median nerve cross-sectional area (MNCSA; mm 2 ), which can be measured using ultrasonography (US), compared with electrophysiological parameters in patients with mild and moderate carpal tunnel syndrome (CTS). Methods: The study included 72 wrists of 25 patients with CTS diagnosis and 23 healthy controls. Median and ulnar sensory and motor nerve conduction study results and MNCSA values determined by US, of all subjects were recorded. Electrophysiological and US data of the patient and control groups were compared, and a correlation between MNCSA and velocity and latency of sensory and motor conduction of median nerves was investigated. Moreover, Receiver operating characteristic ROC curve analysis was performed to determine the cut-off value for diagnosing CTS with MNCSA. Differences between the mean MNCSA values, median nerve sensory conduction velocity (SCV), and motor distal latency (MDL) were statistically significant between the groups. Results: Differences between the mean MNCSA value...

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Section: Discussionunclassified

Section: Introductionunclassified

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Role of ultrasonography in patients with mild and moderate carpal tunnel syndrome

Bulut¹,

Yıldırım²

2017

Eur J Ther

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“…DTI, with evaluation of the fractional anisotropy and diffusion trace, has been proven to be feasible and capable of detecting median nerve injury in CTS. However, a significant diagnostic advantage of DTI compared with standard MRN or to clinical combined with electrophysiological parameters has not been found so far [33][34][35], which might be due to its low signal-to-noise ratio and low spatial resolution.…”

Section: Mrn In Distally-symmetric Polyneuropathiesmentioning

confidence: 99%

MR Neurography: Diagnostic Imaging in the PNS

2015

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The diagnostic work-up of peripheral neuropathies is often challenging and is mainly based on a combination of clinical and electrophysiological examinations. One of the most important difficulties is the accurate determination of the lesion site (lesion localization), lesion extension, and spatial lesion dispersion, which all represent essential diagnostic information crucial for finding the correct diagnosis and hence an adequate therapeutic approach. A typical pitfall in the conventional diagnostic reasoning is the differentiation between a distal, complete cross-sectional nerve lesion and a more proximally located, fascicular nerve lesion. Magnetic resonance neurography (MRN) has been proven to be capable of improving the diagnostic accuracy by providing direct, noninvasive visualization of nerve injury with high structural resolution even reaching the anatomical level of single nerve fascicles (fascicular imaging) and at the same time with large anatomical coverage. It is also feasible to detect structural nerve damage earlier and with higher sensitivity than gold-standard nerve conduction studies. The purpose of this study is to review the literature for current developments and advances in MRN for the precise spatial detection of nerve lesions in focal and non-focal disorders of the peripheral nervous system.

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“…Diffusion tensor imaging (DTI) of the peripheral nerve has been successfully used in the wrist region for imaging the median nerve and diagnosing carpal tunnel syndrome (CTS) by fiber tracking and by measuring fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) value (1)(2)(3)(4)(5). In addition to fiber tracking, Skorpil et al (6), in 2007, used the maximum intensity projection (MIP) technique to reconstruct sciatic nerves based on magnetic resonance (MR) DTI images, both single-direction and all directions.…”

Section: Introductionmentioning

confidence: 99%

Volume-Rendered Three-Dimensional Display of the Peripheral Nerves in the Wrist Region Using Magnetic Resonance Diffusion Tensor Imaging

Zhou

Jin

et al. 2016

Iran J Radiol

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Background: In addition to fiber tracking, stereoscopic display of the peripheral nerves can be obtained based on magnetic resonance (MR) diffusion tensor imaging (DTI) data using post-processing methods, including volume rendering (VR) and maximum intensity projection (MIP). However, sufficient suppression of the image noise remains a challenge. Objectives: To achieve three-dimensional (3D) display of the peripheral nerves in the wrist region using two post-processing methods for DTI, i.e. VR reconstruction for single-direction images and the subtraction of unidirectionally encoded images for suppression of heavily isotropic objects (SUSHI); to compare the quality of images obtained via the two approaches; and to explore their clinical applications. Materials and Methods: We performed DTI scans using 6 (DTI6) and 25 (DTI25) encoding diffusion directions for 20 wrists of 10 healthy adult volunteers. We used VR to reconstruct 2 types of images: 1, single-direction (anterior-posterior [AP] direction) and 2, SUSHI (AP direction with the subtraction of the superior-inferior [SI] direction). The 3D nerve image quality, noise level, and degree of noise-removal difficulty were evaluated according to custom evaluation scales. The preliminary clinical applications of these methods were explored through follow-ups with patients with nerve laceration in the wrist region. Results: Single-direction VR reconstruction clearly showed the nerves for both DTI6 and DTI25 but with obvious noise. In DTI25, VR reconstruction for SUSHI showed the nerves clearly with excellent nerve signal intensity. In DTI6, SUSHI post-processing lost some ulnar nerve signal intensity, resulting in a significant difference in image quality scores between single-direction images and SUSHI. Most of the noise was removed after SUSHI post-processing. Conclusion: VR reconstruction for both single-direction images and SUSHI using DTI25 raw data provides excellent 3D displays of the peripheral nerves in the wrist region. SUSHI post-processing is a useful denoising tool because it automatically reduces the majority of isotropic object noise.

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The Diagnostic and Grading Value of Diffusion Tensor Imaging in Patients with Carpal Tunnel Syndrome

Cited by 26 publications

References 31 publications

Role of ultrasonography in patients with mild and moderate carpal tunnel syndrome

Role of ultrasonography in patients with mild and moderate carpal tunnel syndrome

MR Neurography: Diagnostic Imaging in the PNS

Volume-Rendered Three-Dimensional Display of the Peripheral Nerves in the Wrist Region Using Magnetic Resonance Diffusion Tensor Imaging

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