Utility of MRI Diffusion Tensor Imaging in Carpal Tunnel Syndrome: A Meta-Analysis

Wang, Hong; Ma, Jingxu; Zhao, Liping; Wang, Yunling; Jia, Xuchao

doi:10.12659/msm.895758

Cited by 38 publications

(22 citation statements)

References 48 publications

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“…Therefore, it was suggested that plain radiograph should not be taken as a routine CTS diagnostic tool unless hard tissue-related changes were suspected. Recent advances in imaging techniques in ultrasound and MRI, i.e., shear wave elastography [25], pressuremonitor elastography [26], diffusion tensor imaging of MRI [27], have been reported to be more beneficial in diagnosing neurological conditions of carpal tunnel syndrome.…”

Section: Discussionmentioning

confidence: 99%

Radiographic characteristics of wrists in idiopathic carpal tunnel syndrome patients

Ikeda

Yoshii

Ogawa

et al. 2020

BMC Musculoskelet Disord

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Background: To determine the radiographic characteristics of wrists in idiopathic carpal tunnel syndrome patients, we compared the radiographic parameters of the wrists between carpal tunnel syndrome patients and nonsymptomatic controls. Methods:We evaluated radiographic parameters of 94 wrists of 62 idiopathic carpal tunnel syndrome patients and 94 asymptomatic wrists of 94 controls. Carpal tunnel syndrome was diagnosed by clinical findings and nerve conduction studies. The lack of symptoms was confirmed with the medical records and interviews for the controls. X-ray images of the postero-anterior and lateral views of the wrist were taken. Using the obtained X-ray images, the indices of radial inclination, volar tilt, ulnar variance, and transverse and antero-posterior diameters of the wrists were measured. Two raters independently performed the measurement. One rater measured without information of clinical symptoms. Inter-rater reliabilities for each parameter were evaluated by the intra-class correlation coefficients. The averages of the measurements of two raters were compared between the carpal tunnel syndrome patients and the controls. Results: The intra-class correlation coefficients were 0.58 for radial inclination, 0.77 for ulnar variance, 0.99 for transverse diameter, 0.60 for volar tilt, and 0.91 for antero-posterior diameter. Statistically significant correlations were found for all parameters (P < 0.01). The ulnar variance was significantly larger in the carpal tunnel syndrome patients compared to the controls (1.7 +/− 1.8 mm and 0.8 +/− 1.5 mm for the patients and controls, respectively P < 0.01). There were no significant differences in the other parameters.Conclusions: Significant differences in the ulnar variance were observed between carpal tunnel syndrome patients and controls. This suggests that the imbalance of radioulnar bone length is one of the risk factors to develop carpal tunnel syndrome. The positive ulnar variance may be an index that needs attention to the development of carpal tunnel syndrome. Level of evidence: level III, a case control study.

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Section: Discussionmentioning

confidence: 99%

Radiographic characteristics of wrists in idiopathic carpal tunnel syndrome patients

Ikeda

Yoshii

Ogawa

et al. 2020

BMC Musculoskelet Disord

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“…Recently, the advancement of radiographic diagnosing has been progressing dramatically. The diffusion-weighted image (DWI) of MRI is able to capture edematous changes in brain and peripheral nerves 17) . The apparent diffusion coefficient could be an indicator when detecting damage of the nerve root, the amount of which increases at the lesion of angiogenic edema 18) .…”

Section: Discussionmentioning

confidence: 99%

Radiculopathy Contralateral to the Side of Disc Herniation -Microendoscopic Observation-

Hayashi

Iba

Ohnaru

et al. 2018

Spine Surg Relat Res

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Introduction: There are patients with lumbar disc herniation (LDH) having contralateral sciatic symptoms although the mechanisms of this clinical feature are still not well understood. The purpose of this study was to investigate these mechanisms by microendoscopic findings. Methods: Patients were performed microendoscopic surgery using over-the-top approach (ME-OTT), with laminoplasty, extirpation of herniation, and observation of the contralateral nerve root. The over-the-top approach was applied through the same incision from the herniation side. Clinical results were assessed according to the clinical scoring system established by the Japanese Orthopedic Association (JOA) score. Results: This study consisted of five patients, with the average age of 55.6 years old. The mean preoperative JOA score was 13 points. Three cases were Grade II and two were Grade III degrees of disc herniation. Levels of herniation were one at L3-4 and four at L4-5. Remission of sciatic symptoms was obtained in all cases after surgery. The average and percent improvements (%IP) of JOA scores at 2 months after surgery were 27.8 points and 92%, respectively. By the approach from the herniation side using ME-OTT, image around the contralateral nerve root was obtained without radical intervention. By ME-OTT, redness of the nerve root and fibrosis around the symptomatic nerve root were identified, whereas inflammatory changes were not apparent on the ipsilateral nerve root. Conclusions: Operative treatment of LDH with contralateral symptoms by ME-OTT was a useful procedure for decompression and observation of the affected nerve root. Asymptomatic disc herniation, "silent disc herniation," was considered at the herniation side since there were less inflammatory changes around the ipsilateral nerve root. In contrast, compression of dura toward the opposite side by disc herniation could have led to mechanical stress against the contralateral nerve root and triggered inflammation at lateral recess, resulting in radicular pain.

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“…A correlation between median DTI metrics and electrophysiology for the carpal tunnel nerve has been reported, suggesting a role for DTI in the in vivo assessment of axon and myelin sheath integrity 7,[42][43][44] . According to a meta-analysis published in 2016 that included 316 patients and 293 healthy controls across 12 studies, fractional anisotropy of the median nerve was significantly lower in patients with CTS, and this measure enabled diagnosis of CTS with an overall sensitivity of 82.8% and a specificity of 77.8% 44 . Despite these encouraging preliminary results, DTI of peripheral nerve should still be considered experimental owing to the relatively small datasets in these studies and the variability of DTI thresholds across studies.…”

Section: Entrapment Neuropathiesmentioning

confidence: 95%

New technologies for the assessment of neuropathies

et al. 2017

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Peripheral neuropathies are among the most common neurological disorders 1 . In routine clinical practice, diagnosis of peripheral neuropathies is typically based on clinical assessment, nerve conduction studies and needle electromyography, which can determine whether symptoms are caused by primary axonal damage or demyelinating damage. This distinction is often relevant to therapeutic choices and to prognosis, as axonal damage typically reflects an inflammatory (for example, vasculitic) or degenerative (for example, hereditary or idiopathic) process that correlates with disability, whereas demyelinating damage can reflect a hereditary neuro pathy, but more often reflects an acquired immunemediated neuropathy. Besides metabolic, inflammatory or primary degenerative neuropathies, peripheral nerves can also be damaged by compression from adjacent tissue structures, such as tendons, cysts or haematomas. In this case, proper identification of the site, nature and degree of the lesion might be challenging, but is relevant to treatment and prognosis. Moreover, some patients present with symptoms that suggest damage to small nerve fibres, which nerve conduction studies cannot be used to detect.In the past 15 years, several techniques have become available to investigate focal and diffuse peripheral neuropathies, and their reliability has widened the spectrum of diagnostic tools for clinicians and improved assessment of neuropathies. In this Review, we provide an overview of these new and emerging technologies. We first discuss peripheral nerve imaging with MRI and ultrasonography, which can provide information about the precise localization of neuro pathies and the pathological processes involved in large-fibre neuropathies, and can complement clinical and electrophysiological evaluation. We then consider techniques that can provide diagnostic information when the pathological process is restricted to small nerve fibres and is consequently not detectable with nerve conduction studies or neuroimaging. These include skin biopsy, which is established in clinical practice, and the emerging techniques of corneal confocal microscopy, laser-evoked potentials and heat-related and pain-related evoked potentials, and microneurography.Nerve imaging technology Advances in imaging techniques have made it possible to gain great insight into nerve pathology with magnetic resonance and ultrasound. Each approach offers distinct advantages, and can provide different information about damage to large myelinated fibres. Abstract | Technical advances are rapidly changing the clinical and instrumental approach to peripheral nerve diseases. Magnetic resonance neurography, diffusion tensor imaging and nerve ultrasonography are increasingly entering the diagnostic workup of peripheral neuropathies as tools that complement neurophysiology and enable investigation of proximal structures, such as plexuses and roots. Progress in the design of magnetic resonance scanners and sequences, and the development of high-frequency ultrasound probes mean th...

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Utility of MRI Diffusion Tensor Imaging in Carpal Tunnel Syndrome: A Meta-Analysis

Cited by 38 publications

References 48 publications

Radiographic characteristics of wrists in idiopathic carpal tunnel syndrome patients

Radiographic characteristics of wrists in idiopathic carpal tunnel syndrome patients

Radiculopathy Contralateral to the Side of Disc Herniation -Microendoscopic Observation-

New technologies for the assessment of neuropathies

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