Value of superb microvascular imaging ultrasonography in the diagnosis of carpal tunnel syndrome

Abstract

The aim of this study was to compare the value of superb microvascular imaging (SMI) in carpal tunnel syndrome (CTS) with that of color Doppler ultrasonography (CDUS) and power Doppler ultrasonography (PDUS).Fifty patients with symptomatic CTS and 25 healthy volunteers were enrolled. The cross-sectional area (CSA), CDUS score, PDUS score, and SMI score of the median nerve (MN) at the carpal tunnel were recorded. The value of different ultrasonography (US) diagnostic strategies was calculated.The blood flow display ratio in the MN of the healthy volunteers had no statistical difference between CDUS, PDUS, and SMI (20%, 32%, and 48%, respectively, P >.05). The blood flow display ratio for SMI in patients was significantly higher than that of CDUS and PDUS (90%, 52%, and 60%, respectively, P <.005). The accuracy of SMI score ≥2 (79%) was much higher than that of CDUS and PDUS (61% and 63%, respectively, P <.05). Comprehensive consideration of SMI and CSA, CSA≥10.5 mm2, and/or SMI score ≥2 has the highest accuracy (83%), significantly higher than that of CSA combination with CDUS or PDUS (68% and 69%, respectively, P <.05).SMI is more sensitive to display the blood flow in the MN with CTS than CDUS and PDUS. It might significantly improve the diagnosis value for CTS.

Clinical Applications of Superb Microvascular Imaging in the Liver, Breast, Thyroid, Skeletal Muscle, and Carotid Plaques

“…48 Superb Microvascular Imaging can help evaluate the hypervascularity in the median nerve, and the reported ratio of the blood flow display was better in SMI than in CDFI and PDFI. 45 Superb Microvascular Imaging scores were strongly correlated with the distal motor latency, amplitude of the sensory action potential, and sensory neurotransmission rate in patients with CTS. 44 Nerve cross-sectional area measurement is considered a classic method for the diagnosis of CTS, and the diagnosis thresholds vary from 9 to 15 mm 2 , depending on the sex, height, and weight of the patient, among other factors.…”

“…Chronic nerve compression results in a massive number of blood vessels, and macroscopic inspection of surgical findings in patients with CTS has also revealed hypervascularity in the median nerve . Superb Microvascular Imaging can help evaluate the hypervascularity in the median nerve, and the reported ratio of the blood flow display was better in SMI than in CDFI and PDFI . Superb Microvascular Imaging scores were strongly correlated with the distal motor latency, amplitude of the sensory action potential, and sensory neurotransmission rate in patients with CTS .…”

“…Musculoskeletal US can monitor angiogenesis within musculoskeletal soft tissues and facilitate the evaluation of disease activities . In recent studies, SMI was used to assess arthritis, lateral epicondylitis, and carpal tunnel syndrome (CTS) . Lim et al assessed the efficacy of SMI in detecting joint inflammation and found that SMI had the ability to detect mild inflammation that was difficult to observe by PDFI, with improved resolution and sensitivity (Figure ).…”

“…40 In recent studies, SMI was used to assess arthritis, lateral epicondylitis, and carpal tunnel syndrome (CTS). [41][42][43][44][45] Lim et al 43 assessed the efficacy of SMI in detecting joint inflammation and found that SMI had the ability to detect mild inflammation that was difficult to observe by PDFI, with improved resolution and sensitivity (Figure 4). This result was confirmed by a study conducted by Yokota et al 41 In their study, SMI scores were much higher than PDFI scores in patients with rheumatoid arthritis.…”

Elderly Fitz-Hugh–Curtis syndrome observed with superb microvascular imaging system

“…Some recent reports have also noted that SMI is useful for assessing minute vascular flow in patients with carpal tunnel syndrome [10] and breast lesions [11]. SMI is also useful for visualizing the small vascular architecture of the liver surface associated with progression of fibrosis in patients with chronic hepatitis C [12].…”