Diabetik Polinöropatili hastalarda KTS teşhisinde el bileği B mod ve doppler ultrasonografisinin diagnostik değeri

Öz

Amaç: Diabetik polinöropatili (DPN) hastalarda karpal tünel sendromu (KTS) teşhisinde el bileği B mod ve doppler ultrasonografisinin diagnostik değerini araştırmak amaçlanmıştır. Materyal ve metod: Klinik muayene ve elektrofizyolojik inceleme ile DPN tanısı almış 21 hasta, KTS grubu (20 el) ve kontrol grubu (22 el) olarak iki gruba ayrıldı. Median sinir kesit alanı (MSA) ve düzleşme oranı, karpal tünel girişi [proksimal (p)] ve bilek kıvrımı [distal (d)] düzeylerden ölçüldü. Renkli Doppler ultrason incelemesindeher iki el nötral pozisyonda iken radial ve ulnar arterler yüksek rezolüsyonlu 12 MHz transduser (Logic 7)ile değerlendirildi. Bulgular: Gruplar arası karşılaştırmada KTS grubunda, kontrol grubuna göre proksimal ve distal düzeyden ölçülen MSAdeğerleri anlamlı olarak daha büyük bulundu (Sırasıyla, p=0.006, p=0.002). Gruplar arası karşılaştırmada her iki radial ve ulnar arter akım karakteristiklerinde farklılık yoktu (p>0.05). ROC eğrisi analizinde KTS tanısındaki eşik değer MSA-p ≥ 12.5 mm2 (ROC eğrisinin altında kalan alan (AUC) 0.73; duyarlılığı %60 ve özgüllüğü %78) ve MSAd ≥ 13.5 mm2 (AUC 0.75; duyarlılık %65 ve özgüllük %87)olarak bulundu. Sonuç: Diabetik polinöropati ile eş zamanlı KTS geliştiği düşünülen hastalarda el bileği ultrasonografisi diagnostik bir modalite olabilir. 

Anahtar Kelimeler

• Karpal tünel sendromu,median sinir,ultrasonografi

The diagnostic value of wrist B-mode and Doppler ultrasonography in the diagnosis of CTS in diabetic polineuropathy patients

Öz

Background: The diagnostic value of B-mode and Doppler ultrasonography of the wrist in the diagnosis of carpal tunnel syndrome (CTS) in patients with diabetic polyneuropathy (DPN) was aimed to investigate. Materials and Methods: 21 patients, who were diagnosed DPN with clinical examination and electrophysiological study, were divided into two groups: CTS group (20 hands) and control group (22 hands). The median nerve crosssectional area (MSA) and flattening ratio of the median nerve were measured at the level of carpal tunnel entrance [proximal (p)] and the wrist crease [distal (d)]. In color Doppler ultrasound examination, radial and ulnar arteries were evaluated with high resolution 12 MHz transducer (Logic 7) while both hands were in neutral position. 

Results: In comparison between groups, in the CTS group MSE values, measured at the proximal and distal levels, were significantly higher than control group (respectively, p=0.006, p=0.002). In comparison between groups, both radial and ulnar artery flow characteristics did not differ (p>0.05). With the ROC curve analysis, the threshold value in the diagnosis of CTS was found as MSA-p ≥ 12.5 mm2 (area under the ROC curve (AUC) 0.73; sensitivity 60% and specificity 78%) and MSA-d ≥ 13.5 mm2 (AUC 0.75; sensitivity 65% and specificity 87%). Conclusions: Wrist ultrasonography may be a diagnostic modality in patients with diabetic polyneuropathy when it is suspected concurrent CTS. 

Anahtar Kelimeler

• Carpal Tunnel Syndrome,median nerve,ultrasonography

Kaynakça

1. 1) de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol. 1992;45(4):373-6. 2) Perkins BA, Olaleye D, Bril V. Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care. 2002;25(3):565-9. 3) Jablecki CK, Andary MT, Floeter MK, Miller RG, Quartly CA, Vennix MJ, et al. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2002;58(11):1589-92. 4) Ubogu EE, Benatar M. Electrodiagnostic criteria for carpal tunnel syndrome in axonal polyneuropathy. Muscle Nerve. 2006;33(6):747-52. 5) Visser LH, Smidt MH, Lee ML. High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome. J Neurol Neurosurg Psychiatry. 2008;79(1):63-7. 6) Duncan I, Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome. AJR Am J Roentgenol. 1999;173(3):681-4. 7) Watanabe T, Ito H, Morita A, Uno Y, Nishimura T, Kawase H, et al. Sonographic evaluation of the median nerve in diabetic patients: comparison with nerve conduction studies. J Ultrasound Med. 2009;28(6):727- 34. 8) Ozcan HN, Kara M, Ozcan F, Bostanoglu S, Karademir MA, Erkin G, et al. Dynamic Doppler evaluation of the radial and ulnar arteries in patients with carpal tunnel syndrome. AJR Am J Roentgenol. 2011;197(5):817-20. 9) Ghasemi-Esfe AR, Morteza A, Khalilzadeh O, Mazloumi M, Ghasemi-Esfe M, Rahmani M. Color Doppler ultrasound for evaluation of vasomotor activity in patients with carpal tunnel syndrome. Skeletal Radiol. 2012;41(3):281-6. 10) You H, Simmons Z, Freivalds A, Kothari MJ, Naidu SH. Relationships between clinical symptom severity scales and nerve conduction measures in carpal tunnel syndrome. Muscle Nerve. 1999;22(4):497-501. 11) Keith MW, Masear V, Chung K, Maupin K, Andary M, Amadio PC, et al. Diagnosis of carpal tunnel syndrome. J Am Acad Orthop Surg. 2009;17(6):389-96. 12) Chen SF, Lu CH, Huang CR, Chuang YC, Tsai NW, Chang CC, et al. Ultrasonographic median nerve crosssection areas measured by 8-point "inching test" for idiopathic carpal tunnel syndrome: a correlation of nerve conduction study severity and duration of clinical symptoms. BMC Med Imaging. 2011; 11:22. 13) Tsai NW, Lee LH, Huang CR, Chang WN, Wang HC, Lin YJ, et al. The diagnostic value of ultrasonography in carpal tunnel syndrome: a comparison between diabetic and non-diabetic patients. BMC Neurol. 2013; 13(1):65. 14) Chen SF, Huang CR, Tsai NW, Chang CC, Lu CH, Chuang YC, et al. Ultrasonographic assessment of carpal tunnel syndrome of mild and moderate severity in diabetic patients by using an 8-point measurement of median nerve cross-sectional areas. BMC Med Imaging. 2012; 12:15. 15) Jordan SE, Greider JL, Jr. Autonomic activity in the carpal tunnel syndrome. Orthop Rev. 1987;16(3):165-9.